Key Facts About Medicaid Coverage for People Living in Rural Areas
Some words and 4 simple, easy to understand charts on Medicaid on who uses Medicaid in rural areas and under the age of 65 years. Four minutes of read time to get the idea. If Republicans and Tr__p are going to whack rural citizens, you might as well know a little about them. Five-minute read.
Approximately 66 million people in the United States live in rural areas. This is ~20% of the population. Those living in rural areas may have unique health care challenges compared to individuals living in urban areas. They report poorer physical and mental health. They have lower incomes and higher rates of poverty than individuals living in urban areas. Also, individuals in rural areas may have less access to health care services due to provider shortages in rural areas. Also, many rural hospitals have closed or are at risk of closure.
Medicaid helps mitigate some of these challenges. It covers nearly half of all births in rural areas and one-fifth of inpatient discharges in rural hospitals. Studie show the Affordable Care Act (ACA) Medicaid expansion is associated with improved hospital financial performance and lower likelihood of hospital closure. In particular rural hospitals can experience significant increases in the number of visits to providers for services such as mammograms, substance use disorders, in rural areas, and higher staffing levels in rural community health centers.
1. Nearly 1 in 4 people in rural areas have Medicaid coverage.
Medicaid is the second largest source of health care coverage in both rural and urban areas. Medicaid covers a somewhat higher share of people (including those who have both Medicaid and Medicare coverage) in rural areas compared to urban areas. Twenty-four (24%) percent as compared to twenty-one (21%) percent. While employer-sponsored insurance is the largest source of health care coverage in rural and urban areas. It covers a lower share of people in rural areas (42%) compared to urban areas (50%). The rates of uninsurance are similar across both rural and urban areas.
States have wide variation in their rates of Medicaid coverage in rural areas and in their shares of Medicaid enrollees who are living in rural areas (Appendix Table 1). In six states, at least half of Medicaid enrollees are living in rural areas – Vermont, Wyoming, South Dakota, Mississippi, Montana and Kentucky.
2. People living in rural areas in expansion states have higher rates of Medicaid coverage and lower rates of uninsurance compared to non-expansion states.
States expanding Medicaid have a somewhat larger share of individuals enrolled in Medicaid (including those dually enrolled in Medicaid and Medicare) in rural areas (25%) than states that did not expand Medicaid (22%). This contributes to a lower uninsured rate in rural areas – in expansion states. Seven percent (7%) of people are uninsured compared to 11% in states that did not expand Medicaid. Expansion and non-expansion states have similar rates of employer-sponsored health insurance coverage in rural areas (42% vs 41%).
Research shows that Medicaid enrollees, in general, have substantially better access to care than people who are uninsured and are less likely to postpone or go without needed care due to cost, as federal rules generally limit out of pocket Medicaid costs. A study focused specifically on rural Medicaid enrollees found that gaining Medicaid coverage significantly increased the likelihood that rural residents felt their health care needs were addressed from when they were uninsured.
3. Children and expansion adults represent over half of rural Medicaid enrollees.
In rural areas, children are the largest Medicaid eligibility group, constituting 36% of enrollees, followed by expansion adults who represent 20% of rural Medicaid enrollees. When looking only at Medicaid enrollees who live in the most rural areas (i.e. rural areas not adjacent to metropolitan areas), the share of expansion adults increases to 24% of enrollees (Appendix Figure 1).
In expansion states, the share of rural Medicaid enrollees who are eligible through the ACA expansion jumps to 30% (data not shown), a group that is more at risk of losing Medicaid coverage given the targeting of federal spending reductions to expansion states. A majority (63%) of rural enrollees are White, with smaller shares of Black (12%) and Hispanic (10%) enrollees. This is a notably different demographic make-up compared to urban enrollees, where only one-third of urban enrollees are White (data not shown).
4. Nearly 4 in 10 rural Medicaid enrollees under age 65 have a diagnosed chronic condition.
Chronic conditions are conditions lasting at least one year. The conditions require ongoing medical care or limit daily activities (e.g. heart disease, diabetes, cancer, mental illness, etc.). Thirty-eight percent of rural Medicaid enrollees under age 65 and not dually enrolled in Medicare have at least one diagnosed chronic condition. Of those with at least one chronic condition, approximately one-quarter have three or more chronic conditions (data not shown).
The most diagnosed chronic conditions for these rural Medicaid enrollees are physical (which include high blood pressure, obesity and high cholesterol). Twenty-four percent (24%) of rural Medicaid enrollees have at least one diagnosed physical health condition. Behavioral health conditions, which include mental health and substance use conditions, are diagnosed in 22% of rural Medicaid enrollees and 5% of rural Medicaid enrollees have a diagnosed cognitive impairment. Conditions including dementia and intellectual and developmental disabilities, which often cause functional limitations that require long-term care.
Rates of diagnosed chronic conditions are calculated from Medicaid claims data. It reflects only diagnoses recorded during medical visits in 2021 and do not measure overall prevalence. Prevalence rates from surveys are generally higher than claims-based estimates because not everyone is screened, treated, or has a recorded diagnosis for their chronic conditions in claims data in any given year. The numbers exclude Medicaid enrollees who also have Medicare (since Medicare is the primary payer for outpatient and acute care services), as well as enrollees ages 65 and older, nearly all of whom also have Medicare coverage (see Methods for more details).
“Medicaid’s Role in Small Towns and Rural Areas,” Center For Children and Families