Outpatient Mental Health Treatment, Median Household Income, and Residential Segregation: Improving Measurement of Spatial Accessibility for Medicaid Recipients

Columbia University Health Sciences, New York NY

Investigators

Abstract

PROJECT SUMMARY Medicaid recipients face challenges in accessing mental health services due to low participation by providers. Outpatient mental health providers are particularly inaccessible to Medicaid recipients compared to privately insured individuals, and racialized disparities for mental health treatment can also be observed among Medicaid recipients. Given ongoing challenges in mental health treatment access, particularly among low-income and racialized individuals, identifying potentially modifiable factors that could increase provider access for these populations is an urgent priority. One measure of access to health services is spatial accessibility, i.e., the relationship between the location of providers and potential patients, with consideration to travel distance or time. Two geographic factors that may contribute to reducing spatial accessibility to Medicaid-accepting mental health providers are neighborhood-level median household income and residential segregation. Firstly, Medicaid recipients are becoming increasingly concentrated in low-income neighborhoods due to income-driven segregation, and lower neighborhood-level median income influences office-based and facility-based provider density. Secondly, due to a legacy of social and institutionalized forms of residential segregation, racialized and minoritized Medicaid recipients may be particularly vulnerable to geographic barriers to mental health provider access. Therefore, spatial analyses of Medicaid mental health workforce shortages require simultaneous assessment of neighborhood-level income and residential segregation to better serve racialized and minoritized populations. In this study, Aim 1A will assess whether lower median household income at the census-tract level is associated with lower spatial accessibility to outpatient Medicaid-accepting providers. Aim 1B will assess whether lower residential segregation at the census-tract level is associated with lower spatial accessibility to Medicaid-accepting outpatient mental health providers. If median household income and residential segregation are individually associated with spatial accessibility of providers, Aim 2 will assess whether residential segregation at the census-tract level modifies the association between median household income and spatial accessibility to Medicaid-accepting outpatient mental health providers. For all aims, three categories of outpatient providers will be assessed: 1) overall 2) office-based 3) outpatient facility-based. Findings from this study will advance the National Institute of Mental Health’s strategic plan goal to “conduct research to better understand, predict, and reduce mental health workforce shortages…in certain geographic areas (e.g., underserved communities).” Accomplishing these aims would also increase our understanding of how to address structural racism and mental health inequity for Medicaid recipients in the US. The results can inform policies and programmatic efforts to reduce workforce shortages, such as informing field placements for existing loan repayment programs in underserved areas. The science presented in this proposal will lay the foundation for the future career of the Principal Investigator, a Punjabi woman and junior scientist, as an independent researcher.