There has been little previous research on rural beneficiaries' perspectives on access to care under Medicaid managed care. The study reported here considers the perspective of the rural beneficiary in four states in order to broaden understanding of whether Medicaid managed care programs provide acceptable access to healthcare services. The study examines access to healthcare among rural children ages 0-17 who are enrolled in either fully capitated (New Mexico and Washington) or primary care case management (PCCM) Medicaid managed care plans (North Carolina and North Dakota), and compares this access to that of urban beneficiaries. Overall, this study finds that parents of children living in the rural areas who are enrolled in a Medicaid managed care program are almost always able to get the medical care they need. Rural children who are Medicaid enrollees have primary care providers, their parents know how to access care when needed after hours, and although rural children sometimes use the ER, they do not rely on that source of care more than urban parents do. Where barriers to medical care are reported, they are often consistent with those barriers reported for rural residents generally, and do not appear to be related to restrictions from managed care programs. Access to dental services remains a substantial problem, not just for children in rural areas, but for all Medicaid enrollees. 2004