Federal policies aimed at increasing health insurance coverage among children represent a success story. Due principally to expansions in Medicaid eligibility through the State Children's Health Insurance Program, the national proportion of children who lack health insurance for an entire year has declined from 13% in 1997–1998 to five percent in 2012. Insurance alone, however, may not be sufficient to ensure access among rural children. Many providers, particularly specialists, do not accept Medicaid in addition, rural children have fewer practitioners of all kinds available to them. Finally, the picture of children's status in the rural U.S. is made more complex by rising diversity in race/ethnicity and increasing poverty.

We used three waves of the National Survey of Children's Health (2003, 2007, 2011/12), a nationally representative sample of U.S. families with children, to create a portrait of the changing status of rural and urban children across the 2003–2012 decade. This Chartbook focuses on the demographics of rural children, their financial access to care, reported use of care, and parentally-reported health status. A companion volume, Disparities in Access to Oral Health Care Among Rural Children: Current Status and Models for Innovation, explores trends in children's oral health across the same time frame.