Rural and Urban Parents Report on Access to Health Care for Their Children with Medicaid Managed Care. Working Paper Series No. 84.

摘要

States have increasingly turned to managed care as a delivery system for their Medicaid programs. There are many barriers to the implementation of Medicaid managed care in rural areas, including provider resistance, the absence of commercial managed care, inadequate provider supply and lack of networks, limited beneficiaries across whom to spread risk, and lack of legislative or political will. Still, Medicaid managed care programs have been implemented in many more rural areas than some initially thought possible. There has been little previous research on rural beneficiaries perspectives on access to care under Medicaid managed care. The study reported here considers the perspective of the rural beneficiary in four states in order to broaden understanding of whether Medicaid managed care programs provide acceptable access to health care services. The study examines access to health care among rural children ages 0-17 who are enrolled in either fully capitated (New Mexico and Washington) or primary care case management (PCCM) Medicaid managed care plans (North Carolina and North Dakota), and compares this access to that of urban beneficiaries. Areas of focus include the ability to find a participating health care provider within a reasonable distance, coordination of care concerning services such as specialty care that are more likely to be located in urban areas, and use of the emergency room. A particular focus of the study is services such as dental and transportation, which are typically carved out of managed care programs but are particularly relevant to rural populations.