Medicaid is the primary payer for behavioral health services; however, we know little about the variation in use of behavioral health services and telebehavioral health services prior to and during the COVID-19 pandemic, especially in rural and mental health professional shortage areas. As federal and state policymakers push for further Medicaid expansion in the 12 non-expansion states, it is important for workforce planning to understand patterns and variation in behavioral health service delivery in a mature Medicaid expansion state subject to COVID-19 impacts. Michigan’s Medicaid program, Healthy Michigan Plan, is one such example that can be used to explore the impacts of the COVID-19 on behavioral health care.

Research Questions

This study aims to provide an overview of the patterns of behavioral health service use by Michigan Medicaid enrollees before and during the COVID-19 pandemic.

  • Did Michigan Medicaid enrollees experience an increase in mental health and substance use disorder diagnoses during the COVID-19 pandemic?
  • Was there an increase in mental health and substance use disorder service use among Michigan Medicaid enrollees during the COVID-19 pandemic?
  • Did telebehavioral health use among Michigan Medicaid enrollees increase during the COVID-19 pandemic?


A wealth of research conveys the MH and SUD burden of the COVID-19 pandemic. Other analyses on the prevalence of MH and SUD conditions, experiences of stress and loneliness, and crisis events in Michigan demonstrate that Michigan residents experienced similar increases in mental health adverse events. Our findings suggest that despite the increased prevalence of MH and SUD following the implementation of stay-at-home orders in Michigan in March 2020, there was no corresponding immediate or delayed increase in MH and SUD outpatient service use among participants enrolled in Michigan Medicaid.


Our findings also align with existing research demonstrating a rapid expansion of telemental health prompted by COVID-19 social distancing guidelines. Though our research cannot assess the causal effect of Michigan Medicaid telehealth policies on outpatient MH and SUD telehealth use, we encourage future work to examine the relationship between specific Medicaid telehealth policies and MH and SUD service use. Further, we call attention to our finding that people aged ≥18 years benefitted more than individuals aged <18 years. This finding suggests that access to pediatric MH and SUD health care during the pandemic may have differed from MH and SUD care access for adults. We also highlight that Medicaid enrollees aged ≥65 years had the largest percentage increase in the proportion of outpatient MH and SUD involving telehealth. This population includes Medicare–Medicaid dual eligibles, suggesting that the Medicare telemental health policies enacted during the COVID-19 pandemic may affect access to behavioral health service use for this population.




Full Report


Victoria Schoebel, MPH
Isabella Ginsberg
Kyle Grazier, DrPH, MPH, MS
Sarah Clark, MPH (The Susan B. Meister Child Health Evaluation and Research; CHEAR)