Loss to cardiology follow-up is a significant concern for patients with CHD, especially as they approach the age of transition from pediatric to adult health care. Our study sought to determine patterns of care received within the same health system among patients with CHD lost to follow-up at a pediatric cardiology clinic serving a predominantly rural and historically disadvantaged region. Nearly half of patients in our study were seen elsewhere in the health system after loss to cardiology follow-up, most frequently at other subspecialty clinics and the ED. On multivariable analysis, patients with Medicaid insurance and those living closer to the cardiology clinic were more likely to continue receiving care from the health system; whereas severity of CHD (based on specific diagnosis or history of cardiac surgery) was not strongly associated with receiving care at locations other than the cardiology clinic. Considering that patients with CHD lost to cardiology follow-up are frequently seen in other clinical settings within the same health system, greater multidisciplinary collaboration can improve identification of patients lost to cardiology follow-up and encourage these patients to re-establish care with a cardiology clinic. Lapses in care are estimated to affect 30–70% of patients with CHD. Patients diagnosed with less severe lesions, undergoing fewer surgical or interventional procedures, not taking long-term cardiac medications, and patients with a history of clinic non-attendance are all at an increased risk of loss to follow-up. Meanwhile, White patients and patients of higher socioeconomic status are more likely to remain under cardiology follow-up. In our analysis, patients with Medicaid insurance had an increased likelihood of returning to a primary care clinic or to the ED after loss to cardiology follow-up, which reveals an opportunity to recontact these patients and re-enroll them into cardiology care. Patients living in rural areas are more likely to cite distance to care and loss of income related to taking time off work as significant barriers to maintaining continuity of care. Similarly, in our study, patients who live further from the clinic were less likely to be seen again in primary care clinics, subspecialty clinics, or the ED after loss to cardiology follow-up.