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This April marks the fifth annual Medicaid Awareness Month. Medicaid is a vital source of care for people with disabilities across the country, over 10 million people with disabilities rely on Medicaid for access to health care. Up to 1 in 4 Americans have some type of disability. The Medicaid 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 to ensuring people with disabilities continue to get the care they need. 

President Biden took bold steps to strengthen the Medicaid program by signing the American Rescue Plan into law. Importantly, the American Rescue Plan provided additional financial incentives for states that had not yet implemented Medicaid expansion. Since the signage of the ARP, four previous holdout states, Missouri, Oklahoma, South Dakota, and North Carolina have adopted Medicaid. These measures will have profound impacts on Americans with disabilities for years to come. Expanding access to health care is particularly important as millions of Americans have contracted the COVID-19, with some “long haulers” facing the possibility of lifelong disabilities.

By The Numbers 

• Up To 1 In 4 U.S. Adults Have A Disability. 26 percent of Americans have a disability in the U.S. Thanks to the ACA, insurance companies can no longer deny them coverage, drop their coverage for no reason, or charge them more because of a pre-existing condition.
• Over 10 Million Medicaid Enrollees Under 65 Depend On Medicaid For Care. More than 10 million people under age 65 enrolled in Medicaid live with at least one disability.
• Nearly 45 Percent Of Adults With Disabilities Have Medicaid Coverage. Medicaid covers 45 percent of nonelderly adults with disabilities, including adults with physical disabilities, developmental disabilities, brain injuries, and mental illness.
• 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.

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 over 20 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. The program has increased access to lifesaving cancer screenings, improved infant and maternal health, and increased access to substance use treatment — and the list goes on.

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 low-income or as parents in non-expansion states.

Medicaid Expansion Helps Adults Gain Access To Care Without Having To Wait On A Disability Determination. Medicaid expansion helps adults with disabilities gain quicker access to coverage without waiting for a disability determination, which can take years. The ACA Medicaid expansion has allowed people who previously weren’t eligible for coverage, and would otherwise be uninsured, gain coverage. Many uninsured individuals with pre-existing conditions who would have not qualified for Social Security Disability Insurance yet, can now be covered under the ACA.

Medicaid Expansion Reduces Out-Of-Pocket Health Care Spending, Which Is Especially Important For People With Disabilities Who Often Have Limited Incomes. The average out-of-pocket spending decreased in states that expanded Medicaid. 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 Helps People With Disabilities Receive Comprehensive, Consistent 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 Covers A Broad Range Of Preventive And Medical Services. Thanks to Medicaid, nonelderly adults with disabilities have access to regular preventive care and treatment for chronic illnesses and conditions. States are now required to provide a minimum amount of services for adults, such as hospital stays, physician, lab, and x-ray services, and nursing home care.

Medicaid Provides Half Of Long-Term Care In U.S. Medicaid provides half the nation’s long-term care. Medicaid providers and consumers have worked to broaden access to care in home- and community-based settings, where many seniors and people with disabilities would prefer to live. 

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

Medicaid Expansion Increased Employment For People With Disabilities. Individuals with disabilities living in Medicaid expansion states are more likely to be employed than are those living in non-expansion states. They are able to access and maintain Medicaid coverage while earning at levels that previously would have made them ineligible. For people with disabilities in non-expansion states, the existing population health disparities may widen.

This April marks the 5th annual Medicaid Awareness Month. The Affordable Care Act’s (ACA) Medicaid expansion has been a critical part of working towards the goal of every American having access to affordable and quality health insurance, but Republicans in 10 states have not yet implemented expansion of the program, blocking millions from coverage and access to essential health care. Holdout states are located in the southern and midwest regions with significant rural populations. 60 million Americans reside in rural areas across the United States.

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 2-3 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.
• Rural Hospitals Rely On Medicaid. 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 2023, over 600 rural hospitals are at risk of closing in the near future.
• 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. 673 rural hospitals are at risk of closing, and estimated that if those hospitals shut down, 99,000 health care jobs in rural communities would be lost.

How Medicaid Expansion Helps Rural Americans

Nearly 14 million Medicaid enrollees reside in rural areas. Health care for rural Americans is especially important due to higher prevalence of pre-existing conditions and barriers to accessing health care. The success of Medicaid expansion across the country demonstrates the need for the 10 holdout states to finally adopt expansion. Almost 20 percent of uninsured Americans live in rural areas and would benefit from the long awaited expansion. 

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 Journal of Health Economics found that Medicaid expansion reduced mortality in people aged 20 to 64 by 3.6 percent. 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 alone. One in four rural hospitals face closure without more federal funding in 2022. 

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.

Beyond just being a source of jobs, hospitals tend to pay higher wages than other rural industries. As the House of Representatives Minority Staff report on rural hospitals highlights, “The average pay of hospital employees in rural counties is 43 percent higher than the average pay of other workers in the same counties.” As Mark Holmes, the director of the Rural Health Research Program at the University of North Carolina, emphasizes, hospital closures in rural communities can be like losing a factory: “Losing an employer of 150 people with good jobs is like losing a manufacturing plant…Hospitals are usually the largest, or the second-largest, employer in a community. That’s something that’s easy to lose sight of because we think of this from a health standpoint. But the effects are wide-ranging when a hospital closes.”

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.

This April marks the 5th annual Medicaid Awareness Month. Medicaid is an essential pillar in providing coverage for communities of color. 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, 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. And for people of color who live in rural areas, who are LGBTQI+, who have a disability, or who are low income, these intersectional dimensions of their identities compound the health disparities they experience.

Research confirms that Medicaid expansion saves lives and drastically reduces racial/ethnic health disparities. 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 2.1 million uninsured adults are locked out of coverage in the 10 holdout states refusing Medicaid expansion, with people of color comprising 62 percent of those who would gain coverage if these 10 states expanded Medicaid. 

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. 
• About 1 in 4 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 2.1 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 2 million uninsured adults could gain coverage; people of color make up nearly 62 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 majority of people in America who would gain coverage if the remaining 10 holdout states expanded Medicaid are people of color. 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. 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. 

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 75 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. Residents in states where Medicaid has been expanded are more likely to receive higher quality care, including for chronic health conditions, such as diabetes and hypertension that disproportionately impact communities of color. 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 79 percent of Black LGBTQI+ Americans and 67 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 out-of-pocket health care spending forced more than 10 million Americans into poverty in 2016 alone, 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. Nearly 9 million Latinos, 6.8 million Black people, over 2 million AAPI, and 830,000 Native Americans and Alaskan Natives suffer from a mental health disorder. Medicaid is the single-largest payer for mental health services in America, serving 26 percent of all adults living with a serious mental health condition. It is also an important source of coverage for substance use disorder services.