Citation URL: http://www.urban.org/SusanWallWallin

This paper analyzes the ability of rural communities to maintain health care services for their residents in a changing health care environment. In addition to the constantly evolving health care marketplace, factors that influence the structure and strength of the rural health care safety net include demography, geography, and policies at the federal, state, and local levels. The safety net in rural areas generally includes almost all local providers. Therefore, maintaining the safety net in rural communities strengthens the entire health care infrastructure. The study describes the health care safety net in 11 rural counties in five states (AL, MN, MS, TX, and WA).

As in many areas of the country, low-income people in Washington, D.C., face a number of challenges in obtaining health services delivered in a timely manner, in an appropriate setting, and with attention to continuity and quality of care. One barrier is financial; nearly 30 percent of nonelderly DC residents below 200 percent of the federal poverty level (FPL) are uninsured. Another barrier is availability; many economically depressed sections of the city are underserved by health care providers. Hospitals and clinics that serve the poor are experiencing some financial strain as competition among hospitals for paying patients continues to increase and Medicaid payments are held in check. The District's Medicaid program has for many years paid facilities relatively generous rates.

Using data obtained from 1996-1997 case studies of 13 states, this study examines the influence of states- strategies aimed at increasing federal Medicaid matching dollars—which we call maximization—on the design of their Medicaid managed care programs. The study showed that as states made the shift to managed care, some found that responsibilities undertaken in part through maximization strategies proved to be in conflict with their Medicaid managed care initiatives (Health Services Research 1999 April; 34(1): 281-293).

There are two Highlights for each state. The Highlights that focus on health cover Medicaid, other public insurance programs, the health care marketplace, and the role of public providers. The Highlights capture policies in place and planned in 1996 and early 1997.

There are two Highlights for each state. The Highlights that focus on health cover Medicaid, other public insurance programs, the health care marketplace, and the role of public providers. The Highlights capture policies in place and planned in 1996 and early 1997.

There are two Highlights for each state. The Highlights that focus on health cover Medicaid, other public insurance programs, the health care marketplace, and the role of public providers. The Highlights capture policies in place and planned in 1996 and early 1997.

The report investigates how the health safety net has changed since the implementation of federal welfare reform. It finds that the combination of rising numbers of uninsured and the growing penetration of managed care is undermining the ability of health care providers, especially hospitals, to continue to provide care to the uninsured. Nine findings relating to changes to Medicaid, HIPAA, employer-sponsored coverage, and long-term care dominate the study's portrait of state health policy.

[Health Affairs] Public health systems are undergoing major changes. Historically, population-oriented services framed the responsibilities of the public health system. Yet over time, clinical services, particularly maternal and child health care, became an important component. More recently, many public health agencies have begun to refocus on traditional services, largely in response to Medicaid managed care and an associated decline in clients. This paper examines such transformations in thirteen states.

The state reports describe the safety net and health care programs in place for low-income people on the eve of welfare reform. The reports also analyze the particular circumstances that are shaping the state's response to the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA). The state reports are based on case studies in the respective state.

There are two Highlights for each state. The Highlights that focus on health cover Medicaid, other public insurance programs, the health care marketplace, and the role of public providers. The Highlights capture policies in place and planned in 1996 and early 1997.

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