A new brief from the Kaiser Family Foundation examines the role of Medicaid in rural America. The 52 million children and nonelderly adults living in the most rural areas of the U.S. are more likely to be low income, more likely to have a disability and less likely to be employed or to have private insurance coverage compared to residents of urban and other areas.  Individuals in rural areas also face significant barriers to accessing care, including provider shortages, recent closures of rural hospitals, and long travel distances to providers.

The brief explains that Medicaid plays a central role in helping to fill the gaps in private coverage in rural America, covering nearly one in four (24%) nonelderly individuals in rural areas.  In many states, the share of the nonelderly population covered by Medicaid is higher in rural areas than in urban or other areas, and these differences are large in several states — including California, Hawaii, Kentucky, Arizona, Arkansas and Florida.

The brief also highlights the role of the Affordable Care Act’s (ACA) Medicaid expansion in driving recent coverage gains in rural areas. Between 2013 and 2015, rural areas that expanded Medicaid had larger Medicaid coverage gains (from 21% to 26% with Medicaid) compared to rural areas in non-expansion states (from 20% to 21%). Individuals in rural areas within non-expansion states were nearly twice as likely to be uninsured as those in expansion states (15% vs. 9%) in 2015. Given the large role of Medicaid in rural areas, reductions in federal Medicaid spending – either through repeal of the ACA, restructuring of Medicaid’s financing or both – could disproportionately affect people in rural communities.

The brief includes state-level data as well as a link to a county-based map highlighting rural areas of the country.