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Member Research & Reports

Member Research & Reports

WashU: Medicaid Enrollment Growth Higher in Urban Areas

Enrollment in Medicaid grew more rapidly in metropolitan areas than in rural areas in states that did not expand the program under the Affordable Care Act, according to new research from the Brown School at Washington University in St. Louis.

[Photo: Dr. Abigail Barker]

Researchers compared urban/rural Medicaid growth rates from October 2013 – before the ACA went into effect — to November 2016, during which time Medicaid enrollment grew by 27 percent. They found that the growth rates varied widely among states that did not expand the program under the ACA, as well as among those that did.

The findings include:

More research is needed to examine the causes of these variations, wrote Dr. Abigail Barker, the lead author, of Brown School. She said potential reasons include differing outreach efforts, fewer ACA navigators in rural areas, as well as broader political and social factors. In addition, the wide variation in pre-ACA eligibility levels for parents and children is likely a factor.

“At the policy level, best practices gleaned from states with higher enrollment rates could be implemented in states with lower enrollment rates,” she concluded.

The brief was published this month by the Center for Rural Health Policy Analysis at the Rural Health Policy Research Institute.  Other authors include Dr. Timothy McBride, Professor at the Brown School; Kelsey Huntzberry, of the Brown School; and Dr. Keith Mueller, Professor at the University of Iowa.

Changing Rural and Urban Enrollment in State Medicaid Programs