{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T13:03:27Z","timestamp":1789995807102,"version":"4.0.1"},"reference-count":46,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"vor","delay-in-days":64,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Rural Health"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Tele\u2010behavioral health (TBH) expanded significantly during the COVID\u201019 pandemic, but the extent to which this addressed or reinforced existing rural\u2013urban disparities remains unclear, especially in states with diverse and underserved populations. This study investigates the role of rurality and broadband access in TBH utilization among adult Medicaid beneficiaries in New Mexico\u2014a highly rural and racially diverse state.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed New Mexico Medicaid claims data from March 2019 to March 2021 for outpatient behavioral health visits. Using logistic regression models, we assessed differences in TBH use by rurality, race\/ethnicity, and broadband connectivity across pre\u2010 and post\u2010public health emergency (PHE) periods. Visits were categorized by modality (in\u2010person, audio\u2010only, video) and linked with county\u2010level data on broadband access and provider availability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Our study included 2,934,451 behavioral health visits among 216,898 unique Medicaid members. Total patient visits for BH increased by 19.2% from 1,326,473 (72.7% urban, 27.3% rural) to 1,607,978 (72.3% urban, 27.7% rural) across the study period. Urban patients had greater odds of TBH use (specifically audio\u2010only visits) compared to rural patients, even in rural counties with high broadband access. Modeling results demonstrated that urban patients had greater odds of a TBH visit as compared to rural patients, which was more pronounced in high versus low connectivity counties (OR 2.20; 95% CI 2.21, 2.27 vs. OR 1.53; 95% CI 1.51, 1.56). Native American patients had the greatest odds of TBH visits, which may reflect established telehealth infrastructure within the Indian Health Service.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>TBH expanded behavioral health access for Medicaid beneficiaries, but rural disparities persist and are not mitigated by broadband access alone. Rather, existing telehealth infrastructure appears to be related to improved rural TBH access. These findings underscore the need for policy efforts beyond broadband expansion to achieve equitable TBH access across diverse and rural populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jrh.70155","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T10:46:16Z","timestamp":1777891576000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Rural\u2010Urban and Racial\u2010Ethnic Differences in Tele\u2010Behavioral Health Access for Medicaid Beneficiaries"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3072-8401","authenticated-orcid":false,"given":"Margaret","family":"Greenwood\u2010Ericksen","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine School of Medicine University of New Mexico  Albuquerque New Mexico USA"},{"name":"Department of Psychiatry and Behavioral Sciences School of Medicine University of New Mexico  Albuquerque New Mexico USA"},{"name":"University of New Mexico Center for Health Policy, College of Population Health University of New Mexico  Albuquerque New Mexico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Quazi","sequence":"additional","affiliation":[{"name":"Department of Family and Community Health, School of Nursing West Virginia University  Morgantown West Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chloe","family":"Slator","sequence":"additional","affiliation":[{"name":"School of Medicine University of New Mexico  Albuquerque New Mexico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoya","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences School of Medicine University of New Mexico  Albuquerque New Mexico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler","family":"Kincaid","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences School of Medicine University of New Mexico  Albuquerque New Mexico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alanna","family":"Dancis","sequence":"additional","affiliation":[{"name":"Medicaid Assistance Division Healthcare Authority, State of New Mexico  Santa Fe New Mexico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4868-6078","authenticated-orcid":false,"given":"Jane M.","family":"Zhu","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine Oregon Health &amp; Science University  Portland Oregon USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0451-8355","authenticated-orcid":false,"given":"Amber","family":"Sabbatini","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doug","family":"Ziedonis","sequence":"additional","affiliation":[{"name":"Striver Health Innovations LLC  Albuquerque New Mexico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Kamdar","sequence":"additional","affiliation":[{"name":"University of New Mexico Center for Health Policy, College of Population Health University of New Mexico  Albuquerque New Mexico USA"},{"name":"Institute for Healthcare Policy and Innovation University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Bonham","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences School of Medicine University of New Mexico  Albuquerque New Mexico USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,4]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2022.06.012"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.2185\/jrm.2022\u2010059"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pop.2022.04.002"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2021.01297"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2022.4936"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1377\/forefront.20211004.155145"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12776"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.31640"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2020.2666"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/jamiaopen\/ooaf056"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11920\u2010021\u201001274\u20104"},{"key":"e_1_2_9_13_1","unstructured":"C.HorstmanandA.Shah The State of Rural Primary Care in the United States(Commenwealth Fund 2025)https:\/\/www.commonwealthfund.org\/publications\/issue\u2010briefs\/2025\/nov\/state\u2010rural\u2010primary\u2010care\u2010united\u2010states."},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1017\/cts.2020.42"},{"key":"e_1_2_9_15_1","unstructured":"\u201cSuicide Rates by State \u201dCenters for Disease Control Suicide Prevention accessed March 15 2026 https:\/\/www.cdc.gov\/suicide\/facts\/rates\u2010by\u2010state.html."},{"key":"e_1_2_9_16_1","unstructured":"\u201cDrug Overdose Mortality \u201dCenters for Disease Control Stats of the States accessed March 15 2026 https:\/\/www.cdc.gov\/nchs\/state\u2010stats\/deaths\/drug\u2010overdose.html."},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2018.02.005"},{"key":"e_1_2_9_18_1","unstructured":"\u201cRural Health for New Mexico Overview \u201dRural Health Information Hub accessed March 15 2026 https:\/\/www.ruralhealthinfo.org\/states\/new\u2010mexico."},{"key":"e_1_2_9_19_1","unstructured":"\u201cQuickFacts: New Mexico \u201dU.S. Census Bureau accessed March 19 2025 https:\/\/www.census.gov\/quickfacts\/fact\/table\/NM\/PST045223."},{"key":"e_1_2_9_20_1","unstructured":"\u201cState of New Mexico Office of Broadband Access & Expansion \u201dConnect New Mexico State Digital Equity Plan accessed March 15 2026 https:\/\/broadbandexpanded.com\/files\/iija_plans\/NM%20\u2010%20Digital%20Equity%20Plan%20\u2010%20Final.pdf."},{"key":"e_1_2_9_21_1","unstructured":"\u201cNew Mexico Telehealth Act \u201dNew Mexico Legislature accessed March 15 2026 https:\/\/www.nmlegis.gov\/sessions\/04%20Regular\/final\/HB0581.html."},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1001\/virtualmentor.2014.16.12.stas1\u20101412"},{"key":"e_1_2_9_23_1","unstructured":"\u201cTelehealth Services Key to Accessing and Providing Continuity of Care During the COVID\u201019 Pandemic | July 2021 Blogs \u201dIndian Health Services accessed July 25 2024 https:\/\/www.ihs.gov\/newsroom\/ihs\u2010blog\/july2021\/telehealth\u2010services\u2010key\u2010to\u2010accessing\u2010and\u2010providing\u2010continuity\u2010of\u2010care\u2010during\u2010the\u2010covid\u201019\u2010pandemic\/."},{"key":"e_1_2_9_24_1","unstructured":"D.Mathews A.Abernethy A. 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