Recorded presentation

Pam C. Silberman, JD, DrPH, Stephanie Poley, BA, Matthew Rudolf, BA, and Rebecca Slifkin, PhD. Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Airport Road, CB# 7590, Chapel Hill, NC 27599-7590, 919-843-8248, stephanie_poley@unc.edu

Research Problem and Hypothesis: Most states are struggling with severe budget shortfalls. Medicaid is the second largest expenditure in most states’ budgets and costs are growing faster than revenues. In response to budget pressures, states have begun to modify their Medicaid program. Strategies for decreasing program costs include reducing or freezing provider payments, cutting benefits or eligibility, limiting coverage of prescription drugs, and increasing cost sharing. The objective of this research is to assess the impact of these changes in rural communities. Changes that reduce patient revenues and/or increase the numbers of uninsured could potentially wreck havoc on an already fragile rural healthcare infrastructure.

Data and methods: Researchers conducted a 50-state telephone survey with key informants in state Medicaid agencies, Offices of Rural Health and rural health associations. After identifying Medicaid policy changes, informants were asked about their impact on enrollment, provider participation, provider financial viability, and access to care in rural communities.

Results and conclusions: Preliminary data suggests that while the Medicaid changes have caused problems in both rural and urban communities, some challenges and responses are unique to rural communities. Changes in Medicaid enrollment procedures have made it more difficult to enroll in some states, causing greater problems in some rural communities because of consolidation of application sites and transportation barriers. In reaction to anticipated provider payment reductions, rural providers in some states have become increasingly interested in RHC or FQHC status to enhance their Medicaid reimbursement. Other states are focusing increased energy on outreach programs to avert access barriers created by Medicaid policy changes. In some states, the impact of Medicaid program changes have not been so acutely sensed because other issues such as workforce supply, particularly for dental, obstetrical, and other specialty providers have created more immediate and pressing problems for rural communities. Some states have reported that they anticipate more dramatic cutbacks will be made once the short-term increase in FMAP expires in June 2004.

Policy implications: States are faced with continued fiscal pressure to reduce Medicaid costs. As states consider options, they should explicitly examine the effect of strategies on rural communities, and consider the role Medicaid plays in covering rural beneficiaries and supporting the rural health infrastructure. Although any cut backs in the Medicaid program will have negative consequences for low-income individuals and providers everywhere, state policy-makers must ensure that rural places do not shoulder more than their share of the burden.

Learning Objectives:

• As a result of the session, participants will understand how states have altered their Medicaid programs to cope with state budget pressures, and will recognize how such changes have affected rural communities. Participants will also learn what efforts are being made to avert potentially detrimental access problems stemming from such policy changes.

Keywords: Medicaid, Rural Communities

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation