PROJECT SUMMARY/ABSTRACT Candidate: Margaret Greenwood-Ericksen is an early career emergency physician and health services researcher who seeks to transform Medicaid policy to advance rural mental health (MH) equity. Her long-term career goal is to develop an independent program of research evaluating the impact of Medicaid policy interventions on MH outcomes, including co-occurring substance use disorder (SUD), in rural and underrepresented minority (URM) communities. This K08 award is vital to her ability to achieve this goal through protected time, training, and mentored research studies. Research Context: There are well- documented disparities in addressing MH and co-occurring SUD in rural settings, particularly amongst URM communities. The Emergency Department (ED) is a major access point for rural, Medicaid beneficiaries seeking MH care, but outcomes after such ED visits are understudied. Medicaid alternative payment models (APMs) are increasingly deployed to reduce expensive ED-based care, but there is a need to examine the impact of APMs on MH disparities in rural and URM communities. New Mexico (NM) is ideal for this research as a largely rural state with one of the nation’s highest Medicaid insurance rates (49%) with a majority-minority composition including large Native American (12%) and Hispanic (48%) communities. The overall goal of this K08 is a detailed, state-based study measuring rural MH disparities while testing the effectiveness of NM Medicaid’s APM as an intervention in rural and URM communities and examining these findings nationally for a future R01 by the PI studying the impact of different states’ Medicaid policy interventions on rural MH outcomes. Specific Aims: 1) Measure patient-, health system-, and community-factors associated with differences in care quality for MH-related ED visits among rural Medicaid beneficiaries, 2) Test how New Mexico Medicaid MH policy statistically moderates the relationship between rurality and Medicaid quality measure performance, 3) Identify key policy targets and outcome measures for multistate Medicaid MH policy evaluation. To accomplish these aims, the PI will learn and apply advanced statistical techniques to NM Medicaid claims, measuring the intersecting factors on rural MH disparities and testing the effectiveness of NM Medicaid’s MH APM. The PI will then convene an Expert Panel to examine these findings across Medicaid programs, identifying measures for a future multistate R01 on Medicaid MH policy. Career Development Plan: Working closely with mentors, she will 1) Acquire expertise in MH services research and policy, 2) Develop methodologic expertise in Medicaid claims analysis, multilevel models, and clustered propensity matching, 3) Learn frameworks for conducting multistate Medicaid policy evaluations and to disseminate research findings. She has outstanding environmental and mentorship support, including top leadership, a national Advisory Board, and a CTSC with a strong track record of supporting faculty. Submission responds to AHRQ’s SEN on Health Equity (NOT-HS-21-014) and Policy on Priority Populations (NOT-HS-21-015).

PROJECT NARRATIVE The Emergency Department (ED) is a major access point for rural and underrepresented minority (URM) persons seeking mental health (MH) and co-occurring substance use disorder (SUD) treatment, but outcomes after such ED visits are greatly understudied. The overall research goal of this K08 is a detailed, state-based study measuring the effectiveness of New Mexico Medicaid’s Alternative Payment Model (APM) as an intervention in rural and URM communities and scaling these findings nationally through a Technical Expert Panel who will identify key policy and outcome measures for inclusion in Medicaid policy analysis. This work lays the foundation for multistate comparisons to prospectively test the impact of Medicaid policy interventions (e.g., APMs) on rural mental health outcomes.