Telemental Health Expenditures Among Children and Adolescents

The COVID-19 pandemic brought about a shift to telemental health care among youth (1), but little is known about telemental health care expenditures since the pandemic. We present the first analysis of national expenditure patterns for youth outpatient video and telephone mental health services. We analyzed data from the 2021 Medical Expenditure Panel Survey, a nationally representative survey of the US civilian non-institutionalized population. We included participants ages 5 to 17. Outpatient mental health care included mental health condition-related or psychotherapy visits. Out-of-pocket expenditures were defined as any direct payments for mental health services made for eligible patients by household members. Total expenditures included payments from all sources for mental health services. Among youth with any outpatient video telemental health expenditure in 2021, we estimated the weighted mean of annual out-of-pocket expenditures for outpatient video telemental health visits as a percentage of total expenditures for outpatient video telemental health video visits (“out-of-pocket percentage”). The out-of-pocket percentage represents the amount patients pay for care relative to the amount covered by third parties (e.g., public or private insurance), and therefore provides a measure of the economic burden not alleviated by third-party payors. We calculated means within each sociodemographic and impairment stratum and assessed differences between strata using survey-weighted generalized linear models. Each model included the sociodemographic characteristic as the independent variable of interest, adjusted for age group, sex, and functional impairment (2, 3). Age, sex, and functional impairment strata were adjusted for the other two covariates. These analyses were repeated for youth with any outpatient telephone telemental health expenditure in 2021. We performed similar analyses including adjustments for health insurance and family income. Hispanic youth, non-Hispanic Black, and other non-Hispanic youth had significantly lower out-of-pocket percentages for outpatient video telemental health compared to non-Hispanic White youth after adjusting for sex, age group, and functional impairment. After adjusting for health insurance and family income, we did not find significant differences between non-Hispanic White and Black youth. Youth with only public insurance and who spoke Spanish at home had significantly lower out-of-pocket percentages than those who had any private insurance and spoke English at home, respectively, after adjusting for sex, age group, and functional impairment, and after adjusting for health insurance and family income. Youth with severe functional impairment had significantly lower out-of-pocket percentages than those without severe functional impairment when adjusting for sex and age group. After adjusting for health insurance and family income, we did not find significant differences in the impairment stratum. Our findings suggest that future potential limitations on third-party telemental health care coverage may disproportionately impact youth belonging to underserved racial and ethnic populations. Third-party payors should provide coverage to ensure equitable access for those unable to pay out-of-pocket.