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Women Depend on Medicaid Across the Lifespan

Women comprise the majority of the adult Medicaid population, covering 19% of women ages 19-64 compared to 14% of men in 2023.1 Medicaid and CHIP cover pregnant women at higher income levels than other adults, with a median income eligibility across states of 213% of the federal poverty level (FPL).2 The Affordable Care Act (ACA) allowed states to expand Medicaid to all adults up to 138% FPL, covering many more low-income women regardless of pregnancy, parenting, or disability status in 40 states and D.C.3

Highlights

  • The Medicaid expansion is a critical source of coverage for adult women. Nearly half of adult women ages 19-49 and more than 60% of older women ages 50-64 covered by Medicaid are enrolled under the Medicaid expansion.4
  • Medicaid ensures women get needed health care before, during and after a pregnancy, covering at least 41% of births nationwide.5 Medicaid expansion is linked to improved maternal health outcomes.6
  • Medicaid is the nation’s primary payer of long-term care.7 Women make up 6 in 10 of the 12 million Americans who rely on Medicaid to supplement Medicare coverage.8 Women 65 and older covered by Medicare are more likely to use the supplemental Medicaid support for long-term care and home- and community-based services.9
  • As health coverage for low-income Americans, Medicaid provides an important economic support for women. Women are more likely to live in poverty, Medicaid coverage shields women and their families from unexpected health care costs.10

Medicaid helps women get the preventive care they need.

Health coverage ensures women have access to preventive care, which can improve health outcomes as a whole. Medicaid coverage includes services such as effective interventions for smoking, alcohol, and substance use, as well as treatment for chronic conditions, such as diabetes, heart disease, and depression.11

Medicaid expansion has allowed more women to access preventive care. It has been linked to an increase in the utilization of preventive care services including well woman visits, domestic and interpersonal violence screenings, and breastfeeding support.12

Medicaid is a major payer of maternity care.

Medicaid plays a central role in efforts to address the maternal health crisis, paying for at least 41% of births nationally and nearly half of all births in rural areas.13,14 Medicaid-financed births range from 18% in Utah to 64% of births in Louisiana.15 The ACA’s Medicaid expansion, allowing more women to access needed care before they become pregnant, has been linked to larger decreases in maternal and infant mortality and improved birth outcomes and preconception health.16 All but two states have also opted to extend postpartum coverage from 60 days to 12 months following birth, ensuring continuous access to health coverage during a critical year of family change.17

States have led efforts to enhance maternal health services18 in Medicaid, including adoption of recommended practices19 surrounding and following birth, such as mental health care.20 States have expanded the use of Medicaid-funded services or providers, such as community-based21 doulas,22 community health workers,23 and home visiting.24

Medicaid is especially important to rural mothers.25 Nationally, 23% of women of childbearing age in rural areas are covered by Medicaid as compared to 20% of women in metro areas. In 20 rural counties, half of women of childbearing age are covered by Medicaid.26 Rural communities have suffered hospital closures27, and multiple studies have documented declines in obstetrical services at rural hospitals that remain open.28,29,30 These closures of hospital-based obstetric care units are linked to poorer birth outcomes.31

Medicaid supports women’s mental health and substance use treatment services.

Women are slightly more likely than men to report poor mental health (28% versus 23%).32 Medicaid is the largest payer for mental health and substance use condition services.33 With maternal mental health risk on the rise, Medicaid can also help more women access behavioral health care during pregnancy and the postpartum year.34 Medicaid has also been a major player in combating the nation’s opioid crisis.35 Substance use surrounding pregnancy is a leading cause of maternal death in the U.S., rising significantly in recent years.36 The parents of 1 in 4 children experience substance use disorders.37 Medicaid can help pregnant women and parents access needed care to address poor maternal health outcomes and prevent unnecessary foster care placement.38 Research shows Medicaid expansion is also associated with reductions in child neglect.39

Medicaid provides care unique to women’s health, including family planning services and breast cancer treatment.

Two-thirds of women with Medicaid coverage are in their childbearing years (ages 19-49).40 Women covered by Medicaid cannot be charged out-of-pocket fees for family planning services. Specific family planning services offered vary by state but examples include contraceptive methods, testing for sexually transmitted infections and HIV, and screenings for breast and cervical cancer.41

Medicaid requires states to cover screenings such as mammograms and pap tests. Medicaid expansion has also been associated with Medicaid enrollees receiving earlier diagnoses for cancer, fewer treatment delays, and having access to more treatment options that can improve the prognosis of cancer.42

The Breast and Cervical Cancer Prevention and Treatment Act allows states to extend  limited Medicaid coverage to uninsured women for cancer treatment.43 This is an optional program, but all states participate.44 In 2021, 43,000 women were enrolled in Medicaid through this program.45

Medicaid provides health and economic security to low-income workers and caregivers, most of whom are women.

