Safety Net Activities of Independent Rural Health Clinics

Rural Health Clinics (RHCs) are an important part of the rural health care infrastructure as they provide a wide range of primary care services to the rural residents of 45 states. Since RHCs are located in underserved rural areas and serve vulnerable populations, many consider them safety net providers. In this paper we explore whether and to what extent independent RHCs are serving a safety net role, or have the capacity to serve that role. We address this question through a telephone survey of 392 randomly selected independent RHCs. Response rate for the survey was 93%. We investigated whether and to what extent RHCs offer free or discounted care and serve Medicaid populations. We also sought to determine if the proximity of a federally funded Community Health Center might have an effect on the extent to which an RHC serves the safety net role. Key Findings: 86% of the RHCs surveyed provide free or discounted care, and an estimated 27% of their visits are from Medicaid patients, although only 47% reported that they help their patients enroll in Medicaid; proximity of a Community Health Center, either in the same county or in the same zip code, was not associated with offering free or discounted care, but was associated with the percentage of total patient visits attributable to Medicaid patients; using 30% or more of patients on Medicaid as a threshold, we found that RHCs with a CHC in the same county were significantly less likely to meet this threshold (38%) as compared with RHCs without a CHC in their county (65%)