(Washington, DC, Tuesday, September 25, 2018) – The Georgetown University Center for Children and Families and the University of North Carolina NC Rural Health Research Project are releasing a new report that will include state-by-state data on the uninsured rates for low-income residents of metro and non-metro areas and the impact of the Affordable Care Act’s Medicaid expansion decision.  States’ decisions to expand Medicaid has paid off for residents of small towns and rural areas even more than it has for those living in metro areas.

• Rural areas tend to have higher rates of uninsured people. As the report shows, in many Medicaid expansion states, the gaps between non-metro and metro areas in the uninsured rate for low-income adults have largely been eliminated.
• In states that expanded Medicaid, low-income adult citizens living in small towns and rural areas saw their uninsured rates improve from 35% to 16%, while those in non-expansion states only saw modest improvements to their uninsured rates from 38% to 32%.
• In states that have not yet expanded Medicaid, Medicaid expansion would be good for the entire state but the most dramatic improvements to uninsured rates would most likely be felt in small towns and rural areas of the state.
• Nationally, as well as at the state-level, the sharpest decline in uninured rates has occurred in rural areas and small towns of states that expanded Medicaid.

Because Medicaid plays such a large role in small towns and rural areas, any changes to the program are likely to significantly affect the children and families living in small towns and rural communities. In many Medicaid expansion states, the gaps between non-metro and metro areas in the uninsured rate for low-income citizen adults have largely been eliminated. Non-expansion states with the highest rate of uninsured low-income adults in small towns and rural areas are South Dakota, Georgia, Oklahoma, Florida, Texas, Alabama, Missouri, and Mississippi.

States with the biggest coverage disparities between rural areas and small towns and metro areas are: Virginia, Utah, Florida, and Missouri. The full report is available at: ccf.georgetown.edu, along with interactive maps showing state and county-by-county breakdowns of coverage data.