Transportation barriers and children's access to and utilization of Medicaid-covered services in Texas: Urban/Rural policy considerations

As a general rule, rural residents are more likely to report access barriers than those living in urban areas. However, a 2007 evaluation of Medicaid-eligible EPSDT clients in Texas alters some of these previously held assumptions. Data were collected from a telephone survey of 5,163 randomly selected parents/guardians of Medicaid-covered children. 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 to report receiving all of the dental care their child needed during the past year. Rural respondents reported significantly higher utilization rates of overall medical services during the past year than their urban peers. Among dental services and EPSDT checkups, urban and rural parents/guardians reported nearly identical utilization rates. Greater than one-third of urban and rural parents/guardians reported missing an appointment during the past year due to transportation-related barriers, most often leading to missed opportunities for EPSDT checkups. Among those that missed 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 transportation barriers to care are a statewide problem in Texas rather than solely a rural problem. Thus, policy interventions aimed at improving access to care for Medicaid populations should help all children within the state. However, policy solutions may need to be tailored to specific areas because of differences in delivering services in urban and rural environments.