PP904 - Mapping Medicaid: Unraveling Provider Networks and Distribution Across Texas

Abstract:
This study examined the geographic dispersion of Medicaid-enrolled audiologists in Texas, analyzing distribution across Public Health Service Regions, rurality, and US-Mexico border status. A total of 311 Medicaid-enrolled providers were identified and were predominantly clustered in metropolitan areas. Over 99% of Texas counties were insufficiently staffed to meet Medicaid beneficiary needs. Rural and border regions also faced significant access barriers, while no Public Health Service Regions were fully workforce sufficient. The findings highlight an urgent need for targeted health policy interventions to address these shortages and improve audiology service accessibility for Medicaid beneficiaries across Texas.

Summary:
Objectives
This study aimed to characterize the geographic dispersion of audiologists enrolled to provide care through Texas Medicaid programs. Additionally, Medicaid audiologist networks in Texas were assessed across Public Health Service Regions (PHSRs), rurality designations, and US-Mexico Border status.

Rationale
With an estimated 6 million Texans affected by hearing loss and Medicaid coordinating benefits for approximately 17% of the state's population, ensuring adequate and timely access to audiological care is crucial. Analyzing the distribution of Medicaid-enrolled audiologists provides insight into the accessibility of audiology services for Medicaid beneficiaries across the state.

Design
This cross-sectional study utilized publicly available data from the Texas Medicaid and Healthcare Partnership provider lookup tool and licensee information from the Texas Department of Licensure and Regulation. The analytic sample included 311 audiologists enrolled to provide services under Traditional Medicaid in 2024. Counties were categorized by PHSRs, rural-urban continuum codes, and US-Mexico border designation (yes/no). Population data were derived from the 2023 US Census Bureau's American Community Survey. A sufficiency benchmark of 1,700 Medicaid beneficiaries to 1 audiologist was established. Due to anticipated small cell counts, Fisher's Exact Tests were employed to compare Medicaid population to audiology provider ratios across categories.

Results
The study revealed that 99.6% (253/254) of Texas counties were insufficiently staffed to meet the needs of Medicaid beneficiaries. Medicaid-enrolled audiology providers were predominantly clustered around metropolitan areas, creating significant access barriers for non-metro regions. No Texas PHSRs were fully workforce sufficient, and the regions did not differ significantly in their understaffing (p = 0.37). Rurality analysis showed that 69 of 70 rural counties had no Medicaid-enrolled audiologist, though workforce sufficiency did not differ significantly based on rurality designation (p = 0.34). Of the 32 US-Mexico border counties, 96.9% (31/32) were Medicaid workforce insufficient, with only five border counties having at least one Medicaid-enrolled audiology provider.

Conclusions
This study underscores a critical shortage of Medicaid-enrolled audiologists across Texas, with nearly all counties insufficiently staffed to meet beneficiary needs. The concentration of providers in metropolitan areas highlights significant access issues for rural and border regions. These findings suggest that the insufficiency of the Medicaid audiology workforce is a statewide problem rather than a localized issue. The study emphasizes the urgent need for targeted health policy interventions to address these shortages, potentially through provider incentives, expanded networks, or increased utilization of telehealth services in Texas. Similar changes may exist in other states, warranting further investigation.