WASHINGTON (October 17, 2025) — As states prepare proposals for the new Rural Health Transformation Program (RHTP) — a $50 billion federal investment to strengthen health care across rural America — researchers at the George Washington University’s Mullan Institute for Health Workforce Equity have released new data showing deep and persistent disparities in access to Medicaid primary care providers between rural and urban communities.
To identify disparities, the Mullan Institute developed the U.S. Medicaid Primary Care Workforce Tracker, the only publicly available source that geographically identifies Medicaid primary care providers at the local level across the nation.
The findings, published in The Milbank Quarterly, found striking geographic disparities in access to Medicaid primary care providers, with rural areas facing significant shortages compared to urban communities.
“The Rural Health Transformation Program represents one of the largest opportunities in decades to rebuild health infrastructure in rural America,” said Dr. Patricia Pittman, director of the George Washington University Mullan Institute for Health Workforce Equity. “By grounding these investments in data, states can ensure funds are targeted where they will have the greatest impact on access, equity, and sustainability.”
The tracker allows users to view provider data by rural areas at the county level — providing states and policymakers with an unprecedented look at the local distribution of the Medicaid primary care workforce.
Key Findings:
- Rural counties consistently have fewer Medicaid-participating primary care providers per 100,000 enrollees compared to urban counties.
- Rural areas are increasingly relying on nurse practitioners and physician associates, with the number of NPs rising from 165 to 236 per 100,000 Medicaid enrollees in just five years.
- Many rural counties lack key specialties such as OBGYNs and midwives.
The Tracker, developed using data from the Transformed Medicaid Statistical Information System (T-MSIS) between 2016 and 2021, includes Medicaid and CHIP data across all U.S. states, territories, and the District of Columbia.
The Mullan Institute team emphasizes that the Tracker is a resource for informed action, not a prescriptive tool. By providing transparent, detailed data, it enables states to tailor workforce strategies that meet their own unique needs — from expanding NP residency programs to improving Medicaid participation rates.
-GW-