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ashoup
In Research, Fact Sheet, News

FACT SHEET: Medicaid is Essential For Seniors & Older Adults’ Coverage

Medicaid Is the Largest Funder of Long-Term Care For Seniors and Without It, Millions Would Be Without Care

This April marks the 7th annual Medicaid Awareness Month. Medicaid remains a critical source of coverage as Americans age, with Medicaid serving as a primary funder for long-term care and filling many of the gaps in Medicare coverage, such as premium costs, transportation to medical appointments, and medical equipment. 18.2 million Americans aged 50 and up rely on Medicaid coverage. Without Medicaid, millions of seniors would be forced to go without lifesaving care. These benefits often go unnoticed but are essential to the health and well-being of seniors nationwide.  

Medicaid is a popular, lifesaving program, but Republicans want to cut it and rip coverage away from millions of hardworking families. Over 66 percent of Americans, including 55 percent of Republicans, have a favorable opinion of Medicaid. 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. Republicans also won’t quit their mission to repeal the Affordable Care Act (ACA) and Medicaid expansion, putting health care for millions of women and families in jeopardy. 

By The Numbers

  • Millions of Seniors & Older Americans Rely On Medicaid Coverage. 7.2 million Americans over 65 are enrolled in Medicaid and more than 11 million Americans ages 50 to 64 have health coverage through Medicaid – many thanks to the Affordable Care Act’s Medicaid expansion.
  • Nearly 6 Million Older Adults Live Below The Federal Poverty Level. For millions of seniors and older Americans on fixed incomes, Medicaid is a lifeline.
  • Medicaid Funds Nearly Half Of Long-Term Care Nationwide. As seniors age, long-term care services become more essential, serving about 70 percent of seniors who will need some form of long-term care in their lives.
  • 1.5 Million People Would Gain Coverage If Remaining States Expanded Medicaid. 1.5 million people would gain Medicaid coverage if the remaining states implemented expansion, roughly 270,000 of the uninsured in the coverage gap are aged 55-64.
  • Medicaid Pays For 62 Percent Of Long-Term Care Residents In Nursing Homes. Medicaid covers nursing home bills for over 60 percent of residents in nursing homes. In 2019, this totaled over $50 billion. The median private nursing home room cost over $100,000 yearly in 2024.
  • 12 Million Medicare Beneficiaries Also Have Medicaid Coverage. Nearly 8 million of the dual eligible Medicare-Medicaid beneficiaries are “full benefit” Medicaid enrollees who have access to a range of Medicaid benefits, not otherwise covered by Medicare.

Seniors And Older Adults Depend On Medicaid For Affordable, Comprehensive Care. As of 2021, 3.6 million older adults are going without coverage. Older Americans often have more complex health issues, requiring additional medical attention that is costly, pushing care out of reach. For seniors on Medicare, Medicaid helps fill many of the gaps in Medicare coverage, such as transportation to medical appointments and medical equipment. 

Medicaid Supplements Medicare Coverage For Millions Of Seniors. 12 million seniors are eligible Medicare-Medicaid dual beneficiaries. Nearly 8 million are “full benefit” Medicaid enrollees who have access to a range of Medicaid benefits, not otherwise covered by Medicare. Nearly half of dual enrollees are seniors of color and over half of dual enrollees suffer from long-term disabilities. 

Medicaid Helps Seniors And Older Americans Stay Retired And Out Of Poverty. Many seniors and older Americans survive off of low incomes or have chronic health conditions that prohibit them from working. Medicaid allows these individuals living on fixed incomes and often have chronic diseases to continue getting the care they need by filling in the gaps in their Medicare coverage without having to worry about choosing between food and housing or their health. 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 seniors and older adults. 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 as Americans age. 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.

Low-Income Seniors With Medicare Depend On Medicaid For Long-Term Care. It is estimated that 70 percent of seniors will need long-term care at some point and 62 percent of nursing facility residents utilize Medicaid to receive their care. Medicaid is a critical provider of home- and community-based care that are essential to keep loved ones at home with their families and neighbors. Without Medicaid, many seniors would not be able to afford these needed services with Medicare alone. 84 percent of individuals in nursing facilities covered by Medicaid in 2019 were dually eligible, with Medicaid covering costs once Medicare benefits have been depleted. 

