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April marks the 7th annual Medicaid Awareness Month. Medicaid is a vital source of care for people with disabilities across the country and helps ensure they can access quality care. Up to 1 in 4 Americans have some type of disability. The program also provides half of all long-term care in the United States, which includes essential home- and community-based services for people with disabilities. Protecting access to Medicaid is essential for ensuring that people with disabilities get the care they need. 

Medicaid is a popular, lifesaving program, but Republicans want to cut it and rip coverage away from millions of hardworking families. Voters agree that it is important to prevent harmful cuts to Medicaid that would reduce health care access. Yet the latest GOP scheme slashes trillions from Medicaid and would throw millions of people off their coverage through block granting and burdensome work reporting requirements. These requirements are especially cruel for Americans with disabilities who may not be able to work long hours or secure a health-related exemption from the requirement. Republicans also won’t quit their mission to repeal the Affordable Care Act (ACA) and Medicaid expansion, putting health care for millions of people in jeopardy.  

By The Numbers 

• 1 In 3 Medicaid Enrollees Have A Disability. One-third of Medicaid enrollees report having a disability, and 11 percent of enrollees qualified for Medicaid based on a disability determination.
• Up To 1 In 4 U.S. Adults Have A Disability. Up to 27 percent of American adults have some type of disability. Medicaid covers 43 percent of nonelderly adults with disabilities, including adults with physical disabilities, developmental disabilities, brain injuries, and mental illnesses.
• Over 10 Million Non-Elderly Adults Are Enrolled in Medicaid Due To At Least One Disability. More than 10 million people under age 65 enrolled in Medicaid qualified as a result of a disability determination. Other individuals with disabilities may qualify for Medicaid due to age, pregnancy, or income.
• Medicaid Covers Half Of All Long-Term Care. The Medicaid program provides half of all long-term care in the United States, which includes essential home- and community-based services for people with disabilities.
• Millions Lose Medicaid Coverage In Unwinding Post-Pandemic. As Medicaid transitions back to its pre-pandemic eligibility and enrollment rules, too many people are losing coverage because of the carelessness and callousness of certain Republican governors who are terminating coverage for people who may still be eligible. Americans with disabilities are at an increased risk of losing Medicaid coverage due to the renewal process barrier, regardless of whether individuals remain eligible.

Americans with disabilities have faced barriers to achieving and maintaining optimal health. They are 1.4x more likely to have obesity, 2x more likely to smoke, 2x more likely to have diabetes, and 2.8x more likely to have heart disease. Yet 1 in 4 report having an unmet health care need because of cost in the past year and the same proportion report not having a usual health care provider. Medicaid enrollees with disabilities have access to regular preventive care and treatment for chronic illnesses and conditions. States are also required to provide key services for adults, such as hospital stays, physician, lab, and x-ray services, and nursing home care.

In 2010, the ACA opened the door for states to expand Medicaid, and the results are piling in: Medicaid expansion works. In addition to providing coverage for about 24 million people, expansion has resulted in healthier people, communities, and economies. Study after study shows that Medicaid expansion increases access to care, improves financial security, and leads to better health outcomes for people with disabilities. 

People With Disabilities Rely On Medicaid Expansion For Coverage. More than six in 10 nonelderly Medicaid adults with disabilities do not receive SSI, meaning that they qualify for Medicaid on another basis (such as income, or as parents in non-expansion states). Medicaid is a significant source of health care coverage for these adults, providing critical access to care for serious health conditions and supporting those in the workforce.

Medicaid Expansion Helps Adults With Disabilities Gain Access To Affordable Care Without Having To Wait. Medicaid expansion helps adults with disabilities gain quicker access to coverage without waiting for a disability determination, which can take years. Thanks to the Affordable Care Act (ACA), Medicaid expansion has allowed people gain coverage who previously were not eligible for coverage and otherwise would have been uninsured. Many uninsured individuals with pre-existing conditions who would not have qualified for Social Security Disability Insurance yet are also eligible for coverage under Medicaid expansion.

Medicaid Expansion Has Improved Health Care Services For People With Disabilities. According to the same 2021 study, Medicaid expansion often improves the services provided to people with disabilities, as states have been able to provide better coverage of critical services including specialized treatments and coverage for behavioral health concerns and other chronic conditions.

