That means Louisiana is not entering the Medicaid changes with a strong health care system that can easily absorb a loss of coverage. The legislation was designed to address a longstanding disparity between independent rural clinics and certain hospital-affiliated rural clinics. Rural clinics and rural hospitals may be competing for patients, doctors and Medicaid dollars even though both are necessary parts of the rural health system. The money is intended to strengthen rural health care, expand access, improve technology and support new approaches to delivering care. Health care advocates warn that losing coverage could make it harder for vulnerable residents to receive care.