Increased Medicaid Funding For Caregivers Benefits People With Disabilities. The Biden-Harris administration recently announced renewed efforts to increase Medicaid funding for caregivers, a critical contingent of care for millions of people with disabilities who rely on these types of providers to meet their basic needs.

Hundreds of Thousands of Seniors Are Stuck In The Medicaid Coverage Gap. 10 states have refused to expand Medicaid under the Affordable Care Act (ACA), stranding many seniors with low incomes in the Medicaid coverage gap. As a result, over 407,000 older Americans 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 seniors from at least 25 percent of those in the Medicaid coverage gap in Tennessee, Alabama, Georgia, South Carolina, and Florida.

  • Over 10,000 Older Americans Died Prematurely Due To States’ Decisions Not To Expand Medicaid. Due to states’ decisions not to expand Medicaid under the ACA, 10,444 older Americans died prematurely between 2014 and 2017 alone in the 10 states that have refused to expand the program.

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.
ashoup
In Research, Fact Sheet, News

FACT SHEET: Medicaid Works For Women & Children

April marks the 7th annual Medicaid Awareness Month. Medicaid is an essential source of coverage for women and children. More than 18 million, or nearly 1 in 5, adult women are enrolled in Medicaid. Approximately 40 million, or half of all children in the U.S., are enrolled in Medicaid or the Children’s Health Insurance Program. Medicaid coverage brings affordable care and financial security to women and families, and it helps narrow racial and rural disparities in health care. As the nation faces an unacceptably high and worsening rate of pregnancy-related death, Medicaid coverage is more important than ever to help pregnant women and new moms access the health care they need. 

Medicaid is a popular, lifesaving program, but Republicans want to cut it and rip coverage away from millions of hardworking families. Over 66 percent of Americans, including 55 percent of Republicans, have a favorable opinion of Medicaid. 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. And as Medicaid transitions back to its pre-pandemic eligibility and enrollment rules, too many people, especially children are losing coverage because of the carelessness and callousness of certain Republican governors who are terminating coverage for people who may still be eligible. Republicans also won’t quit their mission to repeal the Affordable Care Act (ACA) and Medicaid expansion, putting health care for millions of women and families in jeopardy.  

By The Numbers

  • Medicaid Covers Nearly 18.5 Million Women Nationwide. 18.44 million adult women ages 19-64 rely on Medicaid for coverage.
  • Most Women On Medicaid Are Working Or Have Caregiving Responsibilities. According to the Kaiser Family Foundation, the vast majority of women enrolled in Medicaid work, including mothers on Medicaid. In 2020, 93 percent of women enrolled in Medicaid were either working, going to school, at home caring for young children or relatives, or experiencing an illness or disability that does not permit them to work. 
  • Medicaid Is A Major Source Of Coverage For Women Of Color. Due to systemic inequality that results in fewer women of color having access to employer-provided coverage, women of color are disproportionately likely to enroll in Medicaid. 31 percent of Black women and 27 percent of Hispanic or Latina women rely on Medicaid, compared with just over 16 percent of white individuals. Women of color experience higher rates of poverty than white women and remain less likely to have access to quality care.
  • Medicaid Covers Nearly Half Of Women With Disabilities. Medicaid covers more than 44 percent of nonelderly women with mental and physical disabilities. As of 2019, Medicaid was the source of health coverage for one in four American women with mental illness.
  • Over 50 Percent Of Children Are Enrolled In Medicaid And CHIP. Approximately 40 million children in the United States are enrolled in Medicaid or CHIP. 
  • 1.6 Million People Would Gain Coverage If Remaining States Expanded Medicaid. Estimates from the Center on Budget and Policy Priorities found that roughly 1.6 million people, including children, would enroll in Medicaid and CHIP if the remaining 10 states implemented expansion. These states are Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wyoming, and Wisconsin. 
  • The Children’s Uninsured Rate In Medicaid Holdout States Is Double The Rate In Expansion States. In 2021, the child uninsured rate was 7.1 percent in holdout states, compared to 4 percent in states that adopted expansion. If holdout states expanded Medicaid, the number of uninsured children would drop by 7.3 percent. 
  • Almost Half Of Births Are Covered By Medicaid. Medicaid covers over 40 percent of births in the United States. Thanks to the American Rescue Plan, states were given the option to extend coverage to new mothers for one year postpartum, which improves maternal health outcomes. Congress subsequently made this option permanent as part of end-of-year legislation signed into law at the end of 2022. 45 states, the District of Columbia, and the United States Virgin Islands have extended postpartum Medicaid coverage for a full year, and Nevada and Idaho are planning to do so. Arkansas, Iowa, and Wisconsin have not extended postpartum coverage. 

