Expanding rural managed care: enrollment patterns and prospects.

This paper synthesizes national data on rural HMO enrollment in commercial plans, Medicaid HMOs and prepaid plans, and Medicare risk-based plans. Although most rural counties now are included in the service area of at least one commercial HMO, rural HMO enrollment rates are still very low. The expansion of HMO capacity to serve rural enrollees, the continued implementation of Medicaid waivers, and the recent passage of the Balanced Budget Act of 1997 with substantial Medicare program revisions suggest increased rural managed care enrollment in the future.