Medicaid Expansion Reduces Out-Of-Pocket Health Care Spending, Which Is Especially Important For People With Disabilities Who Often Have Limited Incomes. A majority, or nearly 85 percent, of adults with disabilities who have Medicaid coverage earn annual incomes of less than 200 percent of the FPL, $12,060 for an individual, making access to affordable health care even more essential. In 2022, CMS adopted rules to lower maximum out-of-pocket costs by $400.

Medicaid Is One Of The Most Effective Anti-Poverty Programs, Particularly For People With Disabilities. Medicaid reduces poverty by limiting out-of-pocket spending and expanding state-level Medicaid programs.  The average out-of-pocket spending decreased in states that expanded Medicaid. The poverty-reducing effects were greatest for adults with disabilities, elderly, children, and racial/ethnic minorities.

Medicaid Expansion Has Increased Employment For People With Disabilities. According to a 2021 study, individuals with disabilities living in Medicaid expansion states are more likely to be employed than those living in non-expansion states. In expansion states, people with disabilities have seen increased health coverage and employment rates compared to non-expansion states. On the other hand, Republican-backed work reporting requirements reduce employment and can jeopardize health care for people with disabilities because definitions are outdated and don’t accommodate many types of disabilities that affect peoples’ ability to work. 

Hundreds of Thousands of Americans With Disabilities Are Stuck Without Coverage In States That Have Refused to Expand Medicaid. 10 states have refused to expand Medicaid under the Affordable Care Act (ACA), stranding many adults with low incomes in the Medicaid coverage gap. As a result, over 265,000 Americans with disabilities with incomes below the federal poverty level are ineligible for Medicaid or ACA marketplace assistance in these states. Over half of these individuals reside in Texas or Florida, and adults with disabilities form at least 20 percent of those in the Medicaid coverage gap in Alabama, South Carolina, Kansas, Tennessee, and Wyoming. 

Medicaid Helps People With Disabilities Access Comprehensive, Consistent Long-Term Care. Medicaid beneficiaries with disabilities comprised 95 percent of the fees for service of long-term care services while making up less than 25 percent of people who are enrolled in the program. 

• Medicaid Provides Half Of Long-Term Care In The U.S. Medicaid provides half the nation’s long-term care – a broad category encompassing a critical array of services available for people with prolonged illnesses, disabilities, and other chronic conditions. Medicaid providers and consumers have worked to broaden access to care in at-home and community-based settings, where many seniors and people with disabilities would prefer to live.

Increased Medicaid Funding For Caregivers Benefits People With Disabilities. The Biden-Harris administration recently finalized new rules that require Medicaid to provide increased funding for home care services, a critical component of care for millions of people with disabilities who rely on care workers to meet their basic needs while living in their homes and communities.

Protect Our Care will continue to host events and activities throughout Medicaid Awareness Month, which includes the following themes each week:

• Week 1: Republican threats to Medicaid. In the first week of Medicaid Awareness Month, Protect Our Care focused on how Republicans are actively seeking cuts to Medicaid while GOP leaders in 10 states continue to block Medicaid expansion. 
• Week 2: Medicaid helps people of color and rural Americans. In week two, Protect Our Care highlighted how Medicaid is a critical tool to expand access to coverage, which together with policies that address other social and structural determinants of health, narrow stark disparities in health care, improve families’ financial security, and make people healthier. 
• Week 3: Medicaid helps women and kids. For week three, Protect Our Care brought attention to the vital role of Medicaid for mothers and children across the country.
• Week 4: Medicaid helps seniors and people with disabilities. The final week focuses on how Medicaid helps seniors and people with disabilities access lifesaving care. 

