title: Availability of New Medicaid Patient Appointments and the Role of Rural Health Clinics.
abstract: OBJECTIVE
  To examine the willingness to accept new Medicaid patients among certified rural health clinics (RHCs) and other nonsafety net rural providers.
  
  
  METHODS
  Experimental (audit) data from a 10-state study of primary care practices, county-level information from the Area Health Resource File, and RHC information from the Center for Medicare and Medicaid Services.
  
  
  METHODS
  We generate appointment rates for rural and nonrural areas by patient-payer type (private, Medicaid, self-pay) to then motivate our focus on within-rural variation by clinic type (RHC vs. non-RHC). Multivariate linear models test for statistical differences and assess the estimates' sensitivity to the inclusion of control variables.
  
  
  METHODS
  The primary data are from a large field study.
  
  
  RESULTS
  Approximately 80 percent of Medicaid callers receive an appointment in rural areas-a rate more than 20 percentage points greater than nonrural areas. Importantly, within rural areas, RHCs offer appointments to prospective Medicaid patients nearly 95 percent of the time, while the rural (nonsafety net) non-RHC Medicaid rate is less than 75 percent. Measured differences are robust to covariate adjustment.
  
  
  CONCLUSIONS
  Our study suggests that RHC status, with its alternative payment model, is strongly associated with new Medicaid patient acceptance. Altering RHC financial incentives may have consequences for rural Medicaid enrollees.
authors.affiliation: Leonard Davis Institute of Health Economics, Colonial Penn Center, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Richards
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Brendan
authors.initials: B
authors.lastname: Saloner
authors.affiliation: Health Policy Center, Urban Institute, Washington, DC.
authors.forename: Genevieve M
authors.initials: GM
authors.lastname: Kenney
authors.affiliation: Perelman School of Medicine, Center for Emergency Care Policy & Research, University of Pennsylvania, Philadelphia, PA.
authors.forename: Karin V
authors.initials: KV
authors.lastname: Rhodes
authors.affiliation: Wharton School and Perelman School of Medicine, Leonard Davis Institute of Health Economics, Colonial Penn Center, University of Pennsylvania, Philadelphia, PA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Polsky
mesh_terms: D001071:Appointments and Schedules; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008484:Medicaid / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D019035:Rural Health Services / Q000706:statistics & numerical data*; D064876:Safety-net Providers / Q000706:statistics & numerical data; D014481:United States; D019037:Urban Health Services / Q000706:statistics & numerical data
keywords: Medicaid; audit methodology; primary care; rural health care; rural health clinics