Demographic characteristics of rural enrollees differed from those of urban enrollees in several ways, most notably in racial/ethnic composition. White Medicaid enrollees made up the majority of the rural enrollee population (67.1%), whereas they were a minority in urban areas (38.5%). This reflects the overall demographics of rural America: in 2014, rural populations were 79.5% white compared to 60% of urban populations.

Race/ethnicity and rurality were associated with the distribution of 2012 Medicaid enrollees across eligibility categories. Overall, rural populations were slightly more likely to be eligible because of age or a disabling condition than were urban populations. Among white and black enrollees, eligibility through aged status was more likely for rural than for urban residents; among Hispanic and American Indian/Alaska Native groups, however, the opposite was true. Similarly, white and black rural enrollees were more likely than their urban peers to qualify because of disability; again the opposite was true for Hispanic and American Indian/Alaska Native populations.

Children were the largest subgroup of Medicaid enrollees in the 2012 sample studied, accounting for 51.4% of all enrollees. The Hispanic Medicaid population was most heavily slanted toward children, with their proportion in the populations increasing from 63.4% in urban areas to 73.6% in the most rural communities. Although it is possible that many Hispanic adults may not qualify for Medicaid, these individuals may also seek care at lower rates and thus not encounter providers who encourage qualified individuals to apply. Hispanic adults were markedly more likely than white adults to lack a usual source of care in 2012-2013 (32.6% versus 19.2%) and to report no health care visits during the past year (24.0% versus 16.1%).

Not surprisingly, enrollment in a managed care plan/health maintenance organization was lower among rural residents, either for part or all of the year. Given the lower managed care penetration rates and lower population density within rural areas, the availability of such plans is likely to be lower in these areas. In addition, state-by-state differences in policy will affect this enrollment, with some states mandating larger populations to enroll in managed care plans than others. Regardless, these plans have important implications in regards to utilization and access to care that may differ among rural populations.