Republicans in 10 States Are Blocking Medicaid Expansion, Jeopardizing Health Care and Increasing Health Care Costs for Rural Americans

This April marks the 7th annual Medicaid Awareness Month. About one in five – 66 million – Americans reside in rural areas across the United States and nearly 14 million are enrolled in Medicaid. Medicaid is a vital source of coverage for people across rural America, who are more likely to lack insurance, experience negative health outcomes, and have more barriers to accessing care. The Affordable Care Act’s (ACA) Medicaid expansion has been a critical part of working towards the goal of closing gaps in health outcomes for rural Americans. Medicaid expansion saves lives, helps keep rural hospitals open, improves families’ financial security, and boosts local economies. The success of Medicaid expansion across the country demonstrates the need for the 10 holdout states to finally expand their Medicaid programs to the 1.6 million people in the coverage gap who have no option for health coverage. 10 percent of rural Americans are uninsured and would benefit from the long awaited expansion. 

However, Republican elected leaders in 10 states refuse to implement Medicaid expansion, blocking 1.6 million from the access to essential health care and financial security Medicaid provides. These holdout states, located in the southern and midwest regions of the U.S. with significant rural populations, are leaving over $13 billion in federal Medicaid funding on the table. In addition to blocking Medicaid expansion in 10 states, MAGA-Republicans want to cut trillions from Medicaid by introducing onerous work reporting requirements and radically restructuring the program through block grants. Donald Trump has promised to follow through on his plan to repeal the ACA, which would end Medicaid expansion and throw the entire health care system into chaos, risking coverage for at least 45 million Americans and ending protections for Americans with preexisting conditions. On the other hand, President Biden and Democrats in Congress have worked to protect and strengthen Medicaid by creating multi-billion dollar incentives for Medicaid expansion, stopping onerous work requirements, pushing for expanded postpartum coverage, and working to minimize the impacts of Medicaid unwinding. 

By The Numbers

• Millions Of Rural Americans Depend On Medicaid. Nearly 14 million Medicaid enrollees reside in rural areas.
• Medicaid Strengthens Health In Rural America. Overall, rural residents have worse health outcomes and tend to be older, poorer, and sicker than those in urban areas.
• Rural States Need Medicaid. Uninsurance rates in rural America are 2 to 3 percentage points higher than in urban areas. States that expanded Medicaid experienced a 7 point increase in insured rates after the passage of the Affordable Care Act.
• Medicaid Helps Keep Rural Hospitals Open. Since 2005, more than 150 rural hospitals have closed, including 20 closures in 2020 alone. Rural hospitals in Medicaid expansion states are 62 percent less likely to close. In 2024, over 400 rural hospitals are at risk of closing in the near future. When hospitals face financial hardship, obstetric services are among the first to be cut. Fewer than half of all rural counties in the United States had hospital-based obstetric care
• Rural Hospitals Strengthen Local Economies. Hospitals employ ten percent of total county employment. Rural areas with hospital closures experience economic downturns with a 14 percent reduction in country employment. 418 rural hospitals are at risk of closing, and estimated that if those hospitals shut down, over 90,000 health care jobs in rural communities would be lost.

How Medicaid Expansion Helps Rural Americans

Medicaid Expansion Saves Lives. Medicaid expansion has been proven to increase access to care, improve financial security, and save lives. A study published in the Lancet found that Medicaid expansion reduced all-cause of mortality. Mortality rates in rural areas are much higher than in urban areas due to a disparity in health care access and increased prevalence of fatal diseases, suicide, and overdoses. 

Medicaid Expansion Reduces Income Inequality And Medical Debt. Medicaid expansion reduces poverty and income inequality across the board by helping low income families access care without jeopardizing income that they may use for other basic living expenses. A 2019 Health Affairs study found that Medicare, Medicaid, and premium subsidies account for one-third of poverty reduction in households without a disability recipient. Medicaid has also been shown to reduce the prevalence of medical debt with nearly 80 percent of the counties with the highest medical debt being from states that haven’t yet expanded Medicaid. 

Medicaid Expansion Plays A Central Role In Fighting The Opioid Crisis. Rural America largely lacks the ability to treat substance use disorders with 65 percent of rural counties lacking the ability to prescribe buprenorphine, an effective drug used to treat opioid dependency. Starting in 2020, Medicaid began covering all medications, therapies, and counseling services that are approved by the Food and Drug Administration to treat opioid use disorders. Medicaid covers an estimated four in ten people with an opioid use disorder. Medicaid expansion in the remaining 10 states is a necessary foundation to help low-income, rural families dealing with higher rates of substance use disorders. 

