Rural-Urban and Racial-Ethnic Differences in Tele-Behavioral Health Access for Medicaid Beneficiaries

Area of Science:

• Health Services Research
• Telemedicine
• Health Disparities

Background:

• Tele-behavioral health (TBH) use surged during the COVID-19 pandemic.
• The impact of TBH on rural-urban disparities in healthcare access remains understudied, particularly in diverse states.
• New Mexico, a rural and diverse state, provides a unique setting to examine these issues.

Purpose of the Study:

• To investigate the role of rurality and broadband access in TBH utilization among adult Medicaid beneficiaries in New Mexico.
• To analyze pre- and post-pandemic trends in TBH use across different patient demographics and geographic locations.
• To identify factors influencing equitable access to tele-behavioral health services.

Main Methods:

• Analysis of New Mexico Medicaid claims data (March 2019-March 2021) for outpatient behavioral health visits.
• Logistic regression models to assess TBH use differences by rurality, race/ethnicity, and broadband connectivity.
• Categorization of visits by modality (in-person, audio-only, video) and linkage with county-level broadband and provider data.

Main Results:

• A total of 2,934,451 behavioral health visits among 216,898 Medicaid members were analyzed.
• Urban patients exhibited higher odds of TBH use, particularly audio-only visits, compared to rural patients, irrespective of broadband access.
• Native American patients showed the highest odds of TBH visits, potentially due to existing Indian Health Service telehealth infrastructure.

Conclusions:

• TBH has expanded behavioral health access for Medicaid beneficiaries, but rural disparities persist.
• Broadband access alone is insufficient to mitigate rural-urban disparities in TBH utilization.
• Policy interventions must consider existing telehealth infrastructure to ensure equitable TBH access for diverse and rural populations.