Federally Qualified Health Centers (FQHCs) are a safety net for low-income individuals needing mental and/or physical health care. The COVID-19 pandemic required FQHCs (and other health organizations) to pivot rapidly to telehealth. In theory, telehealth services can expand access to needed care. The COVID-19 pandemic provides a natural opportunity to "test" this assumption. We compared sociodemographic differences in patients accessing behavioral health services pre- and peri-COVID-19 at an FQHC. We also investigated potential patient sociodemographic disparities in telebehavioral health service use during the first year of the COVID-19 pandemic. Data were collected from a single FQHC (13 sites, 4 integrated primary care medical clinics) in the southern United States. Participants included 5,190 patients (69.2% female, 59.7% persons of color) attending a total of 16,474 behavioral health sessions across 2 years (one pre- and one peri-COVID-19). Before the COVID-19 pandemic, 100% of behavioral health visits were conducted in person. During the pandemic, nearly half of behavioral health visits were conducted via telehealth. Telehealth visits were most frequently attended by adults, non-Latinx Whites, women, and people making ≤ 200% of the federal poverty level. A combination of in-person and telehealth service delivery models should be used by FQHCs to maximize access to care for different demographic groups. FQHCs should consider key factors (e.g., access, ableism, technology facility, and language) to increase patients' ability to take advantage of telehealth services where available. (PsycInfo Database Record (c) 2024 APA, all rights reserved).