Medicaid and Rural Health - Overview of Medicaid’s Role in Rural Health Care

Sep 21, 2026

Medicaid supports health coverage for large numbers of Americans living in rural areas, where nearly one-quarter of people under 65 are covered and many face overlapping risks from low income, poverty, and limited access. Rural residents generally experience poorer health outcomes, higher mortality, and greater burdens of smoking, obesity, and inactivity, alongside higher barriers to care from provider shortages and travel constraints. The brief explains rural socioeconomic, insurance, and health patterns, then reviews provider availability—especially primary care and hospitals—and highlights key Medicaid policies shaping rural health access.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages14

Reading Time35 min

AccessFree to download

Characteristics of Rural Residents

Socioeconomic characteristics

Insurance coverage

Health status

Provider Availability in Rural Areas

Primary care

April 2021 Advising Congress on Medicaid and CHIP Policy Medicaid and Rural Health Medicaid is an important source of health care coverage for the 60 million Americans living in rural areas (U.S. Census Bureau 2017) . 1 Nearly a quarter of individuals under age 65 who live in rural areas are covered by Medicaid, as well as 22 percent of people dually enrolled in Medicaid and Medicare (NCHS 2018, MedPAC 2020) . Overall, rural residents have worse health outcomes and tend to be older, poorer, and sicker than those in urban areas (ERS 2020a, Foutz et al. 2017, Moy et al. 2017) . They are also more likely to have lower levels of education, less likely to be in the labor force, and less likely to be covered by private insurance if they are working (Pender et al. 2019, Mueller et al. 2018, Foutz et al. 2017) . Rural residents face barriers to accessing health care due to a limited number of providers, especially those providing specialized care. They may also lack access to reliable transportation and may have to travel long distances to access health care services (Foutz et al. 2017) . This brief provides an overview of the role Medicaid plays in rural health. It begins by describing the characteristics of rural residents generally, including socioeconomic factors, insurance status, and health status. It then describes provider availability, particularly for primary care services and rural hospitals. It concludes by discussing a few Medicaid policies that are particularly important for providing health care in rural areas. Characteristics of Rural Residents While we have limited data on Medicaid beneficiaries living in rural areas, general information on rural residents may shed light on their circumstances. As such, some of the characteristics of rural residents described below are likely true for Medicaid beneficiaries living in those areas. Socioeconomic characteristics Rural residents have lower incomes than their urban counterparts and rural areas have higher overall poverty rates, particularly among racial and ethnic minorities.2 While less than one quarter of individuals living in rural areas are racial and ethnic minorities, in 2018, rural residents who are Black had the highest rate of poverty (31.6 percent), followed by American Indians and Alaska Natives (30.9 percent), and those of Hispanic origin (23.8 percent) (ERS 2020b, Foutz et al. 2017) . By contrast, the poverty rate for rural whites was 14.0 percent (ERS 2020b) . Insurance coverage Individuals under age 65 who live in rural areas are less likely to have private insurance coverage and are more likely to be uninsured than residents of urban and other areas.3 This is due in part to greater employment in jobs that do not offer employer-sponsored insurance and lower participation in the labor force (Foutz et al. 20 17) .4 In addition, many rural states have not expanded Medicaid to the new adult group. Rural areas in states that implemented the Medicaid expansion to low-income adults under the Patient Protection and Affordable Care Act (ACA, P. L. 111-148, as amended) experienced larger gains in coverage than those in non-expansion states. 5 In rural areas, the Medicaid coverage rate in expansion states increased from 21 to 26 percent between 2013 and 2015, while non-expansion states saw an increase of one percentage point from 20 to 21 percent. During this same time period, the uninsured rate in rural areas within expansion states fell by nearly half from 16 to 9 percent; largely a reflection of gains in Medicaid coverage in these states (Foutz et al. 2017) . Health status Rural residents have worse health outcomes and higher death rates than their urban counterparts. For example, individuals living in rural areas report poorer physical and mental health, and have higher rates of cigarette smoking, obesity, and physical inactivity (Moy et al. 2017) . Mortality rates are higher in rural areas for the five major causes of death in the United

FAQs

How does Medicaid coverage differ for rural residents compared with urban residents?

Individuals under 65 living in rural areas are less likely to have private insurance and are more likely to be uninsured than residents of urban and other areas. Medicaid expansion in rural areas was associated with larger gains in coverage and reductions in the uninsured rate.

What health and socioeconomic challenges are described for rural residents?

Rural residents have lower incomes and higher poverty rates, especially among racial and ethnic minorities. They also report poorer physical and mental health, higher death rates, and higher rates of cigarette smoking, obesity, and physical inactivity.

What provider access barriers affect rural health care access?

Rural residents have less access to health care services and are less likely to receive preventive care, partly because fewer providers practice in rural areas. Shortages are pronounced for behavioral health providers, and hospital closures can further reduce access.

Sep 21, 2026

Upload by Taylor Morgan