Interviews with state Medicaid officials reveal that although managed
care programs have been implemented in rural areas, participation re m
ains 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, lac
k 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 require
ments, and primary care case management requirements, to implement pro
grams in rural environments.