Georgetown University Center for Children and Families, with data from the University of North Carolina’s Sheps Rural Health Research Center, has examined the role Medicaid plays in health insurance coverage in rural areas, including how state Medicaid expansions helped reduce uninsurance, as part of our rural health policy project launched in 2017. Now we have posted new national and state maps that build on this work and present updated data for 2020-2021.
We previously wrote that Medicaid is a lifeline for small towns and rural areas. This is even more true today. Rural areas are more likely to face barriers to coverage and care such as a lack of access to transportation, poor internet connectivity, hospital closures, and provider shortages, and people living in rural areas tend to experience worse health outcomes as a result. Being uninsured only exacerbates barriers to coverage for anyone.
Medicaid enrollment has grown over the past several years as the continuous coverage protection helped more people get and keep Medicaid coverage during the pandemic. But now, as states begin unwinding, the financial strain of coverage losses and higher uncompensated care costs could hit rural health systems especially hard. Children are at greatest risk of losing Medicaid coverage despite remaining eligible.
Nationwide, almost half (47%) of children and 1 in 5 (18%) of adults rely on Medicaid coverage in small towns and rural areas (compared to about 40% of children and 15% of adults in metro areas). We’re keeping a close eye on the unwinding here at CCF and these new data make clear that the stakes are even higher for families in rural communities. These families may experience more barriers during the renewal process as well due to long distances from eligibility offices and lower internet connectivity rates.
At the county level, 9 out of the top 10 counties for rural children’s Medicaid coverage are in New Mexico, with Medicaid covering about 80% of children in those counties. For adults, Kentucky claims 13 out of the top 20 counties, covering between 44%-58% of rural adults in those counties. States across the South and West also host counties with some of the highest rates of Medicaid coverage for both groups. Explore our national maps for more information, or look up your state’s child Medicaid coverage by county here. We will explore this data further in an upcoming issue brief.
[Editor’s Note: If you would like to feature the national map or any of the state maps on your website, look for the embed code at the bottom and cut and paste it to embed the visualization on your website.]