Impact of Medicaid Coverage of Tele-Mental Health Services on Postpartum Mental Health Services: Evidence from Massachusetts.

Background: Tele-mental health services have the potential to reduce barriers to postpartum mental health care, particularly for Medicaid-insured individuals who face geographic and logistical challenges. In January 2019, Massachusetts Medicaid became one of the few states to implement payment parity for tele-mental health services before the COVID-19 pandemic, ensuring equal coverage for tele-mental health and in-person visits. This policy change provides a unique opportunity to evaluate whether payment parity improves postpartum mental health service utilization. This study aimed to estimate the impact of Massachusetts Medicaid's coverage of tele-mental health services at parity with in-person visits on postpartum mental health service utilization among Medicaid-insured birthing individuals. Methods: A difference-in-differences (DD) analysis using the Massachusetts All-Payer Claims Database from January 1, 2016, to March 10, 2020. This study compared Medicaid and privately insured individuals before and after Massachusetts implemented tele-mental health payment parity in January 2019. Results: Among the 138,669 individuals in the sample, 81,494 were covered by Medicaid, and 57,175 were privately insured. Postpartum tele-mental health use was minimal across the sample (0.07%). The adjusted DD analysis indicated no statistically significant increase in tele-mental health utilization among Medicaid enrollees compared to privately insured individuals (adjusted difference: 0.08 percentage points; 95% CI: -0.02 to 0.17). Conclusion: The implementation of tele-mental health payment parity did not significantly increase tele-mental health utilization among Medicaid-insured birthing individuals in Massachusetts. Despite policy changes, systemic barriers likely limited the uptake of tele-mental health services, highlighting the need for additional interventions to improve access to postpartum mental health care.