Research Alert: December 18, 2024

Utilization of Inpatient and Emergency Services by Rural and Urban Medicaid Enrollees

This brief used data from the 2019 Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF) to compare urban and rural residents enrolled in either fee-for-service or managed care Medicaid. Researchers focused on inpatient and emergency department (ED) health care utilization.

Key Findings:

• Overall utilization by Medicaid enrollees, as measured by number of ED visits, number of inpatient admissions, inpatient length-of-stay, and inpatient readmission rate, is higher in urban areas than in rural areas.
• Among enrollees who are at least 65 years old, most of whom had Medicare-Medicaid dual eligibility, rural Medicaid enrollees had higher rates of inpatient admissions and ED visits than urban enrollees, while among those in the age categories of below 18 and 18-64 years old, urban enrollees had higher rates. Readmission rates and average inpatient length-of-stay were higher in urban enrollees across all age categories.
• Non-Hispanic Black enrollees had the highest utilization rates compared to enrollees that were non-Hispanic White, and Hispanic of any race. Hispanic enrollees of any race had the lowest utilization rates. Utilization was lowest in Isolated Rural areas, and often highest in Large Rural areas.
• Rural female enrollees (except those in Isolated Rural areas) had higher rates of ED use compared to urban enrollees, while rural male enrollees had lower ED utilization than those in urban areas. Compared to urban areas, male and female enrollees in rural areas had shorter inpatient lengths-of-stay and lower readmission rates.

Additional Resources of Interest:

• More FORHP-funded research on Medicaid and CHIP
• More information about the North Carolina Rural Health Research and Policy Analysis Center