Identifying Rural Health Clinics in Medicaid Data

Date
05/2016
Description

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.

Center
North Carolina Rural Health Research and Policy Analysis Center
Authors
Marisa Domino, Seth Tyree, Regina Rutledge, Mark Holmes