Acute Care Utilization in Medicaid Enrollees Differs by Patient Rurality, Race, and Ethnicity

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.

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.

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.

All Medicaid enrollees with 12 months of full-scope coverage in T-MSIS TAF (N=50,631,371).

Our outcome measures included rate of emergency department (ED) visits and inpatient stays, inpatient length-of-stay (LOS), and spending per-member per-month.

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.

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.