Medicaid Coverage Benefits Mothers And Women Of All Ages

Medicaid Is The Largest Payer Of Reproductive Health Care Coverage. Medicaid covers nearly 17 million women of reproductive age, giving them access to reproductive health care services such as birth control, cancer screenings, and maternity care without cost-sharing. Medicaid’s reproductive health coverage is especially important in states that have further restricted access to abortion in the wake of the Supreme Court overturning Roe v. Wade.

  • Expanding Access To Care At Every Stage. There is an urgent need for quality, affordable health coverage prior to, during, and after giving birth. The United States continues to experience the highest rates of maternal mortality among wealthy nations, deaths that Centers for Disease Control and Prevention (CDC) data show are largely preventable. While 48 percent of maternal deaths occur during pregnancy and delivery, more than half, 52 percent, occur in the year following the birth of a child. Recent CDC data show that 4 in 5 of maternal deaths are preventable. 12 percent of maternal deaths are deemed “late,” occurring between six weeks and one year following delivery, demonstrating the immense need for continuous health access and coverage for a minimum of one year following the birth of a child. The Biden-Harris Administration has established a pathway to coverage, providing states the opportunity to extend postpartum coverage under Medicaid from 60 days to 12 months following birth. Currently, 47 states have elected to extend Medicaid coverage for a full year postpartum.
  • More Than Four In 10 Births Are Covered By Medicaid. More than 4 in 10 births were financed by Medicaid in 2022. Rates varied across the nation, with 61 percent of births financed by Medicaid in Louisiana, and 22 percent in Utah. Medicaid covers 65 percent of all births to Black mothers and 59 percent of all births to Latina mothers.
  • Expanding Medicaid & Closing The Coverage Gap Is Critical To Improving Maternal Health. Women of color consistently experience higher rates of maternal mortality than white women, largely due to the intersection of health with race, gender, poverty, geography, and other social factors.
  • Medicaid Helps Keep Families Out Of Debt. 41 percent of Americans reported having debt due to medical costs or bills. Since Medicaid was expanded by the ACA, the program has covered the medical expenses of millions more poor and near-poor adults than it did previously, helping prevent households from becoming poor because of medical spending.

Medicaid Improves Access To Care For Women. Women with Medicaid are far more likely to receive care than uninsured women. According to the Kaiser Family Foundation, women with Medicaid coverage are less likely than women with private insurance to report delaying or forgoing care due to cost. Women with Medicaid coverage receive preventive care such as cancer screenings and well-women services at roughly the same rates as women with private coverage and at a higher rate than women without insurance. 

Medicaid Helps Pay For Long-Term Care, Relied On By Elderly Women. Medicaid pays for roughly half of the nation’s long-term services and supports. In 2019, women accounted for 59 percent of the 12.3 million dual-eligibles, or people who rely on both Medicare and Medicaid for coverage. Most dual-eligibles are elderly, and many need Medicaid coverage for their long-term care needs.

Medicaid Creates Jobs In The Health Industry, Which Is Overwhelmingly Female. Kaiser Family Foundation estimates that there are 15.5 million frontline health care workers — 77 percent of which are women — establishing Medicaid as a major job creator for women. 

