The Affordable Care Act included provisions for a substantial expansion in Medicaid, but the Supreme Court ruled that states could not be compelled to expand. Many states decided not to expand. These states are disproportionately Southern and rural. Medicaid expansion's effect on rural providers is likely to vary widely across the country. Rural residents tend to have higher enrollment in Medicaid, healthcare providers in the South tend to have lower profitability, and the ACA's Medicaid expansion was coupled with decreases in funding for some safety net services (e.g. DSH).

This project will 1) develop baseline state-level snapshots of rural enrollment in Medicaid and 2) estimate and model enrollment expansion in each state. We will also conduct a baseline provider key informant interviews in late 2013 to gauge expected effects, with follow up interviews in Summer 2014 as a sentinel warning system of early effects of changes to Medicaid in order to inform timely policy development.

Publications

• Rural Provider Perceptions of the ACA: Case Studies in Four States
  Policy Brief
  North Carolina Rural Health Research and Policy Analysis Center
  Date: 02/2015
  This brief summarizes the perceptions from rural providers in four states regarding the early effects of the Affordable Care Act, including changes to patient populations, financial health, and capacity for rural hospitals and rural federally qualified health centers.