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Reforming Access: Trends in Medicaid Enrollment for New Medicare Beneficiaries, 20082011

Keywords: Medicaid;rural health care; rural health clinics; primary care; audit methodology.

Objective: To examine the willingness to accept new Medicaid patients among certified rural health clinics (RHCs) and other nonsafety net rural providers.

Data Sources: Experimental (audit) data from a 10-state study of primary care practices, county-level information from the Area Health Resource File, and RHC information from the Center for Medicare and Medicaid Services.

Study Design: We generate appointment rates for rural and nonrural areas by patient-payer type (private, Medicaid, self-pay) to then motivate our focus on within-rural variation by clinic type (RHC vs. non-RHC). Multivariate linear models test for statistical differences and assess the estimates’ sensitivity to the inclusion of control variables.

Data Collection: The primary data are from a large field study.

Principal Findings: Approximately 80 percent of Medicaid callers receive an appointment in rural areas—a rate more than 20 percentage points greater than nonrural areas. Importantly, within rural areas, RHCs offer appointments to prospective Medicaid patients nearly 95 percent of the time, while the rural (nonsafety net) non-RHC Medicaid rate is less than 75 percent. Measured differences are robust to covariate adjustment.

Conclusions: Our study suggests that RHC status, with its alternative payment model, is strongly associated with new Medicaid patient acceptance. Altering RHC financial incentives may have consequences for rural Medicaid enrollees.

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