Rural states have the most to gain with Medicaid expansion, study suggests

Rural states seem to benefit the most from Medicaid expansion. (Getty Images/James Pintar)

Rural states may have the most to gain from expanding Medicaid, according to a new study from the Georgetown University Center for Children and Families and North Carolina Rural Health Research Program.

The uninsured rate is higher in rural areas than metro areas across the board, in expansion and nonexpansion states, pre- and post-ACA. But coverage among low-income rural residents improved most in expansion states, the analysis says.

The percentage of uninsured adults in rural areas dropped from 35% to 16% between 2008-09 and 2015-16 in expansion states. The uninsured rate declined in nonexpansion states as well, but to a much lesser degree, from 38% to 32% over the same time frame.


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RELATED: Louisiana uninsured rate cut in half due to Medicaid expansion

These coverage gains can benefit the healthcare landscape overall “in areas where shortages are all too common,” the study (PDF) notes.

Rural clinics in expansion states saw an 11% decline in uninsured patients and a 13% increase in patients covered by Medicaid. These clinics also scored better on quality metrics and were able to provide more care more frequently and consistently.

“These gains at rural clinics were not duplicated in urban clinics in those same states, perhaps because patients in urban areas have more access to providers other than these clinics,” the paper says.

RELATED: Study says Medicaid expansion in Michigan improved beneficiaries' financial health

The study echoed prior research that found rural hospitals are less likely to close in expansion states because they provide less uncompensated care. “Keeping a rural community hospital open means that care is available to all residents of the community on a timelier basis and maintains a major employer for the community,” the Georgetown study says.

Moreover, the specific states that have seen the biggest coverage gains have significant rural populations. In Kentucky, Nevada and Colorado, the insured rate among low-income residents rose 27%, 28% and 29% respectively between 2008-09 and 2015-16.

Nonexpansion states, especially ones with large rural populations, should look toward those states and others as an example. The study highlighted Virginia, Utah, Florida and Missouri as states with “especially wide gaps” between rural and urban counties.

Virginia decided to expand Medicaid in May, and Utahans will vote on expansion later this year.

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