Medicaid Enrollment a “Lifeline” for Rural Residents, Children
Medicaid enrollment has the greatest impact in small towns and rural areas, and particularly on children.
Source: Thinkstock
By - Medicaid enrollment rates are highest for adults and children in small town and rural areas, providing a “lifeline” for low-income beneficiaries, according to a new analysis by the Georgetown University Center for Children and Families and the University of North Carolina NC Rural Health Research Program.
"Medicaid is of critical importance to people living in small towns and rural America," said Joan Alker, Georgetown professor and executive director of the Center for Children and Families.
The reliance on federal health insurance programs was most prevalent among children, with an average of almost 45 percent in rural areas depending on the coverage, versus 38 percent of their urban counterparts.
The highest Medicaid enrollment percentages for children were seen in Arkansas (61 percent) and South Carolina (57 percent). Four other states also had Medicaid coverage rates for rural children that exceeded 50 percent: Arizona, North Carolina, Washington and Georgia.
Average adult Medicaid enrollment was nearly the same in rural and urban areas, with 16 percent and 15 percent enrollment respectively. In 13 states, however, 20 percent or more of rural adults were relying solely on Medicaid.
Nationally, the ACA Medicaid expansion program has reduced the uninsured rate 6.4 percent between 2013 to 2016, with the biggest impact in small town and rural areas. The rate of uninsured rural adults in the 31 expansion states decreased 11 percent (nine percent in metros) versus a six percent decrease for states that did not accept the expansion.
The nation’s largest gains in reducing uninsured residents has occurred in Arkansas and Kentucky, with both states seeing uninsured rates drop over 12 percent.
For children, the data shows a clear correlation between increases in Medicaid coverage and decreases in the rate of uninsured kids in small towns and rural areas.
Nationally, the uninsured rate for children in small town and rural areas decreased by 3 percent from 2013 to 2016.
The largest percentage drop in the number of uninsured children was reported in Nevada, with a 14 percent drop in small towns and rural areas.
The steepest decline in the number of uninsured children was seen in Texas, with 52,000 young people in small towns and rural areas now receiving coverage.
Texas did not participate in the ACA Medicaid expansion. The state holds the nation’s highest percentage of uninsured adults at 20.5 percent.
"The declining number of uninsured shown in our research, especially in small towns and rural areas, is striking," said co-author Jack Hoadley, a research professor at the Georgetown University Health Policy Institute, part of the McCourt School of Public Policy. "It means that more people are protected when they need health care services.”
The report cites the large percentages of Medicaid enrollment in small towns and rural areas comes from existing demographic factors such as, “lower household incomes, lower rates of workforce participation, and higher rates of disability.”
Medicaid coverage was on par with private insurance for care access and satisfaction of beneficiaries, the study added. Medicaid coverage also contributed to greater financial security for families, reducing exposure to medical debt and high out-of-pocket costs.
The expansion of the ACA, and a focused effort to enroll children in healthcare coverage, has led to the increased role Medicaid is playing in small town and rural communities.
“Medicaid is a leading insurer of children, and there is evidence that access to the program in childhood improves long-term health, educational, and economic outcomes,” found the report.
“Because Medicaid plays such a large role in small towns and rural areas, any changes to the program are more likely to affect the children and families living in small towns and rural communities.”
