In order for the Affordable Care Act (ACA) Medicaid expansion to effectively meet the needs of rural populations, implementation will need to be based on the underlying differences in rural and urban populations and on the unique needs of rural residents and health systems. Missing information that is critical to informing ACA implementation includes: the extent to which prior public health insurance expansions have covered rural populations; whether rural residents who are expected to be newly eligible for Medicaid in 2014 differ from their urban counterparts; the extent to which rural individuals might differentially benefit from the ACA Medicaid expansion in light of the expansion becoming optional; and whether rural enrollees are likely to have adequate access to primary care. This study addresses these knowledge gaps using the 2007-2011 panels of the Medical Expenditure Panel Survey (MEPS), linked with state-level Medicaid policy data and county-level primary care provider data.
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