Acute Care Utilization in Medicaid Enrollees Differs by Patient Rurality, Race, and Ethnicity
Bibliographic Data
| ID | 9100435 |
|---|---|
| Authors | Hannah Friedman (0000-0002-5449-0987, Center for Health Optimization and Implementation Research (CHOIR), Boston VA Healthcare System, Boston, MA, corresponding author), Kristie Thompson (University of North Carolina at Chapel Hill), Kristie Weisner Thompson (University of North Carolina at Chapel Hill), Lily Wang (0000-0003-0659-0139, University of North Carolina at Chapel Hill), Mark Holmes (0000-0002-6776-1301, University of North Carolina at Chapel Hill), George M Holmes (0000-0002-6169-7847, University of North Carolina at Chapel Hill) |
| Year | 2026 |
| Volume | 64 |
| Issue | 1 |
| Pages | 11-18 |
| Publication date | 2026-01-01 |
| Open Access | No |
| Type | ARTICLE |
| Venue | Medical Care (JOURNAL) |
| Journal identifiers | ISSN: 0025-7079 • E-ISSN: 1537-1948 |
| Publisher | Ovid Technologies (Wolters Kluwer Health) (PUBLISHER) |
| DOI | 10.1097/mlr.0000000000002251 |
| PMID | 41359417 |
| OpenAlex | W4417129101 |
| Language | EN |
| References cited | 30 |
BACKGROUND: Few studies have assessed acute care utilization and health care costs among rural Medicaid enrollees in a national sample; fewer still have examined the relationship of health care utilization with different levels of rurality and enrollee race/ethnicity. OBJECTIVES: This study's objective is to compare Medicaid acute care utilization patterns by race/ethnicity and rurality interactions to identify rural populations with higher health care needs or receiving potentially insufficient care. RESEARCH DESIGNS: We used the 2019 Transformed Medicaid Statistical Information System (T-MSIS) Analytic Files (TAF), which includes inpatient, outpatient, and prescription data on all Medicaid enrollees. We ran zero-inflated poisson, negative binomial, and generalized linear models to examine the association between enrollee rurality (defined using Rural Urban Commuting Area Codes) and race/ethnicity and 4 health care utilization outcomes. SUBJECTS: All Medicaid enrollees with 12 months of full-scope coverage in T-MSIS TAF (N=50,631,371). MEASURES: Our outcome measures included rate of emergency department (ED) visits and inpatient stays, inpatient length-of-stay (LOS), and spending per-member per-month. RESULTS: Rural Medicaid enrollees had lower rates (12.6%-18.2% lower) of inpatient stays compared with urban enrollees, only Medicaid enrollees in Isolated (the most remote) rural areas had lower rates (11.0% reduction) of ED compared with those in urban areas. Average inpatient LOS and spending were both lower for rural Medicaid enrollees. Utilization varied by enrollee race/ethnicity, with the lowest utilization among Hispanic enrollees. CONCLUSION: Rural Medicaid enrollees had generally lower acute care utilization and expenditures; however, heterogeneity by rurality and race/ethnicity suggests that some rural populations have higher health care needs
Acute care · Ethnic group · Health care · Medicaid · Medicaid managed care · Rural health · Rural population · Rurality · Global Health Workforce Issues · Healthcare Policy and Management · Primary Care and Health Outcomes
Validation of a combined comorbidity index
Exposing some important barriers to health care access in the rural USA
Factors Associated With Emergency Department Use Among the Rural Elderly
US Health Care Reform and Rural America
Emergency Department Utilization, Hospital Admissions, and Office-Based Physician Visits Among Under-Resourced African American and Latino Older Adults
Rural Medicare Beneficiaries Have Fewer Follow-up Visits and Greater Emergency Department Use Postdischarge
Disparities in Care Experienced by Older Hispanic Medicare Beneficiaries in Urban and Rural Areas
Which Definition of Rurality Should I Use
| Highly cited | No |
|---|