JMIR Publications

ABSTRACT

Background:

Broad health disparities (HD) persist in CT and the US between minority and white patients, especially in access to and utilization of behavioral telehealth services.

Objective:

To determine the geographic distribution of HDs in CT between Black Female (BF) and White Female (WF) adults in Medicaid behavioral telehealth utilization in 2019 and 2020.

Methods:

We used spatial CT data: (i). Behavioral health utilization from Medicaid claims, from CT Department of Social Services, for third quarters of 2919 and 2020; (ii). Mental health and drug and alcohol treatment facilities and ZCTA-level descriptors from www.Policymap.com (iii). CT ZIP-to-ZIP Code Tabulation Areas (ZCTAs) crosswalk data. Data were joined spatially, merged and analyzed using spatial autoregressive models in Stata 17 (with outcome, predictors, and errors spatial lags). We computed ZCTA level HDs comparing Black vs. White adult female Medicaid beneficiaries’ rates of face-to-face and telehealth behavioral services utilization. Spatial regressions were used to test spatial effects, which are extensions of classic regressions, that add neighbors’ effects a co-variates.

Results:

Distances to nearest treatment facility vary quite widely in CT by ZCTA, from a 0.06 mile to a 13.4 miles, 3.5 miles on average. The overall WF vs. BF female HDs in behavioral healthcare utilization were impacted by the distance to the nearest facility, such that ZCTAs farther away from the nearest facility display larger Black vs. White HDs: nearly statistically significant effect in 2019, significantly in 2020. In 2020, in ZCTAs situated farther away from treatment facilities, both WF & BF Medicaid patients had higher telebehavioral health utilization (spatial effects +1.3% points, and +2.0% points respectively, for 1 more mile farther away). The differential Black vs. White female HDs in telebehavioral healthcare utilization were not impacted by distance to nearest facility, according to the total effect (direct, and indirect through neighboring ZCTAs, p = .259).

Conclusions:

Quantitative analyses indicate broad differences in Medicaid enrollment and utilization of behavioral health services among Black and White female Medicaid recipients in CT, and that these differences were rather stable between 2019 and 2020. It appears that the expansion of telebehavioral health services in 2020 enhanced the access to treatment among residents who were located furthest away from providing facilities. Clinical Trial: NA