Medicaid Coverage Has Long-Term Benefits For Children 

Research Shows Medicaid Prevents Child Deaths. A 2020 study found that children who received health insurance through Medicaid were less likely to die young, be employed in their adult life, and less likely to develop a disability as an adult. 

Medicaid Helps Children Stay Healthy, Leads To Long-Term Benefits For Children When They Grow Up. Medicaid eligibility during childhood lowers the high school dropout rate, raises college enrollment, and increases four-year college attainment. Medicaid for children also has a positive impact on employment opportunities later in life. For each additional year of Medicaid eligibility as a child, adults by age 28 had higher earnings and made $533 additional cumulative tax payments due to their higher incomes.

Thanks To Medicaid, Students Have Access To The Resources They Need To Focus In School. Medicaid’s Early Periodic Screening Diagnostic and Treatment benefit gives children under 21 years old access to comprehensive and preventive health services, such as yearly physicals, hearing, vision, and dental screenings, and physical, mental, and developmental disability treatments. The benefit also helps students gain access to medical supplies, such as hearing aids, glasses, and assistive technology, to help them succeed in school. 

The ACA’s Medicaid Expansion Helps Children Gain Access To Care

After the ACA expanded access to Medicaid, the children’s uninsured rate fell to an all-time low. Research confirms expanding access to Medicaid for parents has had ripple effects for their children. At the same time, the 10 states that continue to reject expansion are limiting children’s health care access: 

Medicaid Expansion Led To Gains In Coverage For Children As Well As Parents. Parents enrolled in Medicaid are more likely to access the support they need to be a healthy and effective parent. When parents gain coverage they are more likely to enroll the whole family, so the family will be protected from the economic strains of medical debt and lay the groundwork for optimal child development. Children of parents who are enrolled in Medicaid are more likely themselves to have coverage, due to parents having a more straightforward experience adding their children than if they have never signed up for coverage before. Medicaid for children will save families an estimated $1,222 per year per child when states implement 12-month continuous Medicaid and CHIP eligibility.

The Children’s Uninsured Rate In States That Have Rejected Expansion Is Twice The Rate In States That Expanded The Program — And That Gap Is Growing. The rate of uninsured children in states that have not expanded their Medicaid coverage grew at nearly three times the rate than that of states that have expanded Medicaid coverage. Texas and Florida, two non-expansion states, were responsible for 41 percent of coverage losses for children in a three-year period. 

When Parents Have Health Insurance, Children Are More Likely To Have Coverage. When parents are covered, their children are more likely to have access to health care and have long term benefits from that coverage. Adults who had health insurance as a child were more likely to have better health as adults, including fewer hospitalizations and emergency visits. Medicaid eligibility during childhood is also more linked to a higher likelihood of graduating from high school and college, as well as having higher wages in adulthood.

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. 
ashoup
In Research, Fact Sheet, News

FACT SHEET: Medicaid Works For Rural Americans

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. 
ashoup
In News, Research, Fact Sheet

FACT SHEET: Medicaid Is a Vital Source of Coverage for Communities Of Color

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. 
ashoup
In News, Report, Research

NEW REPORT: 85 Million Depend on Medicaid and CHIP, But GOP Doubles Down on Plan to Rip Coverage Away

Medicaid Awareness Month: Republicans Wage War on Medicaid As 85 Million Americans Rely on The Program for Affordable Health Care

Read the Full Report Here.

Washington, D.C. — On the first day of Medicaid Awareness Month, Protect Our Care is releasing a new national report detailing Republican plans to slash Medicaid and rip coverage away from millions of Americans. While Medicaid Awareness Month is a celebration of how this vital health care program has touched millions of families across the nation, it is also an important reminder that Medicaid remains under attack by Republicans. 

