Accessibility of Behavioral Health Care Coverage Information Online: The Quality of State Medicaid Websites

Background: The expansion of Medicaid and the Mental Health Parity and Addiction Equity Act under the Affordable Care Act (ACA) offers hope in improving behavioral health care access. Thus far, the ACA has increased insurance coverage to more than 6 million people. Given these gains, it is important that eligible individuals and those already enrolled understand the extent of their behavioral health care coverage through Medicaid. Hence, how Medicaid websites are configured and the information displayed on them may have a considerable impact on what individuals are able to ascertain about applying for Medicaid and what treatments and services are covered once enrolled. 

Methods: To examine the accessibility of behavioral health coverage information on state Medicaid websites, we looked at Medicaid websites for all 50 states and the District of Columbia. Screenshots for each state’s Medicaid homepage and any subsequent pages that emerged either from links present on the homepage or from using the search function to find terms related to behavioral health care coverage were taken and entered into Atlas.ti 7 for analysis. The screenshots were analyzed for their usability and readability. Content analysis was conducted to evaluate usability by quantifying the categories of information provided according to pre-established codes derived from federally established best practices for optimizing user experience of online material. Federal guidelines that were found to have the strongest influence on users’ experiences and empirical support were selected. Additionally, to ascertain the availability and quality of content on behavioral health, information pertaining to eligibility, benefits covered, and availability of behavioral health care clinics and providers were also incorporated as part of the coding scheme. Readability was assessed using the Flesch Reading Ease and Flesch-Kincaid Grade Level measures.

Findings: Specific content on behavioral health care was seldom present on the homepage and was cumbersome to locate. More than three quarters of states had links to behavioral health care coverage, however. For the states that required us to use the search function to locate behavioral health information, the search results did not return relevant information and were mainly geared toward providers. Information that was offered varied widely by state in terms of content, quality and breadth, and was primarily technical in language. Less than a quarter of state websites provided specific information on eligibility and enrollment information. The average Flesch Reading Ease score across states was below 70. Correspondingly, the Flesch-Kincaid Grade Level was on average high school level. The majority of state Medicaid websites failed to meet guidelines for user-friendly designs. 

Implications: These findings suggest that the poor design, language used, and the material communicated on Medicaid websites about behavioral health care may present a barrier for consumers trying to access pertinent information on behavioral health care coverage. Thus, to better facilitate the objective of expanding access to care, redesign of Medicaid websites is necessary to make behavioral health care content easier to locate and comprehend.