Rural-Urban Differences in Medicaid Beneficiary Coverage Transitions

Rural and urban Medicaid beneficiaries may experience different patterns of coverage, yet little is known about how churn—the rate at which coverage ends—and coverage types vary by rurality. Prior research has identified demographic and health differences between rural and urban beneficiaries, but gaps remain regarding the role of administrative barriers, eligibility changes, and access to employment-sponsored insurance in shaping coverage dynamics. Understanding these differences is critical for designing policies that ensure continuity of care and equitable access to benefits.

This study addresses two primary research questions: (1) Do rural and urban Medicaid beneficiaries differ in churn rates? We hypothesize that rural beneficiaries experience higher churn, driven by administrative barriers, lower access to social services, or changes in eligibility. (2) How do coverage types vary by rural-urban status? We hypothesize that rural beneficiaries are less likely to have partial coverage, while prior studies suggest that dual coverage rates may be higher in rural areas, although variation exists by state.

We will conduct a cross-sectional analysis using the most recent two years of T-MSIS data available through the Virtual Research Data Center (VRDC).