“Republican lawmakers are playing a dangerous game as they escalate their attacks against Medicaid and affordable health care,” said Protect Our Care Executive Director Brad Woodhouse. “If MAGA Republicans get their way, Medicaid coverage will be ripped away from kids, seniors, and working people who count on it, reversing all of the progress made by Democrats and the Biden-Harris administration. The consequences of the GOP plans for Medicaid would be devastating, and they are entirely out of step with voters across parties.”

More than one in four Americans are covered through Medicaid or the Children’s Health Insurance Plan (CHIP), and the program serves people from all backgrounds, including children, mothers, people of color, people with disabilities, working families, rural Americans, and seniors. Yet Republicans won’t stop trying to make it harder to access affordable care. The latest GOP budget proposal slashes trillions from Medicaid through block granting and calls for work reporting requirements and other bureaucratic measures designed to throw people off their coverage. GOP leaders in 10 states have failed to expand Medicaid under the Affordable Care Act (ACA), blocking 1.6 million people from lifesaving coverage. Three states under GOP leadership have also failed to expand Medicaid coverage to mothers for 12 months postpartum, refusing to help address the growing maternal mortality rate as one in three pregnancy-related deaths occurs between six weeks and one year after birth. 

On the other hand, President Biden and Democrats in Congress have defended Medicaid from GOP attacks, created multi-billion dollar incentives for Medicaid expansion, stopped onerous work requirements, pushed for expanded postpartum coverage, and worked to minimize the impacts of Medicaid unwinding. The contrast with Republicans could not be clearer. 

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.
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NEW REPORT: Leading Civil Rights Organizations Call on State Leaders to Address History’s Deepest Medicaid Losses by Halting Medicaid Terminations for People Who May Still Be Eligible

New Report Finds That If All States Achieved Results Like Those in the 10 Best States, 4.5 Million People Would Not Have Been Disenrolled from Medicaid for Paperwork Reasons

Watch the Full Event Here.

Read the Full Report Here. 

Washington, DC – Today, U.S. Representative and Congressional Black Caucus Chair Steven Horsford and U.S Representative and Congressional Asian Pacific American Caucus Member Jill Tokuda joined leaders of civil rights and health equity organizations including Protect Our Care for a press call releasing a new report detailing how six months after Medicaid’s pandemic-era continuous coverage requirement ended, millions of people in America are being needlessly disenrolled from critical health care coverage because of missed paperwork, creating an avoidable civil rights and health equity disaster. 

According to the report, more people and more children have lost Medicaid in just six months of unwinding than during any two-year period in American history. The report estimates that more than half of families terminated from Medicaid come from communities of color, including 2.3 million Latinos, 1.8 million African Americans, 400,000 Asian Americans, Native Hawaiians and Pacific Islanders, and more than 400,000 Native Americans,  During the call, speakers called on state leaders to halt procedural disenrollments until they make major reforms that cut such disenrollments to the lowest achievable level.

The report finds that 10 million people have been disenrolled from Medicaid – more than 70% of whom were terminated for nothing more than missing paperwork. If all states performed as well as the states with the lowest rates of procedural disenrollment, two-thirds of procedural terminations would have been prevented, and 4.5 million people would not have been terminated because of missing paperwork. 

Last month, the Biden administration took an important step to address this crisis by requiring states to restore Medicaid to 500,000 people – mostly children – known to have been wrongly terminated. However, state leaders must make further major reforms to ensure that only people known to be ineligible are terminated from Medicaid.

The report is co-authored by the Asian and Pacific Islander American Health Forum, the Leadership Conference on Civil and Human Rights, NAACP, the National Council of Negro Women, the National Council of Urban Indian Health, the National Urban League, the Southern Poverty Law Center Action Fund, UnidosUS, the Coalition on Human Needs, and Protect Our Care. 

“We cannot afford to roll back the hard-fought progress we have made on Medicaid, which has helped to narrow racial disparities in health coverage and provide much-needed access to life-saving care in communities of color,” said U.S. Representative Steven Horsford (D-NV-04), Chair of the Congressional Black Caucus. “As a result of Medicaid “unwinding”, nearly 1.8 million Black Americans’ Medicaid coverage has been terminated in the last six months because of missing paperwork, which will only exacerbate existing disparities in access to health care for communities that we serve. The CBC joins our Tri-Caucus colleagues in calling for states to significantly cut rates of procedural terminations by renewing eligible families’ coverage and placing terminations on hold where possible, and by ensuring that beneficiaries have the necessary tools to complete their paperwork needed to determine their eligibility.”

