Findings show that Medicaid enrollees in only slightly over half of all rural counties in the United States were covered by some type of Medicaid managed care in early 1997, compared with nearly three-fourths of urban counties, and there are important differences in the types of managed care programs.
Rural counties are also less commonly covered by programs that combine types of managed care.
However, it remains to be seen if the legislation will spur states to expand fully capitated programs in rural areas. Yet over half the states who said their main motivation was to reduce costs operated PCCM or mixed type plans rather than full-risk programs. Aside from the statewide capitated programs, most other states have not yet attempted nor been successful at generating significant rural enrollment in capitated programs. Provider resistance and inadequate provider supply are major obstacles to implementing Medicaid managed care in rural areas. Other obstacles include lack of health plan interest in rural markets, consumer resistance, and lack of education and communication in rural areas about managed care.