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Studies document positive aspects of Medicaid coverage for poor families living in rural areas

Medicaid coverage of rural poor families has distinct advantages in certain areas, according to two recent studies supported by the Agency for Health Care Policy and Research (Rural Health Research Center contract 290-93-0038). The first study found that more extensive Medicaid coverage significantly increases the likelihood of more up-to-date immunizations among poor rural children. The second study demonstrates that implementation of Medicaid managed care programs is feasible, even in remote rural areas. Both studies are summarized here.

Mayer, M.L., Clark, S.J., Konrad, T.R., and others (1999, February). "The role of State policies and programs in buffering the effects of poverty on children's immunization receipt." American Journal of Public Health 89(2), pp. 164-170.

Although State policies can enhance delivery of immunizations to poor children, heavy reliance on public-sector immunization does not ensure timely receipt of vaccines. Public- and private-sector collaboration is necessary to protect children from vaccine-preventable diseases, concludes this study. The investigators assessed how many children in a national sample of 8,100 2-year-old children were up-to-date on their immunizations, based on the 1988 National Maternal and Infant Health Survey and its 1991 Longitudinal Follow-Up.

Overall, 33 percent of poor children and 44 percent of other children had up-to-date immunizations. Poor children with public rather than private sources of routine pediatric care were more apt to have their full immunization series. Yet children living in States where most immunizations were delivered in the public sector were less likely to be up to date. The increased demand for public provision of immunizations, coupled with decreased financial resources for community health centers, may underlie this negative relationship, suggest the researchers.

Their analysis also showed that more extensive Medicaid coverage of the poor was associated with a greater likelihood of having up-to-date immunizations among poor children. However, the effects of expanded Medicaid coverage were limited. For about 60 percent of the poor covered by Medicaid, additional Medicaid expansions did not increase the probability of being up to date.

Felt-Lisk, S., Silberman, P., Hoag, S., and Slifkin, R. (1999, March). "Medicaid managed care in rural areas: A ten-State follow-up study." Health Affairs 18(2), pp. 238-245.

At least 703,000 Medicaid beneficiaries in rural areas now participate in capitated managed care, and even more participate in primary care case management (PCCM) programs. States most often cite potential cost savings and hopes of improving access to care as the major reasons for implementing rural managed care programs. These researchers did a case study of 10 States that have already implemented Medicaid managed care programs to discern the feasibility of these programs and their impact on access to care. In 1997, they conducted telephone interviews with 130 key informants in the 10 States, including State agency representatives, rural providers, representatives of managed care organizations, and consumer advocates.

Overall, they found that implementing PCCM and capitated programs was feasible, even in remote rural areas. This was because States took greater time and effort for implementation in rural areas and ensured that program details were workable in these communities. Enough time must be allowed to accomplish certain tasks prior to implementation: building the provider network, building support for the program through interface with local representatives, and (if applicable) designing geographic program boundaries that take into account local service-use patterns, note the researchers. They point out that building provider networks in rural areas requires more time and effort than it does in urban areas because of rural providers' inexperience with managed care and the greater difficulty in communicating with disperse, often remote, independent provider offices.

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