“This report shows what we feared: since the end of the Medicaid continuous coverage requirement, we’ve seen one of the largest losses of health insurance coverage in American history,” said U.S. Representative Nanette Barragán (D-CA-44), ​​Chair of the Congressional Hispanic Caucus. “Millions of Americans, including almost 5 million Latinos, were able to access life-saving health insurance coverage because of the continuous coverage requirement. Now that the requirement has ended, millions of people and especially communities of color, are at risk of losing their health coverage. It’s critical that state leaders take all possible steps to minimize loss of coverage, including by pausing procedural disenrollments as soon as possible. We cannot allow more low-income communities to be left behind. While the Biden Administration has provided states guidance and flexibilities to address this crisis, states must do more to protect families from wrongfully losing Medicaid coverage.”

“As an executive board member of the Congressional Asian Pacific American Caucus and the co-chair of the bipartisan Rural Health Caucus, I know that access to health care is a matter of life and death for our communities of color across the country,” said U.S. Representative Jill Tokuda (D-HI-02), Member of the Congressional Asian Pacific American Caucus. “For too long, black and brown people have been disproportionally represented when it comes both to loss of Medicaid and negative health outcomes due to lack of health access. A majority of Hawaiʻi residents are AANHPI, and I have been particularly concerned about Medicaid redeterminations for our AANHPI communities. There is an ongoing need for in-language materials, community navigators, and outreach from trusted messengers to ensure AANHPI individuals can get the health services and resources they need and in a culturally competent manner. We need to meet patients where they are at. And in doing so, we can improve health outcomes and lower healthcare costs.”

“Advocates and lawmakers alike have been sounding the alarm about Medicaid Unwinding for over a year, urging states to lead and act promptly to preserve health coverage for millions of vulnerable families and children,” said Juliet K. Choi, President and CEO of the Asian & Pacific Islander American Health Forum. “Communities of color, including Asian Americans, Native Hawaiians and Pacific Islanders, are losing life-saving care due to administrative blunders and bureaucracy. We continue to call upon the Biden-Harris administration to act, and on states to mobilize the resources necessary to make sure no family or child is left behind.”

“It is a sad reality that it took a global pandemic for our nation’s elected leadership to expand life-saving healthcare services to hardworking Americans,” said Derrick Johnson, NAACP President & CEO. “The fact of the matter is, our healthcare system has long failed our most vulnerable. This data is further proof that the procedural disenrollment process is steeped in racism. We will not stand by while millions within our community are once again left without a lifeline. The NAACP stands with UnidosUS and other leading civil rights organizations to call for an immediate pause on all procedural Medicaid disenrollments. Our state leaders must make every effort to re-enroll those who have lost coverage, leveraging available data to verify eligibility or providing readily accessible support to complete the paperwork needed to confirm eligibility.”

“The COVID-19 pandemic laid bare inequities in our healthcare system that have plagued the nation, particularly communities of color, for decades,” said Shavon Arline-Bradley, President and CEO of the National Council of Negro Women. “The termination of Medicaid benefitting our children, seniors, and qualified individuals prioritizes procedure over progress. While some states have gotten it right, we call on those states and their lawmakers that have allowed wrongful Medicaid disenrollment to not sit idly by while the constituents that elected them to office go without the critical care they need and deserve. As this comprehensive report shows, the state of health care is in crisis, and this must be reversed immediately.”

“The Medicaid redetermination is proving to be perilous for communities of color, who are disproportionately losing coverage for red tape reasons,” said Marc H. Morial, President and CEO of the National Urban League. “We support the Biden-Harris administration’s actions to enforce the law and call on states to do more to protect their people from becoming uninsured.” 

