As the nation nears full implementation of the Medicaid work reporting requirements Congress enacted in 2025 in H.R. 1, Joan Alker and I took an in-depth look at how these new paperwork requirements to sign-up for and keep Medicaid health coverage will affect residents of rural areas and small towns.
Our previous research has shown how rural areas have somewhat higher rates of Medicaid coverage among the group of adults subject to these work reporting requirements. From this perspective, we then took a closer look at how factors like health care status, unemployment rates, the availability of health care providers, delays in US Postal Service delivery, lack of broadband access, and overall business investment and economic development would affect rural residents.
Put it all together and it is clear that people in rural areas and small towns will have a harder time meeting H.R. 1’s new Medicaid paperwork filing rules and deadlines than those in urban areas. And this means a greater chance of losing their health coverage.
Finally, our new report underscores the point that the loss of coverage is not due to people in rural America not wanting to work hard and follow the rules any more than those in more urban settings. Less investment in rural areas, such as sidewalks, public transportation, economic development, broadband access and less reliable mail service means more barriers to overcome in order to comply with the new Medicaid rules than in urban areas. Both rural and urban residents will face harsh consequences – loss of health coverage – if they are unable to comply with the new rules under tight deadline pressure; however, rural residents will likely face more obstacles as they try to navigate these complex new red-tape barriers.