Medicaid Expansion Is A Lifeline For Rural Hospitals

In states that haven’t expanded Medicaid, rural hospitals are drowning under financial pressure. Low occupancy rates, high levels of uncompensated care, competition with other hospitals, and struggling local economies create a financial burden that rural hospitals face all over the country. Since 2010, 138 rural hospitals have closed, including 20 closures in 2020 and 8 in 2023. In 2024, over 400 hospitals are at risk of closure.

Medicaid Helps Rural Hospitals Stay Open. Rural hospitals in Medicaid expansion states are 62 percent less likely to close. The two most common types of supplemental Medicaid payments are disproportionate share hospital payments, that pay hospitals for uncompensated care for Medicaid and uninsured patients, and upper limit payments, which supplement the gap between fee-for-service Medicaid base payments and the amount that Medicare covers. Some states are also testing the use of global hospital budgets to increase care and improve health outcomes in rural hospitals.

Closure Of Specialized Care And Obstetrical Services. Some hospitals opt to close specific services or facilities that cause patients in rural areas to have to travel further for specialized care. On average, when a rural hospital closes patients have to travel over 20 miles further to access inpatient or emergency care. A 2021 study found that fewer than half of all rural counties in the United States had hospital-based obstetric care. When hospitals face financial hardship, obstetric services are among the first to be cut. Black and Native American women in rural areas are particularly at risk. Black and Native American women are two to three times more likely to die from pregnancy-related causes than white women.

Medicaid Expansion Boosts State Budgets. Medicaid expansion generates enough savings that it is well worth the initial cost, eventually helping boost states budgets. Expansion allows states to access federally matched funds for some people covered by traditional Medicaid. The American Rescue Plan (ARP) provides states with additional funding from the federal government. From 2022 to 2025, the states that haven’t yet expanded Medicaid would gain $90 billion in federal matching funds in addition to $17.6 billion in ARP bonus payments and $6.6 billion from higher state and local tax revenue.

Rural Hospitals Are Large Employers In Their Communities. For rural areas that often have high unemployment rates, hospitals contribute significantly to local economies by employing large numbers of people with relatively high-paying jobs. Rural hospitals typically account for about 5 percent of a rural county’s total employment. Beyond just being a source of jobs, hospitals tend to pay higher wages than other rural industries. Hospital employees with an associate’s degree are paid an average of 21 percent higher than the rest of the population.

Rural Hospitals Boost Local Economies. Besides hospitals providing higher paying jobs in the health care sector, rural hospitals also stimulate the local economies of other industries. Hospitals purchase goods or services from local private businesses which helps stabilize and reinforces the local economy. In turn, strong private sector employment allows for more tax dollars for public goods, such as education and safety services.

Protect Our Care will continue to host events and activities throughout Medicaid Awareness Month, which includes the following themes each week:

• Week 1: Republican threats to Medicaid. Week one will focus on how Republicans are actively seeking cuts to Medicaid while GOP leaders in 10 states continue to block Medicaid expansion. 
• Week 2: Medicaid helps people of color and rural Americans. Week two will highlight how Medicaid is a critical tool to expand access to coverage, which together with policies that address other social and structural determinants of health, narrow stark disparities in health care, improve families’ financial security, and make people healthier. 
• Week 3: Medicaid helps women and kids. Week three will bring attention to the vital role of Medicaid for mothers and children across the country.
• Week 4: Medicaid helps seniors and people with disabilities. The final week will focus on how Medicaid helps seniors and people with disabilities access lifesaving care. 

While President Biden and Democrats Fight to Protect and Expand Medicaid, Republicans Return to Some of Their Oldest Schemes to Cut the Program 

This April marks the 7th annual Medicaid Awareness Month, an important time to bring attention to the communities who rely on Medicaid to stay healthy. Generations of structural racism have resulted in people of color experiencing lower rates of health coverage, worse health outcomes, and staggering health inequities. As a result, Medicaid coverage remains a critical source of coverage and financial security, especially for Black, Latino, and Indigenous families in America who experience poverty at a higher rate than white Americans and remain less likely to have access to quality care – an important driver of health. These groups also face higher rates of chronic conditions that make access to affordable health coverage even more essential.

