Medicaid and CHIP
Research Products & Journal Articles
Browse the full list of research publications on this topic completed by the Rural Health Research Centers.
Products – Freely accessible products include policy briefs, fact sheets, full reports, chartbooks, and interactive data websites.
Journal Articles – Articles in peer-reviewed journals may require a subscription or affiliation with a subscribing library. For these publications, Gateway lists the article citation, a brief summary, a link to additional information and access to the full-text of the article, if available.
2024
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Pediatric and Pregnancy-related Visits at Rural Health Clinics in 2018 Among Medicaid/CHIP Enrollees in 20 States
Policy Brief
Maine Rural Health Research Center
Date: 09/2024
This policy brief reports on the percentage of Medicaid-enrolled children and reproductive age women with pregnancy-related service use who visited a Rural Health Clinic in 2018 in 20 states. -
Identifying Rural Health Clinics Within the Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files
Policy Brief
Maine Rural Health Research Center
Date: 03/2024
This brief describes a methodology for identifying Rural Health Clinic encounters within the Medicaid claims data using Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files.
2023
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Colorectal Cancer Screening in Rural and Urban Primary Care Practices Amid Implementation of the Medicare Access and CHIP Reauthorization Act
Journal Article
Rural and Underserved Health Research Center
Date: 06/2023
This study examined whether colorectal cancer screening rates improved among rural and urban primary care practices amid implementation of the Medicare Access and CHIP Reauthorization Act. Researchers tested for rural/urban differences and changes in screening rates between 2016 and 2020.
2022
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Medicaid Expansion and Access to Naloxone in Metropolitan and Nonmetropolitan Areas
Journal Article
Rural and Underserved Health Research Center
Date: 11/2022
This study evaluated the association of Medicaid expansion at the state level on the number of naloxone prescriptions dispensed and the percentage paid by Medicaid. Increasing the percentage of Medicaid-paid naloxone prescriptions improved access in metro areas.
2021
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Community Health Worker Sustainability: Funding, Payment, and Reimbursement Laws in the United States
Journal Article
Southwest Rural Health Research Center
Date: 04/2021
Recent changes have been made to community health worker (CHW) funding at the federal level, but payment structures vary from state to state. This paper aims to identify funding mechanisms that would enable CHW programs to sustain a robust workforce. -
Geographic Expansion of Medicaid Managed Care Organizations: Assessing Access to Primary Care in Nonmetropolitan Counties
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 03/2021
This brief evaluates the degree to which Medicaid beneficiaries in nonmetropolitan counties that were newly served by managed care organizations in 2012-2018 are able to access primary care, as determined by travel time. The study also examined the association between their primary care access and the strength of network adequacy state policies. -
Sources of Insurance Coverage in Nonmetropolitan Areas: The Role of Public and Private Insurance Since 2009
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 03/2021
This brief uses 2009-13 and 2013-17 American Community Survey five-year estimates to compare types of health insurance coverage for the nonelderly in metropolitan and nonmetropolitan areas. The significant growth in public insurance rates due to Medicaid expansion was larger for those living in nonmetropolitan areas compared to metropolitan areas. -
Trends in Nursing Home Closures in Metropolitan and Nonmetropolitan Counties in the United States, 2008-2018
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 02/2021
Nursing home closures have raised concerns about access to long-term services and supports in rural areas. This study examines trends in closures and characteristics of open and closed nursing homes in metropolitan and nonmetropolitan counties. Furthermore, this study identifies metropolitan and nonmetropolitan counties without any nursing homes.
2020
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Telebehavioral Health Use Among Rural Medicaid Beneficiaries: Relationships With Telehealth Policies
Journal Article
Rural Telehealth Research Center
Date: 09/2020
This study assesses policy levers potentially supporting sustained use of telehealth services. Among rural Medicaid fee-for-service beneficiaries with behavioral health needs, engaging patients through informed consent within provider settings that receive facility fees may facilitate improved access to telebehavioral health services.
2019
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Effects of the Patient Protection and Affordable Care Act on Coverage and Access to Care in Metropolitan vs. Nonmetropolitan Areas Through 2016
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 08/2019
The Patient Protection and Affordable Care Act as a whole led to notable increases in coverage rate and better access to care in both metropolitan and nonmetropolitan areas, and the Medicaid expansion was the key driver of coverage gains in nonmetropolitan areas.