Medicaid, especially through the ACA expansion, is a major source of health and economic support for low-income working women, including unpaid caregivers. Six in 10 women covered by Medicaid are working.46 Medicaid supports nearly one-third of direct care workers, such as personal aides, home health aides, direct support professionals, and nursing assistants.47 Medicaid also covers more than 1 in 4 child care workers– mostly women– who help parents work.48, 49

Medicaid also serves a crucial role in supporting family caregivers and their loved ones, providing health care for many women who are no longer in the paid workforce in order to care for aging parents, spouses or other family members with disabilities.50, 51 Many of these women, sometimes known as “sandwich-generation caregivers,” may also be caring for dependent children, face additional economic barriers due to the lack of affordable, accessible child care and absence of policies such as paid leave. Nearly half of adult women ages 19-49 and more than 60% of older women ages 50-64 covered by Medicaid are enrolled under the Medicaid expansion.52 Medicaid expansion has improved the economic security and health outcomes for low-income adults, including those who work as formal or unpaid caregivers.53 

Medicaid Provides Long-term Care for Older Women and Women with Disabilities

Nearly one in four Medicaid beneficiaries are 65 years old and older or have a disability.54 Nearly one in five Americans ages 50 to 64 are covered by Medicaid, as well as more than 40% of nonelderly women with a broad range of physical and mental disabilities.55 More than 12 million adults are enrolled in both Medicare and Medicaid – 6 in 10 are women.56 Women 65 and older covered by Medicare are more likely to use the supplemental Medicaid support for long-term care and home- and community-based services.57

Medicaid is the largest payer of long-term care in the United States.58 In 2022, Medicaid paid for over half of the $415 billion that the U.S. spent on long-term services and supports.59 In most states, over half of Medicaid spending is on individuals who are seniors and/or have a disability. More than 6 in 10 nursing home residents are covered by Medicaid.60 Seniors and individuals living with disabilities have a higher per-enrollee cost than other groups.61

Medicaid supports women’s health at critical periods throughout their lives, as they experience pregnancy and grow their families, combat unexpected diagnoses, care for their loved ones or others’ families, and age into long-term care needs of their own. Women’s health depends on a strong Medicaid program.

Endnotes

[30]