This Medicaid Awareness Month, Medicaid is under attack by Republicans. The latest GOP scheme slashes trillions from Medicaid through block granting and work reporting requirements and other paperwork and red tape designed to throw people off their coverage. GOP leaders in 10 states have also failed to expand Medicaid under the Affordable Care Act (ACA), blocking 1.6 million people from affordable coverage. Donald Trump has promised to follow through on his plan to repeal the ACA, which would end Medicaid expansion and throw the entire health care system into chaos. The consequences of the GOP war on Medicaid would be particularly devastating for communities of color. President Biden and Democrats, on the other hand, are continuing to fight to address health disparities, expand access to coverage, lower health care costs, and protect Medicaid for years to come.

By The Numbers

• 1 In 5 Medicaid Enrollees Are Black. As of 2022, Black Americans make up 13.6 percent of the U.S. population, but about 20 percent of Medicaid enrollees. 
• 1 in 3 Native American And American Indian People Are Enrolled In Medicaid. According to the 2021 census, 4.3 million people identified as Native American and American Indian. Nearly 27 percent of this group is enrolled in Medicaid. 
• 30 Percent Of Medicaid Enrollees Are Hispanic/Latino. Hispanic/Latino people make up 18.9 percent of the U.S. population, but nearly 30 percent of Medicaid enrollees. 
• 15 Percent Of Asian Americans Are Enrolled In Medicaid. Roughly 6 percent of the American population identify as Asian American equating to about 21 million people.
• More Than 30 Percent Of Native Hawaiian And Other Pacific Islanders (NHOPI) Are Covered By Medicaid. That’s about 207,000 out of 690,000 NHOPI people.
• More Than 1.6 Million People Could Gain Coverage If Holdout States Accepted Expansion. If Republicans did the right thing and expanded Medicaid in the remaining holdout states, more than 1.6 million uninsured adults could gain coverage; people of color make up 61 percent of this group, or roughly 1.3 million people. 

Research Confirms Medicaid Improves Coverage, Health, And Economic Equity

Reduced Racial/Ethnic Disparities In Coverage. Increasing Medicaid access is the single most important action available to expand coverage and address access to quality care as a driver of health. This together with additional actions to address other social and structural determinants of health can reduce racial/ethnic disparities in the American health care system. The Affordable Care Act (ACA) led to historic reductions in racial/ethnic disparities in access to health care, but gaps in insurance coverage narrowed the most in states that adopted Medicaid expansion. 

Closing The Coverage Gap Is Essential For Addressing Health Disparities. Research confirms that Medicaid expansion saves lives and drastically reduces racial/ethnic health coverage disparities. The majority of people in America who would gain coverage if the remaining 10 holdout states expanded Medicaid are people of color. States that expanded their Medicaid programs saw a 51 percent reduction in the gap between uninsured white and Black adults after expansion, and a 45 percent reduction between white and Hispanic/Latino adults. Despite Medicaid expansion’s proven role in reducing racial/ethnic disparities in health care access and improving health outcomes, Republicans have spent years undermining the expansion of Medicaid, blocking millions from coverage. Currently, an estimated 1.5 million uninsured adults are locked out of coverage in the 10 holdout states refusing Medicaid expansion, with people of color comprising 61 percent of those who would gain coverage if these 10 states expanded Medicaid. 

Medicaid Is Essential For Children Now And In The Future. Children of color disproportionately rely on Medicaid coverage, making robust Medicaid access a critical racial/ethnic justice issue for American children. Children of color make up nearly 52 percent of all American children, but nearly 67 percent of the children on Medicaid. This coverage not only provides health coverage in the immediate term, but also provides significant long-term benefits, such as being less likely to be hospitalized and more likely to graduate high school and college.

