Junior doctors' experiences with vulnerability: A rich picture study.

Alcohol and substance use disorders (ASUDs) are major causes of morbidity and mortality in the United States (U.S.), incurring significant individual and societal costs. Telehealth, broadly defined as the use of communications technologies to provide health care at a distance can be effective at treating patients with ASUDs. Indeed, one study showed that retaining ASUD patients in treatment via telehealth visits during the pandemic increased SUD-related outpatient visits and decreased SUD-related hospitalizations. Therefore, state policies that allow the use of telehealth for behavioral health care services, including ASUD treatment, can increase access to ASUD treatment. Having more modes of access available may be especially important for underserved populations, such as those who are low-income and publicly insured. However, there is currently a research gap regarding how telehealth policies relate to utilization of ASUD treatment services in underserved populations. Furthermore, no previous studies have considered state policies surrounding specific telehealth modalities. To address this gap, this study evaluated associations between state-level Medicaid telehealth policies that allow for audio-only and text-based communication and utilization of ASUD services at Federally Qualified Health Centers (FQHCs), which provide health care services to underserved communities in the U.S. Though research prior to the start of the COVID-19 pandemic had shown that telehealth approaches can be effective at addressing ASUDs, regulatory restrictions in some states limited telehealth service delivery during that time prior to the pandemic. State Medicaid program responses to the COVID-19 pandemic in 2020 produced heterogeneous telehealth policies by increasing access to telehealth services in some states but not others and by differentially allowing access to video, audio-only, and text-based health care services. This heterogeneity provided an opportunity for a natural experiment exploring state Medicaid program support for remote access to ASUD services via FQHCs.