In 1977, Public Law 95-210 created the Rural Health Clinic (RHC) Medicare and Medicaid reimbursement designation for qualified primary care practices. RHCs must be located in non-urban areas with documented health care shortages. There are currently more than 4,100 RHCs across the U.S. Some RHCs operate as independent medical practices, while others are part of a hospital-owned system or other health care organization. RHCs are statutorily required to have a nurse practitioner, physician assistant or certified nurse-midwife available for at least 50% of clinic operating hours.
Much less is known about patients of RHCs than about patients of other providers, such as Federally Qualified Health Centers (FQHCs). Previous research conducted by the North Carolina Rural Health Research Program analyzed Medicare claims data to learn more about RHCs and Medicare beneficiaries, including comparisons to rural and urban FQHCs. Conducting similar research for Medicaid enrollees has been more difficult. Unlike federally managed Medicare claims, Medicaid claims are managed by states, and state-to-state differences in identification and treatment of RHCs in claims data make it difficult to conduct national analyses. To better understand Medicaid enrollees’ utilization of RHCs, the North Carolina Rural Health Research Program identified and tested several methods for identifying RHCs in Medicaid claims data. This brief, Identifying Rural Health Clinics in Medicaid Data, describes and compares different methods to identify RHCs in the Medicaid claims of four states.