The NC Rural Health Research Program’s Findings Brief: How Does Medicaid Expansion Affect Insurance Coverage of Rural Populations? examines how states’ decisions on Medicaid expansion are impacting rural areas in the U.S., we used population estimates, current status of state expansion, and state-level insurance estimates to answer two primary questions: 1) How is Medicaid expansion affecting rural populations, and 2) How would it differ if every state were to expand?
When passed, the Affordable Care Act (ACA) required states to expand Medicaid to provide coverage for adults ages 18-64 with incomes up to 138% of the federal poverty level (FPL). However, in June 2012, the Supreme Court ruled that the mandatory Medicaid expansion was unconstitutionally coercive to the states, effectively making the Medicaid expansion optional. As of March 2014, 26 states (including the District of Columbia) had decided to expand Medicaid. Expanding Medicaid to cover all uninsured adults living below 138% FPL was a key component of the ACA, and without the expansion, an estimated five million adults will fall in a coverage gap because they will not qualify for Medicaid or federal health insurance tax credits. Due to historically higher rates of poverty, uninsurance and higher enrollment in Medicaid in rural areas, there is concern that the Supreme Court’s decision may have disproportionate effects on the more rural states.