Geographic Expansion of Medicaid Managed Care Organizations: Assessing Access to Primary Care in Nonmetropolitan Counties


As states have increasingly contracted with managed care organizations (MCOs) to serve their Medicaid populations, many of the counties newly served by Medicaid MCOs within the last decade have been nonmetropolitan counties. This brief assesses access to primary care in nonmetropolitan counties for Medicaid recipients in 15 states that expanded Medicaid MCOs to new geographic areas across the state from 2012-2018.

Researchers calculated and analyzed a "primary care provider (PCP) access score" (summarizing actual driving times to the nearest primary care) using geospatial methods and assessed the relationship between stronger state policies on network adequacy to observed PCP access scores in nonmetropolitan settings. The study found that nonmetropolitan counties that had Medicaid MCOs prior to 2012 experienced better access to primary care than nonmetropolitan counties that expanded to Medicaid MCO coverage after 2012, and that nonmetropolitan counties in states that specify stronger network adequacy travel time requirements for PCPs had better PCP access scores on average than those in states that allow longer travel times. Additionally, researchers estimate that among nonmetropolitan counties that were newly served by Medicaid MCOs in 2012-2018, a segment of roughly 45,000 Medicaid recipients experienced relatively low PCP access scores and thus less access to primary care.

RUPRI Center for Rural Health Policy Analysis
Linda Li, Matthew Najarian, Abigail Barker, Leah Kemper, Timothy McBride, Keith Mueller