Rural Health Policy Project

Top 10 Rural Counties With Largest Share of Kids and Adults Relying on Medicaid to Meet Health Needs

Using data from our Rural Health Policy Project, we just took a look at the counties across the country that have the highest percent of children and adults relying on Medicaid for their health care. As readers of SayAhhh! know, our study found that children living in small towns and rural areas are significantly more likely to receive their health insurance through Medicaid and CHIP. Thus, these areas are more likely to suffer if Congress enacts large Medicaid cuts as is currently being contemplated.

A fascinating new analysis from the LA Times overlaid our data with county presidential voting data. They found that 617 of the 780 counties in rural areas or small towns where over half of the children were covered by Medicaid or CHIP voted for President Trump. As a candidate, Trump said he wasn’t going to cut Medicaid but he has supported the Medicaid cuts approved by the House and pending in the Senate.

For children, our analysis found that four of the top 10 counties are in Mississippi, two are in Georgia and two are in Arkansas. All of the top 10 counties have three-quarters or more of their kids covered by Medicaid.

Our analysis for adults found that Kentucky was the most prominent state with six of the top 10 counties with the largest share of adults enrolled in Medicaid coverage. Bell County, KY ranks No. 9 for kids and No. 3 for adults. Other states with counties that appear in the top 10 include New Mexico, Colorado, Arizona, and West Virginia.

There is some diversity to these counties – though all have very low per-capita income. About half of the top 10 counties for kids are majority white and half are majority black. Some of the poorest areas of the country — the Mississippi Delta and Appalachia regions — figure on these lists.

The counties are listed below:

Top 10 Counties Children:

1 Jefferson Davis County MS 82%
2 Mora County NM 79%
3 Clay County GA 78%
4 Holmes County MS 78%
5 Phillips County AR 77%
6 Calhoun County GA 75%
7 Covington County MS 75%
8 Monroe County AR 74%
9 Bell County KY 74%
10 Leflore County MS 74%

Top 10 Counties Adults:

1 Wolfe County KY 45%
2 Apache County AZ 44%
3 Bell County KY 44%
4 Breathitt County KY 43%
5 Owsley County KY 43%
6 Crowley County CO 42%
7 Lee County KY 42%
8 McDowell County WV 41%
9 Bent County CO 40%
10 Harlan County KY 40%


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.