  1. KFF, “Women’s Health Insurance Coverage,” (Washington: KFF, December 12, 2024), available here. ↩︎
  2. T. Brooks et. al, “Medicaid and CHIP Eligibility, Enrollment, and Renewal Policies as States Resume Routine Operations Following the Unwinding of the Pandemic-Era Continuous Enrollment Provision,” (Washington: KFF, April 1, 2025), available here. ↩︎
  3. KFF, “Status of State Action on the Medicaid Expansion Decision,” (Washington: KFF, May 2025), available here. ↩︎
  4. J. Mathers, J. Tolbert, P. Chidambaram, and S. Cervantes, “5 Key Facts About Medicaid Expansion,” (Washington: KFF, April 25, 2025), available here. ↩︎
  5. KFF, “Births Financed by Medicaid by Metropolitan Status,” (Washington: KFF, 2023), available here. ↩︎
  6. Center for Children and Families, “How Medicaid Supports Maternal and Infant Health,” (Washington: Center for Children and Families, 2025), available here. ↩︎
  7. P. Chidambaram and A. Burns, “10 Things About Long-Term Services and Supports (LTSS),” (Washington: KFF, July 8, 2024), available here. ↩︎
  8. E. Allen, K. Taylor, T. Nelson, and S. Hinojosa, “Guide to Health Equity for Medicare-Medicaid Enrollees (Dual Enrollees),” Washington: Urban Institute, December 2023), available here. ↩︎
  9. M. Peña, M. Mohamed, and A. Burns, “How Does Use of Medicaid Wraparound Services by Dual-Eligible Individuals Vary by Service, State, and Enrollees’ Demographics?” (Washington: KFF, January 31, 2024), available here. ↩︎
  10. S. Sun, “National Snapshot: Poverty Among Women & Families,” (Washington: National Women’s Law Center, January 2023), available here. ↩︎
  11. M. Olfson et. al, “Healthcare Coverage and Service Access for Low-Income Adults with Substance Use Disorders,” Journal of Substance Abuse Treatment, (New York, December 29, 2021), https://doi.org/10.1016/j.jsat.2021.108710, available here. ↩︎
  12. R. Myerson, S. Crawford, and L. Wherry, “Medicaid Expansion Increased Preconception Health Counseling, Folic Acid Intake, and Postpartum Contraception,” Health Affairs, Vol. 39 No. 11, (November 2, 2020), https://doi.org/10.1377/hlthaff.2020.00106, available here. ↩︎
  13. KFF, “Births Financed by Medicaid by Metropolitan Status,” (Washington: KFF, 2023), available here. ↩︎
  14. J. Alker and A. Osorio, “Medicaid Plays a Key Role for Maternal and Infant Health in Rural Communities,” (Washington: Center for Children and Families, May 15, 2025), available here. ↩︎
  15. KFF, “Births Financed by Medicaid by Metropolitan Status,” (Washington: KFF, 2023), available here. ↩︎
  16. Center for Children and Families, “How Medicaid Supports Maternal and Infant Health,” (Washington: Center for Children and Families, 2025), available here. ↩︎
  17. KFF, “Medicaid Postpartum Coverage Extension Tracker,” (Washington: KFF, January 17, 2025), available here. ↩︎
  18. A. Hasan, “States Build Capacity to Address Maternal Mortality through Policy Innovations,” (Washington: National Academy for State Health Policy, September 8, 2023), available here. ↩︎
  19. Alliance for Innovation on Maternal Health, “Participating States and Jurisdictions,” (Washington: AIM), available here. ↩︎
  20. E. Burak, A. Dwyer, T. Mondestin, and K. Johnson, “State Medicaid Opportunities to Support Mental Health of Mothers and Babies During the 12-Month Postpartum Period,” (Washington: Center for Children and Families, January 23, 2024), available here. ↩︎
  21. K. Johnson, H. Shawky, and D. Willis, “Community-Based Doulas and Early Relational Health: The Role of Public Policy and Financing,” (Nurture Connection, April 2024), available here. ↩︎
  22. A. Hasan, “State Medicaid Approaches to Doula Service Benefits,” (Washington: National Academy for State Health Policy, April 16, 2024), available here. ↩︎
  23. C. Meghea, et. al, “Community Health Worker Home Visiting, Birth Outcomes, Maternal Care, and Disparities Among Birthing Individuals with Medicaid Insurance,” JAMA Pediatrics, Vol. 177 No. 9, (American Medical Association, July 24, 2023), doi:10.1001/jamapediatrics.2023.2310, available here. ↩︎
  24. E. Burak and V. Wachino, “Promoting the Mental Health of Parents and Children by Strengthening Medicaid Support for Home Visiting,” (Think Bigger Do Good, May 9, 2023), available here. ↩︎
  25. J. Alker and A. Osorio, “Medicaid Plays a Key Role for Maternal and Infant Health in Rural Communities,” (Washington: Center for Children and Families, May 15, 2025), available here. ↩︎
  26. Ibid. ↩︎
  27. “Rural Hospital Closures,” Cecil G. Sheps Center for Health Services Research, available here. ↩︎
  28. “2025 rural health state of the state,” Chartis Center for Rural Health (February 2025), available here.  ↩︎
  29. K. B. Kozhimannil et al., “Obstetric Care Access at Rural and Urban Hospitals in the United States,” JAMA 333, no. 2 (January 2025): 166-169, available here. ↩︎
  30. A. Stoneburner et al., “Nowhere to Go: Maternity Care Deserts Across the US” (March of Dimes: 2024), available here. ↩︎
  31. K. B. Kozhimannil et al.,  “Association Between Loss of Hospital-Based Obstetric Services and Birth Outcomes in Rural Counties in the United States,” JAMA 319, no. 12 (March 2018): 1239-1247, available here. ↩︎
  32. K. Diep et. al, “Access and Coverage for Mental Health Care for Women,” (Washington: KFF, May 6, 2025), available here. ↩︎
  33. MACPAC, “Behavioral Health,” (Medicaid and CHIP Payment and Access Commission), accessed June 2025, available here. ↩︎
