Children's access to Medicaid medical and dental care in Texas: A comparison of urban and rural residents

As a general rule, rural residents are more likely to report access barriers than those living in urban areas. However, a recent evaluation of Medicaid-covered children in Texas alters some of those previously held assumptions. Data were collected from a telephone survey of 10,200 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 (p <.05) to report receiving all of the dental care their child needed during the past year. When asked about the number of visits to health and dental providers, rural respondents reported significantly higher (p <.05) 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 rates of visits. 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, most often leading to missed opportunities for EPSDT checkups. 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 services for Medicaid populations should help all children. However, policy solutions may need to tailor to specific areas because of the differences in delivering services in urban and rural areas.