Rural Health Policy Project

Medicaid Coverage in Metro and Small Town/Rural Counties, 2020-2021

Click on a state below to view rates of child or non-elderly adult Medicaid coverage in Metro and Small Town/Rural counties.

Alabama (Child, Adult) Alaska (Child, Adult) Arizona (Child, Adult)
Arkansas (Child, Adult) California (Child, Adult) Colorado (Child, Adult)
Connecticut (Child, Adult) Delaware (Child, Adult) District of Columbia (Child, Adult)
Florida (Child, Adult) Georgia (Child, Adult) Hawaii (Child, Adult)
Idaho (Child, Adult) Illinois (Child, Adult) Indiana (Child, Adult)
Iowa (Child, Adult) Kansas (Child, Adult) Kentucky (Child, Adult)
Louisiana (Child, Adult) Maine (Child, Adult) Maryland (Child, Adult)
Massachusetts (Child, Adult) Michigan (Child, Adult) Minnesota (Child, Adult)
Mississippi (Child, Adult) Missouri (Child, Adult) Montana (Child, Adult)
Nebraska (Child, Adult) Nevada (Child, Adult) New Hampshire (Child, Adult)
New Jersey (Child, Adult) New Mexico (Child, Adult) New York (Child, Adult)
North Carolina (Child, Adult) North Dakota (Child, Adult) Ohio (Child, Adult)
Oklahoma (Child, Adult) Oregon (Child, Adult) Pennsylvania (Child, Adult)
Rhode Island (Child, Adult) South Carolina (Child, Adult) South Dakota (Child, Adult)
Tennessee (Child, Adult) Texas (Child, Adult) Utah (Child, Adult)
Vermont (Child, Adult) Virginia (Child, Adult) Washington (Child, Adult)
West Virginia (Child, Adult) Wisconsin (Child, Adult) Wyoming (Child, Adult)



This analysis uses 2020-2021 American Community Survey (ACS) Public Use Microdata Sample (PUMS) data to model the estimated share of children (under age 19) and non-elderly adults (ages 19-64) covered by Medicaid in counties classified as either “Metro” or “Small Town/Rural Area.” County estimates were developed with the assistance of Mark Holmes, PhD and follow the general approach used previously in, e.g. Hoadley J, Alker J, and Holmes M. "Health Insurance Coverage in Small Towns and Rural America: The Role of Medicaid Expansion." 2018.  Georgetown University Health Policy Institute, Center for Children and Families.

In the first step of the estimation, a predictive model is developed that relates social, demographic, and economic factors to individual Medicaid coverage. Two years of ACS data are used to improve sample sizes; however, because only experimental data were released in 2020 due to data quality issues related to the pandemic, 2020 data is weighted half as much as 2021 data and all Medicaid coverage estimates are scaled to 2021 state-level estimates. ACS PUMS data were used to identify demographic characteristics associated with the likelihood that an individual is covered by Medicaid. In the second step, these individual-level relationships are applied to area-level values from corresponding county-level ACS summary data. These are used to estimate the number and share of individuals with Medicaid coverage in each county; county estimates were further adjusted to match state-level targets.

Counties are classified as either “Metro” or “Small Town/Rural Area” using the Missouri Census Data Center’s Master Area Block Level Equivalency (MABLE) Geocorr 2022 data engine. “Small Town/Rural Area” combines the “micropolitan” and “noncore” designations into a single category representing counties with central urban areas of fewer than 50,000 people. Four states (DC, DE, NJ, RI) have no counties classified as a “Small Town/Rural Area.”