Medicaid and Rural Health Care

Abstract

The impact of Medicaid policies on systems of rural health care has typically been understood in terms of payment methods and rates. But Medicaid agencies have multifaceted influences, including service funding, promotion of access and quality, and infrastructure. We present in this article a general framework to explore these facets and examine literature that has attempted to identify and measure the impacts of the Medicaid program on rural health care systems. While the literature is relatively sparse, there is evidence that rural health systems have been both bolstered and challenged by Medicaid policies in several areas. Several contemporary developments in Medicaid, including increased state flexibility, uneven coverage expansion, and aggressive Medicaid purchasing strategies, suggest that tensions between Medicaid policy and rural health care needs could grow in the future. These tensions provide focus for developing a research agenda that explores the intersection of Medicaid and rural concerns; a number of research questions that would be a part of this agenda are presented.

Rural Residents with Disabilities Confront Substantial Barriers to Obtaining Primary Care

“…The researchers believe that levels of unmet need in rural Medicaid recipients are “more than double the rate that has been reported by the overall rural population” (Long, Coughlin, and Kendall 2002, p. 443). Hurley, Crawford, and Praeger (2002, p. 165) argue that Medicaid policies carry “the potential for a significant urban bias, depending on the degree of urbanization of a state.” Thus, the Medicaid experiences of rural residents with disabilities are likely to vary across states, with the risk that Medicaid might bolster urban or regional centers at the expense of limiting support of rural providers.…”

Capitated Medicaid Managed Care in a Rural Area: The Impact of Minnesota's PMAP Program

“…It is also possible that, given the limited capacity of most rural health care systems, physicians in rural Minnesota may have had little ability to change traditional patterns of careseeking by Medicaid beneficiaries. 6 Another aspect of Minnesota's health care market that could explain the limited effect we found is the state's long managed care history. Minnesota was one of the early pioneers of managed care, with health maintenance organizations developing in earnest in the state in the early 1970s.…”

“…If states move to MMC, state policymakers will need to be mindful of the broader system issues that may develop as a result of the changes introduced with managed care, including reduced support for key local providers (eg, safety net providers, rural hospitals, local health departments, and pharmacists) and shifting care from rural providers to providers in urban areas. 6…”

“…Although considerable research has documented the implementation of MMC in rural areas, 2-5 very little is known about how managed care affects rural Medicaid beneficiaries' access to care. [6][7][8] Given the possibility of the expansion of MMC in rural areas, it is important to better understand the effects of managed care on rural Medicaid populations. Although several studies have examined the effects of managed care on the general Medicaid population, the results are mixed.…”

Urban‐rural disparities in interfacility transfers for children during COVID‐19

“…Although telehealth for disease‐specific care, such as for diabetes 34 and mental health care, 35 may represent ways to support rural hospitals to care for children in crisis, policy‐level changes are needed. Children in rural areas are more likely to receive Medicaid than those in urban areas, 36 and policy incentivizing Medicaid‐focused reimbursement and alternative payment models may further support maintaining pediatric services in these at‐risk areas.…”