2018
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Patterns of Telehealth Use Among Rural Medicaid Beneficiaries
Journal Article
Rural Telehealth Research Center
Date: 10/2018
This study uses data from the 2011 Medicaid Analytic eXtract (MAX) to examine the prevalence of telehealth use among rural and urban Medicaid beneficiaries, characteristics of telehealth users, types of telehealth services provided, and diagnoses associated with telehealth use. -
Medicaid Income Eligibility Transitions Among Rural Adults
Policy Brief
Maine Rural Health Research Center
Date: 08/2018
The Affordable Care Act allows Medicaid expansion to adults under 65 with income below 138% of poverty. Research suggests income shifts affecting Medicaid eligibility are common, but the rural impact is unclear. This national study examines rural and urban adults' annual income shifts above or below the Medicaid expansion eligibility threshold. -
The Importance of Rural Hospitals: Transfers and 30-day Readmissions Among Rural Residents and Patients Presenting at Rural Hospitals
Journal Article
University of South Carolina Rural Health Research Center
Date: 07/2018
This study looked at reasons why transfers and readmissions occurred among Medicare patients who first came to rural hospitals. -
Insuring Rural America: Health Insurance Challenges and Opportunities
Policy Brief
RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 07/2018
This brief discusses a series of policy considerations in three main categories: policies related to rural insurance risk, policies related to provider networks, and policies related to rural payment rates and structures.
2017
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Distribution of Disproportionate Share Hospital Payments to Rural and Critical Access Hospitals
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 11/2017
This policy brief provides information about the potential impact of scheduled changes in Medicaid Disproportionate Share Hospital (DSH) payment on hospitals in 47 states. We expect variation across states, because of differences in state policies allocating DSH payments, as well as geographic variation by census region. -
Rural/Urban Analysis on Individual Insurance Market Topics
Fact Sheet
RUPRI Center for Rural Health Policy Analysis
Date: 08/2017
Some special challenges face the development and sustainability of marketplace plans in rural areas. This data release provides some additional detail on some important topics, with particular importance to rural people, places, and providers. -
Changing Rural and Urban Enrollment in State Medicaid Programs
Policy Brief
RUPRI Center for Rural Health Policy Analysis
Date: 01/2017
Medicaid enrollment growth in 36 states is analyzed by rural and expansion status, pre- and post-Affordable Care Act (ACA). Enrollment growth was larger in expansion states but did take place in most states, with significant state-level variation in both groups. Metropolitan areas generally had higher growth than micropolitan and rural areas. -
The Role of Public Versus Private Health Insurance in Ensuring Health Care Access & Affordability for Low-Income Rural Children
Policy Brief
Maine Rural Health Research Center
Date: 01/2017
Medicaid and CHIP have played a critical role in ensuring access to health coverage among children –particularly rural children. This study examines rural-urban differences in children's access to care, and their families' perceived affordability of that care among those enrolled in Medicaid or CHIP, and those with private insurance plans.
2016
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Are Rural Older Adults Benefiting From Increased State Spending on Medicaid Home and Community-Based Services?
Policy Brief
Maine Rural Health Research Center
Date: 06/2016
Little is known about variations in the availability or use of Medicaid Home and Community-Based Services (HCBS) within states, across rural and urban areas. This study used national claims data to examine differences in HCBS use and expenditures among rural and urban older adult Medicaid beneficiaries receiving LTSS.
2015
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Rural Disabled Medicare Beneficiaries Spend More Out-of-Pocket Than Their Urban Counterparts
Policy Brief
Maine Rural Health Research Center
Date: 11/2015
Most beneficiaries seek added coverage to close the gap between the care they need and the costs covered by Medicare. This study evaluated rural-urban differences in out-of-pocket spending, supplemental coverage, and variation in spending by type of service. -
Uncompensated Care Burden May Mean Financial Vulnerability for Rural Hospitals in States That Did Not Expand Medicaid
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 10/2015
Explores the differences of rural hospitals in states with Medicaid expansion and those with nonexpansion, in terms of the amount of uncompensated care they provided and their profitability and market characteristics in 2013. -
Thirty-Day Readmission Rates Among Dual-Eligible Beneficiaries
Journal Article
University of South Carolina Rural Health Research Center
Date: 08/2015
Examines readmission rates and factors affecting readmission of patients eligible for both Medicare and Medicaid (dual-eligibility).
2014
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Health Insurance Coverage of Low-Income Rural Children Increases and Is More Continuous Following CHIP Implementation
Policy Brief
Maine Rural Health Research Center
Date: 03/2014
This study found that following the Children's Health Insurance Program's (CHIP) implementation, health insurance coverage and continuity increased among low-income children, particularly for those living in rural areas. By CHIP's maturity, coverage for rural children improved so much that their uninsured rate dropped below that of urban children.
2012
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The Current and Future Role and Impact of Medicaid in Rural Health
RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 09/2012
This report outlines and describes the current Medicaid program and its importance to rural America. It also discusses rural implications of program expansion, including whether and how states choose to implement changes.
2010
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The Patient Protection and Affordable Care Act of 2010: Impacts on Rural People, Places, and Providers: A First Look
RUPRI Health Panel: Rural Policy Analysis and Applications
Date: 09/2010
This report summarizes six issue areas of the Affordable Care Act and discusses implications for access to services and improving the health status of rural residents. The issue areas are health insurance coverage; Medicare and Medicaid payment; quality, financing, and delivery system reform; public health; healthcare workforce; and long-term care.
2009
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Impact of the Recession on Rural America: Rising Unemployment Leading to More Uninsured in 2009
RUPRI Center for Rural Health Policy Analysis
Date: 06/2009
This brief presents the results of state and county analysis of unemployment rates nationally in urban and rural (non-metropolitan) areas during the period 2007-February 2009 and discusses the impact of rising unemployment on uninsurance in rural areas.
2006
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Rural Health Research in Progress in the Rural Health Research Centers Program, 10th Edition
Maine Rural Health Research Center
Date: 02/2006
This book provides policy makers with a concise source of rural health services research underway in the Rural Health Research Centers funded by the Office of Rural Health Policy and provides a context for legislation that affects rural health services and populations.
2005
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Rural Health Research in Progress in the Rural Health Research Centers Program, 9th Edition
Maine Rural Health Research Center
Date: 02/2005
This book provides policymakers with a concise source of rural health services research underway in the Rural Health Research Centers funded by the Office of Rural Health Policy. It provides a context for legislation current that affects rural health services and populations.
2002
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Tracking Medicaid Managed Care in Rural Communities: A Fifty-State Follow-Up
Journal Article
North Carolina Rural Health Research and Policy Analysis Center
Date: 08/2002
This article updates a 1997 study examining implementation of rural Medicaid-managed care programs.
2001
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Medicaid Managed Behavioral Health Programs in Rural Areas
Policy Brief
Maine Rural Health Research Center
Date: 08/2001
This research and policy brief studies which states have implemented Medicaid-managed behavioral health programs in rural areas. It describes the programs in terms of Medicaid populations served, program design, and implementation model and the experience of programs regarding access to/coordination of services. -
Medicaid Managed Behavioral Health in Rural Areas
Maine Rural Health Research Center
Date: 01/2001
This study of which states have implemented Medicaid managed behavioral health (MMBH) programs in rural areas describes these programs in terms of Medicaid populations served, program design, and implementation model. It also describes the experience of programs regarding access to and coordination of services. -
Rural Implications of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000
RUPRI Center for Rural Health Policy Analysis
Date: 01/2001
This report covers rural health policy, SCHIP Benefit Improvement Plan, and legislation. -
Rural Implications of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000: Concerns, Legislation, and Next Steps
RUPRI Center for Rural Health Policy Analysis
Date: 01/2001
This rural policy brief provides an overview of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 as it impacts rural health.
1999
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Implementation of the State Children's Health Insurance Program: Outreach, Enrollment, and Provider Participation in Rural Areas (Full Report)
Report
NORC Walsh Center for Rural Health Analysis
Date: 11/1999
The State Children's Health Insurance Program (CHIP) provides states with an important source of funding to help low-income, uninsured children overcome financial barriers to medical care. CHIP may be especially important in covering children living in rural areas. This study qualitatively assesses CHIP outreach, enrollment, and provider issues. -
Implementation of the State Children's Health Insurance Program: Outreach, Enrollment, and Provider Participation in Rural Areas (Policy Brief)
Policy Brief
NORC Walsh Center for Rural Health Analysis
Date: 11/1999
The State Children's Health Insurance Program (CHIP) provides states with an important source of funding to help low-income, uninsured children overcome financial barriers to medical care. This policy analysis brief assesses CHIP outreach, enrollment, and provider issues in Colorado, Kansas, Oklahoma, Pennsylvania, and West Virginia.
1998
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Anticipating the 1997 State Children's Health Insurance Program: What's Current in Five Rural States?
NORC Walsh Center for Rural Health Analysis
Date: 01/1998
This study examines aspects of existing children's health insurance or health services for low-income, uninsured children.