Medicaid Increases Volume, Quality of Care in Rural Areas

A new study led by a Boston University School of Public Health researcher Megan Cole finds the first two years of Medicaid expansion under the ACA, 2014 and 2015, bolstered the quality and receipt of care for millions of low-income patients, especially those in rural areas.

The study, published in the June issue of Health Affairs, looked at community health centers, which mostly serve low-income and disproportionately uninsured patients. The researchers found community health centers in expansion states saw an 11.44 percentage point decline in uninsurance, compared with similar community health centers in non-expansion states. Rural community health centers also showed improvements in asthma treatment, body mass index screening and follow-up, and hypertension control, along with substantial increases in 18 types of visits—particularly for mammograms, abnormal breast findings, alcohol-related disorder, and other substance use disorders.

At rural community health centers, Medicaid expansion was associated with approximately 437,000 visits for depression, 141,000 visits for Pap testing, and 457,000 visits for hypertension over the two-year period.

Community health centers in rural areas also saw improvements over their non-expansion counterparts in several treatment areas, including a 3.5 percentage point increase in patients with asthma receiving appropriate pharmacologic treatment, and a a 6.7 percentage point increase in adults receiving a BMI screening and follow-up if needed. The researchers also found a 2.1 percentage point increase in blood pressure control for hypertensive patients, with the greatest relative gains in this area seen among Hispanic patients in rural areas, who had a 5.2 percentage point increase.

The authors wrote that they may not have seen an association between more visits and Medicaid expansion at urban community health centers because patients in urban areas have greater access to other providers, whereas rural patients have fewer choices and so are more likely to continue going to a community health center when they gain insurance coverage.

“Hopefully policymakers are attentive to the fact that scaling back eligibility could reverse these important gains,” Cole says.

West Virginians Together for Medicaid