Background: Rural Health Clinics (RHCs)
(currently numbering about 4,100) have served patients
from underserved rural areas for nearly 40 years.
Although Medicaid is an important payer for RHCs, little
is known about Medicaid patients and the services
provided to them. Previous research conducted by the
North Carolina Rural Health Research Program analyzed
Medicare claims data to learn more about RHCs and
Medicare beneficiaries, including comparisons to rural
and urban FQHCs. Conducting similar research for Medicaid
enrollees has been more difficult. Unlike federally
managed Medicare claims, Medicaid claims are managed by
states, and state-to-state differences in identification
and treatment of RHCs in claims data make it difficult to
conduct national analyses.
The North Carolina Rural Health Research Program
identified and tested several methods for identifying
RHCs in Medicaid claims data. This brief describes and
compares different methods to identify RHCs in the
Medicaid claims of four states.
Methods: State data from North Carolina,
Georgia, California and Texas were drawn from the Centers
for Medicare and Medicaid Services' (CMS) Medicaid
Analytic Files Extract (MAX) data system.
Key Findings: Claims-based payment data
are important for the analysis of Rural Health Clinics
(RHCs) use by Medicaid beneficiaries. However, valid
identification of such claims can be a complex process.
Six potential methods of identifying RHCs in Medicaid
claims are enumerated. The most feasible method of
identifying RHC claims in Medicaid data may be the
combined use of the provider specialty, type of program,
and place of service codes.
The recommended method should assist policy makers and
researchers who are attempting to use Medicaid data to
answer health policy questions related to RHCs.