Document Type

Policy Brief

Publication Date



Access/Insurance, health system reform, rural, access, insurance, children, low-income, Medicaid, policy, MRHRC, health system reform

Publication Title

Role of Public versus Private Health Insurance in Ensuring Health Care Access & Affordability for Low-Income Rural Children


Medicaid and the Children’s Health Insurance Program (CHIP) have played a critical role in ensuring access to health insurance coverage among children and have been particularly important sources of coverage for rural children. More than 35.5 million children were enrolled in Medicaid or CHIP in September 2016—accounting for just over half of total Medicaid and CHIP enrollment. Given the large proportion of rural children covered by public insurance, it is critically important to understand the role of that coverage in ensuring access to affordable healthcare for rural children. Using data from the 2011-2012 National Survey of Children’s Health, this study examined rural-urban differences in children’s access to care, and their families’ perceived affordability of that care among those enrolled in Medicaid or CHIP and those covered by private insurance. Findings indicate that public coverage supported access to care for low-income rural children and low-income rural families reported fewer problems paying medical bills for their child’s care. CHIP is up for reauthorization in 2017 and decisions about the program’s future should consider the potential implications for affordability of healthcare services among rural children.


available on the Maine Rural Health Research Center's website at:

Funding Organization

Federal Office of Rural Health Policy, Health Resources and Services Administration, US Department of Health and Human Services

Grant Number




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