More than half of all Medicaid recipients are enrolled in some form of managed care, but participation in rural areas remains behind that of urban areas. In 1997, the North Carolina Rural Health Research Program conducted a study under an Agency for Health Care Policy and Research delivery order that looked at the extent and type of Medicaid managed care in rural areas. The North Carolina Rural Health Research Program will update the data collected in the prior study to:

• Track changes in geographic coverage and program type over the last three years;
• Assess the extent to which states have taken advantage of provisions in the Balanced Budget Act of 1997 (e.g., allowing states to contract with one managed care organization in rural areas);
• Determine the long-term stability of Medicaid managed care plans in rural areas;
• Examine whether enrollment changes have had a differential impact on states ability to implement Medicaid managed care in rural areas; and
• Identify state strategies to improve access and quality of care in rural communities, particularly in states with Primary Care Case Management (PCCM) programs.

In the first year of this project, data will be collected from all 50 states to analyze changes in urban/rural coverage over the last three years. Year two will involve more in-depth telephone case studies of key informants in selected states.

Publications

• Impact of the Medicaid Budgetary Crisis on Rural Communities
  North Carolina Rural Health Research and Policy Analysis Center
  Date: 08/2003
  This paper provides an overview of the Medicaid program and options states have to reduce program costs. Steps states have proposed or taken to reduce Medicaid costs and the potential impact of these changes on rural areas are discussed. The potential impact on rural communities of federal proposals to redesign Medicaid is assessed.
• Tracking Medicaid Managed Care in Rural Communities: A Fifty-State Follow-Up
  Journal Article
  North Carolina Rural Health Research and Policy Analysis Center
  Date: 08/2002
  This article updates a 1997 study examining implementation of rural Medicaid-managed care programs.