Medicaid managed care programs in rural areas: a fifty-state overview.

Interviews with state Medicaid officials reveal that although managed care programs have been implemented in rural areas, participation remains behind that of urban areas. Many states aim to create a statewide Medicaid managed care program and are struggling to overcome barriers that are greater in rural areas, including providers' resistance, lack of commercial managed care, and inadequate supply of providers. Many have modified contracting strategies and shown flexibility regarding interpretations of travel standards, twenty-four-hour coverage requirements, and primary care case management requirements, to implement programs in rural environments.