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

Margaret Greenwood-Ericksen1,2,3, Mohammed Quazi4, Chloe Slator5

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The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association
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PubMed
Summary
This summary is machine-generated.

Tele-behavioral health (TBH) increased access for Medicaid members, but rural disparities persist. Broadband alone does not fix this; existing telehealth infrastructure is key for equitable rural TBH access.

Keywords:
Medicaidbehavioral healthrural healthtelehealthtele‐behavioral health

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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.