Date on Master's Thesis/Doctoral Dissertation


Document Type

Doctoral Dissertation

Degree Name

Ph. D.


Health Promotion and Behavioral Sciences

Degree Program

Public Health Sciences with a specialization in Health Promotion, PhD

Committee Chair

Wendel, Monica

Committee Co-Chair (if applicable)

Blakely, Craig

Committee Member

Blakely, Craig

Committee Member

Nesbitt, LaQuandra

Committee Member

Possel, Patrick

Committee Member

Creel, Liza


Mental health is an essential component of overall health status, and mental illnesses are a leading cause of disability. In addition to expanding insurance coverage, the Affordable Care Act (ACA) reinforced parity for mental health services in insurance plans. This mixed-methods study assessed mental health service utilization by an urban and predominately African-American population following the successful implementation of the ACA and Medicaid expansion in Louisville, KY. Claims data from one Medicaid Managed Care Organization were analyzed to assess mental health care utilization patterns pre- and post- Medicaid expansion and determine differences in utilization rates between the Medicaid expansion population and other Medicaid beneficiaries, as well as differences in use of mental health services by geography across a Metropolitan region. Additionally, both mental health care providers and residents of the local community were interviewed regarding factors influencing use of mental health care. The results of the study demonstrate that beneficiaries of Medicaid expansion have used their new health insurance to access mental health ambulatory care services, counseling, and psychotropic medications, but may be doing so at a lower rate than other Medicaid beneficiaries in their community. Eleven distinct themes emerged from the qualitative data. Both providers and members of the community cited ongoing barriers to accessing and utilizing mental health services, including a lack of providers, stigma, poor health literacy, and the influences of social determinants of health. However, they recognized a need for mental health promotion within the toxic stress of their environment. The results of this study provide evidence supporting the continuation of policies that promote access to mental health care by reducing the burden of cost. This study also informs understanding of specific community needs that include persistent barriers beyond the scope of ACA. Thus, other policies and strategies are also needed to create health system transformation and foster a culture of health that prioritize mental health care.