  34. Policy Center for Maternal Mental Health, “2025 U.S. Maternal Mental Health Risk and Resources by County,” (Policy Center for Maternal Mental Health, May 2025), available here. ↩︎
  35. Center for Children and Families, “How Medicaid Helps People with Substance Use Disorders,” (Washington: Center for Children and Families, 2025), available here. ↩︎
  36. N. Amodio, M. Thoma, and E. Declercq, “How the U.S. Can Better Understand—and Prevent—Maternal Deaths Related to Substance Use,” (Washington: The Commonwealth Fund, June 3, 2025), available here. ↩︎
  37. S. McCabe, V. McCabe, and T. Schepis, “US Children Living with a Parent with Substance Use Disorder,” JAMA Pediatrics, (American Medical Association, May 12, 2025), doi: 10.1001/jamapediatrics.2025.0828, available here. ↩︎
  38. Center for Children and Families, “How Medicaid Supports Parents in Crisis, Children in or Youth Aging out of Foster Care, Relative Caregivers, and Adoptive Families,” (Washington: Center for Children and Families, 2025), available here. ↩︎
  39. E. McGinty et. al, “Impact of Medicaid Expansion on Reported Incidents of Child Neglect and Physical Abuse,” American Journal of Preventive Medicine, Vol. 62 Issue 1, (American Journal of Preventive Medicine, Elsevier Inc., January 2022), https://doi.org/10.1016/j.amepre.2021.06.010, available here. ↩︎
  40. I. Gomez, U. Ranji, A. Salganicoff, and B. Frederiksen, “Medicaid Coverage for Women,” (Washington: KFF, February 17, 2022), available here. ↩︎
  41. U. Ranji et. al, “Medicaid Coverage of Family Planning Benefits: Findings from a 2021 State Survey,” (Washington: KFF, February 17, 2022), available here. ↩︎
  42. A. Hotca et. al, “The Impact of Medicaid Expansion on Patients with Cancer in the United States: A Review,” Current Oncology, Vol. 30, (Toronto: Current Oncology, July 2023), https://doi.org/10.3390/curroncol30070469, available here. ↩︎
  43. Centers for Disease Control and Prevention, “National Breast and Cervical Cancer Early Detection Program,” (NBCCEDP, September 19, 2024), available here. ↩︎
  44. KFF, “State Eligibility for Medicaid Breast and Cervical Cancer Treatment Program (BCCTP),” (Washington: KFF, July 1, 2021), available here. ↩︎
  45. KFF, “Medicaid Breast and Cervical Cancer Treatment Program Enrollment,” (Washington: KFF, 2021), available here. ↩︎
  46. I. Gomez, J. Tolbert, S. Cervantes, and U. Ranji, “Medicaid Work Requirements: Implications for Low Income Women’s Coverage,” (Washington: KFF, April 30, 2025), available here. ↩︎
  47. Center for Children and Families, “How Medicaid Supports Seniors and People with Disabilities and Their Caregivers,” (Washington: Center for Children and Families, 2025), available here. ↩︎
  48. Center for Children and Families, “Medicaid is a Critical Support for the Early Childhood Education Workforce,” (Washington: Center for Children and Families, 2025), available here. ↩︎
  49. C. McLean et. al, “Early Childhood Workforce Index 2024,” (Berkeley: Center for the Study of Child Care Employment, 2024), available here. ↩︎
  50. Center for Children and Families, “How Medicaid Supports Seniors and People with Disabilities and Their Caregivers,” (Washington: Center for Children and Families, 2025), available here. ↩︎
  51. J. Tavares and M. Cohen, “Profile of Medicaid Population Age 18-64, Working and Non-Working Medicaid Beneficiaries, and “Able-bodied” Nonworking Medicaid Beneficiaries,” (Boston: LeadingAge LTSS Center, May 2025), available here. ↩︎
  52. J. Mathers, J. Tolbert, P. Chidambaram, and S. Cervantes, “5 Key Facts About Medicaid Expansion,” (Washington: KFF, April 25, 2025), available here. ↩︎
  53. M. Guth, R. Garfield, and R. Rudowitz, “The Effects of Medicaid Expansion under the ACA: Studies from January 2014 to January 2020,” (Washington: KFF, March 17, 2020), available here. ↩︎
  54. R. Euhus, A. Burns, and R. Rudowitz, “5 Key Facts About Medicaid Eligibility for Seniors and People with Disabilities,” (Washington: KFF, February 7, 2025), available here. ↩︎
  55. Center for Children and Families, “How Medicaid Supports Older Adults,” (Washington: Center for Children and Families, 2025), available here. ↩︎
  56. E. Allen, K. Taylor, T. Nelson, and S. Hinojosa, “Guide to Health Equity for Medicare-Medicaid Enrollees (Dual Enrollees),” Washington: Urban Institute, December 2023), available here. ↩︎
  57. M. Peña, M. Mohamed, and A. Burns, “How Does Use of Medicaid Wraparound Services by Dual-Eligible Individuals Vary by Service, State, and Enrollees’ Demographics?” (Washington: KFF, January 31, 2024), available here. ↩︎
  58. Medicaid.gov, “Long Term Services and Supports,” (Baltimore: Centers for Medicare & Medicaid Services), accessed June 2025, available here. ↩︎
  59. P. Chidambaram and A. Burns, “10 Things About Long-Term Services and Supports (LTSS),” (Washington: KFF, July 8, 2024), available here. ↩︎
  60. C. Harrington, H. Carrillo, R. Garfield, and E. Squires, “Nursing Facilities, Staffing, Residents and Facility Deficiencies, 2009 Through 2016,” (Washington: KFF, April 3, 2018), available here. ↩︎
  61. R. Euhus and P. Chidambaram, “A Look at Variation in Medicaid Spending Per Enrollee by Group and Across States,” (Washington: KFF, August 16, 2024), available here. ↩︎

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