Background: Rural Health Clinics (RHCs) (currently numbering about 4,100) have served patients from underserved rural areas for nearly 40 years. Although Medicaid is an important payer for RHCs, little is known about Medicaid patients and the services provided to them. This study describes the population who used RHC services from four Medicaid states.

Methods: State data from North Carolina, Georgia, California and Texas were drawn from the Centers for Medicare and Medicaid Services' Medicaid Analytic Files eXtract (MAX) data system. We used the 2009-2010 MAX Other Services claims data, which includes all Medicaid claims that are not identified as inpatient, long-term care, or prescription drug claims.

Key Findings: A substantial number of RHC users in California, Georgia, North Carolina, and Texas are identified as Medicaid enrollees, ranging from approximately 100,000 to over 800,000 people per state.

Demographic characteristics vary substantially by state. The percentage of RHC users who are dually enrolled in Medicare and Medicaid ranges from 1% in Texas to 19% in North Carolina. Fifty to 79% of the RHC user population are coded as living in a rural area following the Federal Office of Rural Health Policy definition. However, 20% of the RHCs in these four states are not in areas defined as rural.

This description of RHC users should assist policy makers and researchers in understanding and planning for the population who receives services from RHCs.