Your browser doesn't support JavaScript. Please upgrade to a modern browser or enable JavaScript in your existing browser.
Skip Navigation U.S. Department of Health and Human Services
Agency for Healthcare Research Quality
Archive print banner

This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: Let us know the nature of the problem, the Web address of what you want, and your contact information.

Please go to for current information.

Strengthening the Rural Health Infrastructure

Developing Your State's Strategy


Dan Campion, Alpha Center, Washington, DC.

This session provided an opportunity for participants to discuss further what issues, strategies, or concerns they are considering with regard to strengthening rural health systems in their States and communities.

Medicaid Managed Care

Among the topics addressed was Medicaid managed care. Many States are moving to mandatory managed care for their Medicaid programs. This is driving the development of managed care in rural communities in these States. The issue of counties taking on risk was discussed. If counties propose to act as Managed Care Organizations (MCOs) and take on full risk, ultimately property taxpayers would be responsible. One participant noted that purchasing reinsurance could help minimize the county's risk. Also raised regarding managed care was whether plans would be required to include public health functions.

Provider-sponsored Organizations (PSOs)

On the issue of licensing provider-sponsored organizations (PSOs) and developing rules for risk-bearing health plans, a few ideas emerged. All agreed that State offices of rural health should get involved when the State departments of insurance discuss these issues. One participant said her State already requires a certificate of insurance or reinsurance to be licensed. It also makes certain exceptions for these entities if they are contracting with Medicare or Medicaid. Another participant added that the number of enrollees needs to reach a "critical mass" in order for a network to have a stable risk pool but that few rural advocates understand these insurance concepts thoroughly.


A concern was raised regarding the low level of funds allocated for the Health Care Financing Administration (HCFA) to educate the public on the new Medicare+Choice program. It was felt that $95 million was not adequate to the task and that States might want to consider providing additional information to rural Medicare beneficiaries through senior centers or other programs (e.g., Area Agencies on Aging).

It was noted that rural areas, on average, have a higher percentage of uninsured persons than urban areas and that high numbers of uninsured place a tremendous burden on rural systems. It was also noted that State and national solutions are needed, as well as local involvement, and that rural areas may need special attention given the fragility of the health care infrastructure.

Current as of November 1997

Previous Section Previous Section         Contents                        

Internet Citation:

Strengthening the Rural Health Infrastructure: Network Development and Managed Care Strategies. Workshop Summary, November 19-21, 1997, User Liaison Program. Agency for Health Care Policy and Research, Rockville, MD.

The information on this page is archived and provided for reference purposes only.

AHRQ Advancing Excellence in Health Care