Children's access to and utilization of Medicaid-covered services in Texas: A comparison of urban and rural residents

As a general rule, rural residents are more likely to report greater access barriers to care than those living in urban areas. However, a recent evaluation of Medicaid-covered children in Texas alters some of these previously held assumptions. Data were collected in late 2007 from a telephone survey of 5,100 randomly selected parents/guardians of Medicaid-covered children. A Mann-Whitney U test was used to compare rates of utilization. Chi square analysis was used to determine statistical significance on access barriers. Urban and rural parents/guardians were equally likely to report receiving all of the medical care their child needed during the past year. However, rural respondents were less likely (p <.05) to report receiving all of the dental care their child needed during the past year. Rural parents/guardians were nearly twice as likely to report an inability to schedule an appointment with a dentist versus those living in urban areas. When asked about the number of visits for all types of medical care, rural parents/guardians reported significantly higher utilization (p <.05) rates of overall medical services during the past year than their urban peers. Among all types of dental services and EPSDT checkups, urban and rural parents/guardians reported nearly identical rates of utilization. However, urban parents/guardians reported significantly higher utilization (p<.05) rates of preventive dental visits than their rural peers. Greater than one-third of urban and rural parents/guardians reported missing or not scheduling an appointment during the past year due to access barriers, most often leading to missed opportunities for EPSDT checkups. Among those that missed routine care during the past year, 22% of rural and 29% of urban parents/guardians said their child ended up needing emergency care at a later date. The results indicate that the issue of access to care is a statewide problem in Texas rather than solely a rural problem. Thus, policy interventions aimed at improving access to medical and dental services for Medicaid populations should help all children within the state. However, policy solutions may need to be tailored to specific areas because of the differences in delivering services in urban and rural environments.