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Tracking the Implementation of Medicaid Managed Care in Rural Areas
More than half of all Medicaid recipients are enrolled in some form of managed care, but participation in rural areas remains behind that of urban areas. In 1997, the North Carolina Rural Health Research Program conducted a study under an AHCPR delivery order that looked at the extent and type of Medicaid managed care in rural areas. The North Carolina Rural Health Research Program will update the data collected in the prior study to:
- Track changes in geographic coverage and program type over the last three years;
- Assess the extent to which states have taken advantage of provisions in the Balanced
Budget Act of 1997 (e.g., allowing states to contract with one managed care organization in rural areas);
- Determine the long-term stability of Medicaid managed care plans in rural areas;
- Examine whether enrollment changes have had a differential impact on states ability to implement Medicaid managed care in rural areas; and
- Identify state strategies to improve access and quality of care in rural communities, particularly in states with PCCM programs.
In the first year of this project, data will be collected from all 50 states to analyze changes in urban/rural coverage over the last three years. Year two will involve more in-depth telephone case studies of key informants in selected states.
Publications
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Impact Of The Medicaid Budgetary Crisis On Rural Communities
Author(s): Pam Silberman, Matthew Rudolf, Cammie D'Alpe, Randy Randolph, Rebecca Slifkin
Report Number: Working Paper No. 77
Date: 08 / 2003
Provides an overview of the Medicaid program and options states have to reduce program costs. Steps states have proposed or taken to reduce Medicaid costs and the potential impact of these changes on rural areas are discussed. The potential impact on rural communities of federal proposals to redesign Medicaid is assessed.
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Tracking Medicaid Managed Care in Rural Communities: A Fifty-State Follow-Up
Author(s): Pam Silberman, Stephanle Poley, Kerry James, Rebecca Slifkin
Citation: Health Affairs, 21(4), 255-263
Date: 08 / 2002
Updates a 1997 study examining implementation of rural Medicaid managed care programs. Among its findings are that there have been significant state-level changes in the types of programs offered; there has been an overall increase in the percentage of urban and rural counties with Medicaid managed care programs; and SCHIP expansion has had little impact on the operation of fully capitated Medicaid managed care programs in rural areas because the increased number of children covered has not been large enough to affect health plans' participation. Concludes that looking only at the increase in rural Medicaid managed care since 1997 could lead to a false impression. While the number of rural counties with fully capitated programs has increased, states' more recent experiences suggest that health plans are pulling out of rural areas just as they are pulling out of urban ones. States may find it difficult to find commercial HMOs willing to participate in Medicaid managed care at prices that states can afford.
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