By In Brief
One in five Americans live in rural areas and small towns and face unique health care challenges. A new report by the Georgetown University Center for Children and Families, a WKKF grantee, finds that Medicaid and the Children’s Health Insurance Program (CHIP) are essential sources of coverage in these communities, with higher enrollment rates among children and non-elderly adults compared to metropolitan areas. As Congress contemplates reductions in federal Medicaid funding, the report outlines how these cuts would likely have a disproportionate impact on rural communities and small towns. This potential impact is particularly concerning for a handful of states and American Indian and Alaska Native communities, where Medicaid enrollment rates reach even higher levels.
Why This Matters
Congress is considering substantial cuts to federal Medicaid funding, and the implications for people living in rural communities and small towns are significant. Rural residents experience worse health outcomes, including higher rates of maternal and infant mortality, heart disease, cancer, stroke, mental illness and overdose deaths. These challenges are compounded by provider shortages, limited internet connectivity and transportation barriers that make accessing health care even more difficult. People living in rural communities have lower incomes and are less likely to receive employer-sponsored health insurance, so public coverage like Medicaid and CHIP play a critical role. More than 40% of rural children rely on Medicaid/CHIP compared to 38.2% in metro areas, while 18.3% of non-elderly rural adults are covered by Medicaid versus 16.3% in metro areas.
Those living in rural communities also struggle when it comes to health care access. In the past decade, 120 hospitals in rural areas have closed and 52% of remaining rural hospitals no longer maintain maternity wards.
Some states would be especially hard hit by these cuts. There are six states where more than half of rural children depend on Medicaid/CHIP for health care: New Mexico (59.9%), Louisiana (57.7%), Arizona (55.9%), Florida (51.9%), South Carolina (51.1%), and Arkansas (50.5%). For non-elderly adults in rural areas, 15 states have Medicaid coverage rates of 20% or higher, with Arizona (35.9%) and New York (33.9%) leading this group.
The impact of potential funding cuts would be particularly severe for American Indian and Alaska Native communities. Forty percent of these populations live in non-metro areas and already face significant health disparities and provider shortages. In rural American Indian and Alaska Native areas, including tribal lands, half of all children rely on Medicaid/CHIP for coverage. Medicaid also plays a crucial role for indigenous seniors. In rural counties within Indian Country, enrollment rates for seniors reach up to 66%, significantly higher than the national rate of under one in five.
The Opportunity
This report presents policymakers with clear evidence about Medicaid’s vital role in the health of rural Americans, and shows that funding cuts would have dire consequences for these communities. The higher rates of Medicaid coverage in rural areas, the heavy reliance on Medicaid/CHIP in specific states, and the importance of the program for American Indian and Alaska Native communities demonstrate how funding cuts would directly affect health care access for these rural residents. Preserving Medicaid funding is essential to ensure that millions of rural children and families can continue accessing the health care they need to thrive.
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