A recent study done by the University of Montana Rural Institute explored the impact that Medicaid expansion has had on people with disabilities living in rural areas of the United States. What they found adds to the growing body of research that expanding Medicaid improves the health and economic security of low-income people. Researchers analyzed data from the 2008-2017 American Community Survey, and here is what they found:

Medicaid Expansion Means No More Pre-Existing Condition Discrimination

Prior to the implementation of the ACA, people with disabilities faced high discrimination rates from insurance providers. Many were viewed as living with a “pre-existing condition,” which made them vulnerable to being denied necessary comprehensive health coverage or subjected to increased premiums that made care unaffordable. Reflecting the positive impact of ACA implementation, researchers found that among people 18-64 years old with disabilities living in rural areas, health insurance coverage increased by 8.6% between 2008, before the ACA was passed, and 2017, after it was implemented. By comparison, those of the same age group with a disability in urban areas increased 7.4% during the same time period.

Medicaid Expansion Increases Coverage Rates for Individuals with Disabilities

Individuals with disabilities living in rural areas of expansion states saw the greatest gains in insurance rates compared to both individuals with disabilities living in urban areas, as well as individuals with disabilities in non-expansion states. For example, this population saw an increase of health insurance coverage rates of 10.7%, while those who resided in non-expansion states only saw a 5.3% increase between 2008 and 2017. For people with disabilities in urban areas of expansion states, the rate of health insurance coverage increased by 8.6% while those with disabilities in urban areas of non-expansion states only saw a 5.9% increase in coverage during that time. These coverage gains have not only meant increased access to care, but they’ve also meant increased quality and volume of care as well. For example, one study found that community health centers in rural areas of expansion states experienced substantial increases in asthma treatment, hypertension control, body mass index screening and follow-up visits, along with increased volumes of mammograms and substance use disorder-related visits.

The Benefits of Medicaid Expansion Have Yet to Be Realized Nationwide

In the 36 states (plus the District of Columbia) which have expanded Medicaid, individuals with disabilities have been better able to access the services and supports they need. In the 14 states which have yet to expand, however, individuals in the Medicaid coverage gap don’t have this same access to care. Unfortunately, individuals in the Medicaid coverage gap are more likely to delay or forgo health care, ration medications and skip preventive services because they are uninsured and unable to afford the costs.

Thankfully, three states with significant rural populations recently voted to close the Medicaid coverage gap – Idaho, Nebraska and Utah – and the benefits of expansion are about to be fully realized in those states. Organizations led by and serving people with disabilities have been at the forefront of these fights. Liz Woodruff, Assistant Director of Programs at Idaho Voices for Children reports that, for years, thousands of Idahoans with disabilities have fallen through the cracks Idaho due to lack of health coverage and access to services, especially in rural areas.

“Idahoans with disabilities shared their stories and helped make Medicaid expansion law in Idaho. Now these Idahoans will receive the consistent treatment and care they need to resolve persistent and debilitating health concerns.”

States that have chosen to expand their Medicaid programs make the message clear: they care about all of their residents’ rights to access health care. While the evidence of the benefits of expansion continues to mount, we hope the states that continue to refuse to expand will take notice and follow suit. 

Tiffany Rodriguez, Together for Medicaid Graduate Intern