Medicaid Coverage Is Critical To Improving Maternal Health. The United States is only one of two nations that has reported an increase in maternal mortality since 2000, including increases over the past three years. According to the Centers for Disease Control and Prevention (CDC), more than 80 percent of these deaths are preventable. Women of color consistently experience higher rates of maternal mortality than white women, with the Center on Budget Policy and Priorities finding this to be the result of a combination of factors, including life-long toxic stress resulting from racism and the impacts of structural racism in the health care system. 30 states have expanded postpartum Medicaid coverage to a full year, covering more than 460,000 individuals. In the 10 states that have refused Medicaid expansion, eight had more than 40 percent of births covered by Medicaid. Medicaid covers 65 percent of all births to Black mothers and 65 percent of women of reproductive age living in the coverage gap are women of color. 

Reduced Racial/Ethnic Disparities In Rural Access To Care. 24 percent of rural Americans identify as a person of color. Rural Americans of color face a greater health disparity than their white counterparts due to barriers to health care access, reporting not having primary care providers, forgoing care due to cost, and having fair to poor health status. States that have expanded Medicaid have improved rural hospital financial performance and lower likelihood of hospital closures. When Arkansas and Kentucky accepted Medicaid expansion, adults in those states became more likely to have a personal doctor, obtain care for ongoing conditions, and have a yearly medical check up.

LGBTQI+ People of Color Have Seen Reduced Health Disparities. Due to both systemic factors as well as complex familial dynamics, the LGBTQI+ community is much more at risk of poverty and uninsurance than cisgender heterosexual Americans. Because of this, Medicaid has become a lifeline for the LGBTQI+ community, especially people of color. Around 46 percent of Black LGBTQI+ Americans and 43 percent of Latino LGTBQI+ Americans with incomes below 400 percent of the Federal Poverty Line qualify for Medicaid. As well, Asian American and Pacific Islander (AAPI) LGBTQI+ Americans are over two times as likely to have Medicaid as their primary insurance compared to cisgender heterosexual AAPI individuals.

Medicaid Improves Financial Security For Families. The racial/ethnic wealth gap in America is staggering. According to data from the US Census Bureau, in 2020, the annual median household income for white Americans was nearly $20,000 higher than for Hispanic/Latino households and nearly $30,000 higher compared to Black households. As a result, policies to boost financial well-being undoubtedly help people of color. The bottom 10th percentile of earners In Medicaid expansion states saw a 22.4 percent boost in their income, compared to 11.4 percent in non-expansion states. Over the past decade, research has shown the gap in medical debt between Medicaid expansion and holdout states has grown approximately 30 percent. In 2020, Americans living in holdout states carried an average of $375 more in medical debt than their counterparts in expansion states.

Medicaid Reduces Poverty And Inequity. Poverty can produce negative long-term consequences for children and adults alike. Medicaid has long been considered one of the most effective anti-poverty programs in the nation, and its expansion has significantly improved health outcomes for people of color. In a nation where Americans are one medical bill away from being pushed into poverty, Medicaid serves as a lifeline not only for health care, but for economic stability. A January 2021 study from Health Affairs found that the ACA helped reduce income inequality across the board, but much more dramatically in Medicaid expansion states.

Medicaid Helps Those Dealing With Behavioral Health Conditions. States that have expanded Medicaid have added behavioral health benefits, including mental health and substance use disorder care, that particularly benefit beneficiaries of color who have disproportionately been affected by these conditions. 28 percent of Black people and 27 percent of Latinos suffer from a mental health or substance use disorder. Medicaid is the single-largest payer for mental health services in America. 40 percent of adults on Medicaid are living with a serious mental health or substance use disorder.

Protect Our Care will continue to host events and activities throughout Medicaid Awareness Month, which includes the following themes each week:

• Week 1: Republican threats to Medicaid. Week one will focus on how Republicans are actively seeking cuts to Medicaid while GOP leaders in 10 states continue to block Medicaid expansion. 
• Week 2: Medicaid helps people of color and rural Americans. Week two will highlight how Medicaid is a critical tool to expand access to coverage, which together with policies that address other social and structural determinants of health, narrow stark disparities in health care, improve families’ financial security, and make people healthier. 
• Week 3: Medicaid helps women and kids. Week three will bring attention to the vital role of Medicaid for mothers and children across the country.
• Week 4: Medicaid helps seniors and people with disabilities. The final week will focus on how Medicaid helps seniors and people with disabilities access lifesaving care.