Rural Health Policy Project

Medicaid is Increasingly Important for Kids and Families in Small Towns and Rural Communities

Since we started doing our annual report on uninsured children six years ago, the slightly higher overall rate for children living in rural areas has caught my eye. As a researcher, I always want to learn more about the populations that have higher uninsured rates. This year, with funding from the Pritzker Children’s Initiative, my colleagues and I had a chance to do so.

Today, Georgetown University’s Center for Children and Families is launching a new Rural Health Policy Project with the release of our 46-state report “Medicaid in Small Towns and Rural America: A Lifeline for Children, Families and Communities.” (It’s 46 states because a handful of states don’t have geographic areas defined as rural.) The report is the culmination of months of extensive analysis by a team of researchers here at Georgetown and the University of North Carolina NC Rural Health Research Program.

The report provides a state-by-state breakdown of Medicaid coverage and uninsured rates for children and adults over time for small towns and rural areas. In addition, some very cool interactive maps featuring county-level information will be published on our website – check them out here!

There’s a lot of great data in here and we will do some follow up blogs to tease out these findings, but here are the top three:

Medicaid plays a larger role in providing health coverage to families living in small towns and rural communities than it does in metropolitan areas, a trend that is particularly striking among children. About 45 percent of children in small towns and rural areas rely on Medicaid for their coverage, compared to 38 percent in metro areas. In 14 states, more than half of the children outside of metro areas receive health benefits from Medicaid and the Children’s Health Insurance Program (CHIP). The vast majority of these children are covered by Medicaid.

The Affordable Care Act’s Medicaid expansion is having an even more dramatic positive impact for people living in small towns and rural areas than in urban areas. Between 2008/09 to 2014/15, the rate of uninsured adults in states that accepted the Medicaid expansion decreased 11 percentage points in non-metro areas. This is larger than the decrease in metropolitan areas of expansion states (9 percentage points) and larger than the decrease in small towns and rural areas in states that did not accept the expansion (6 percentage points).

For children, the data show a clear link between increases in Medicaid coverage and decreases in the rate of uninsured kids in small towns and rural areas. The uninsured rate for children in small towns and rural areas declined by 3 percentage points nationally during the time period examined. Nevada had the largest decline in the rate of uninsured children – a 14 percentage point drop — in small towns and rural areas (Colorado, New Mexico, Oregon and South Carolina also had declines of at least 8 percentage points). Texas had the largest decline in the number of uninsured children, with 52,000 kids in small towns and rural areas gaining health coverage.

One of the reasons that rural areas and small towns rely on Medicaid more is because the overall poverty rates are higher and the types of jobs there, such as agriculture or small businesses, are less likely to offer insurance.

The declining number of uninsured children and adults found in our research, especially in small towns and rural areas, is striking. It means that more people are protected from financial risk when they need health care services and that children and adults are able to access the primary and preventive care they need. Research is clear that children who are insured by Medicaid have better health outcomes, do better in school, and ultimately have better economic prospects.

And while the impact of the ACA’s Medicaid expansion is very clear for adults, for children this is not just an ACA story. The improvements achieved for children are the result of years of bipartisan effort through both Medicaid and CHIP to reduce the number of uninsured kids. The good news is that rural areas and small towns have not been left out from this national success story.

The bad news of course is that this success is threatened by the massive cuts to Medicaid and CHIP that are now under consideration by Congress as I have blogged about elsewhere. As the data in the report makes clear, small towns and rural areas would be especially hard hit by cuts to Medicaid.

Joan Alker is the Executive Director of the Center for Children and Families and a Research Professor at the Georgetown McCourt School of Public Policy.