Rural-urban differences in access utilization and time spent uninsured in an Oregon Medicaid population

This study examined urban–rural differences in access, utilization, medical debt, and time uninsured among Oregon Health Plan (OHP2) beneficiaries during major Medicaid policy changes. Using longitudinal survey data (2003–2006) from 1,535 adults and multivariate logistic regression, we found rural respondents were older and more educated but had similar risks for unmet medical needs, prescription costs, urgent care, primary and emergency care utilization, and medical debt compared to urban respondents. Time uninsured strongly predicted unmet needs and debt across both groups. Findings suggest comparable challenges for rural and urban Medicaid populations during coverage disruptions.