“We are witnessing the deepest and steepest losses in Medicaid insurance coverage in our nation’s history,” said Eric Rodriguez, Senior Vice President, Policy and Advocacy at UnidosUS. “Many have been dropped from Medicaid due to nothing more than missing paperwork and red tape.  Communities of color — including 2.3 million Latinos — are bearing the brunt of those losses, making health care unaffordable for them and deepening already serious health inequities across the country. The report finds that most of those that have lost Medicaid health insurance coverage may have still been eligible and that despite having the funds, state leaders did not invest the money needed to protect families from being unjustly dropped from the program.”

“It is unacceptable that millions of Americans are losing life-saving health care because of preventable paperwork issues,” said Leslie Dach, Founder and Chair of Protect Our Care. “Many of the states that are failing to keep people covered, like Texas, Georgia, and Florida, are the same ones that have rejected Medicaid expansion, leaving families with no place to turn for basic health care. If those states continue on the path of refusing to protect families who rely on Medicaid coverage, the consequences will be devastating, particularly for communities of color and children. Losing access to health care means people won’t get the care they need to stay healthy and thrive, often having to make difficult choices between visiting the doctor or keeping a roof over their heads. While the Biden administration has taken a number of important steps to address this crisis, these states must do more to protect families and stop inappropriately kicking people off Medicaid.”

“The nation’s Medicaid program is vital to the health and well-being of individuals and communities,” said Margaret Huang, president and CEO of the Southern Poverty Law Center and the SPLC Action Fund. “It is incredibly alarming that nearly 10 million people — including millions of children — have been terminated from this program largely because of unnecessary red tape. These ‘procedural’ terminations cause harm, especially to communities of color and children. They also deepen the current healthcare crisis in our Deep South states that have not yet expanded the program. Driving hundreds of thousands of people into not having health coverage is unacceptable and states must do more.”

“It is extremely troubling that some states are dropping huge numbers of people from their Medicaid programs because of bureaucratic hurdles, without even knowing whether they remain eligible,” said Deborah Weinstein, Executive Director of the Coalition on Human Needs.  “States with records so much worse than better-performing states should be required to pause terminations while they improve their systems.”

“The report highlights the disproportionate impact Medicaid unwinding is having on Native communities,” said Francys Crevier (Algonquin), CEO of the National Council of Urban Indian Health. “Medicaid and CHIP coverage are critical to fulfilling the United States’ trust responsibility to maintain and improve Native health, as inadequate insurance coverage is a significant barrier to healthcare access for Native people. Eligible Native children and families are losing coverage for administrative reasons and the federal government has a trust obligation and must do more to protect them.”

“Medicaid pandemic coverage protections were a lifeline for people who struggled to pay all their bills, helping them to see a doctor if they were sick, or get other vitally necessary health care,” said Maya Wiley, president and CEO of The Leadership Conference on Civil and Human Rights. “Since pandemic coverage expired six months ago, we’ve seen the steepest Medicaid coverage losses in history. Make no mistake. Losing Medicaid coverage is losing that lifeline. Those losses have been disproportionately borne by the communities our coalition represents, including people of color, people with disabilities, children, older adults, low-wage workers, and so many others. This deepens and compounds unfair differences in who can and who can’t get the medical care they need. We urge state leaders to do everything in their power to keep eligible folks covered and prevent further catastrophe that is a deep problem for a country that once made great strides on civil rights.”

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In Fact Sheet, Research

FACT SHEET: Medicaid Is A Lifeline For People With Disabilities

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.

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In Fact Sheet, Research

FACT SHEET: Medicaid Fills In Gaps For Seniors & Older Adults’ Coverage

This April marks the 5th annual Medicaid Awareness Month. Medicaid is an essential pillar in providing coverage for seniors and older Americans. Medicaid remains a critical source of coverage as Americans age, with Medicaid serving as a primary funder for long-term care and filling many of the gaps in Medicare coverage, such as transportation to medical appointments and medical equipment. More than 7.2 million American seniors and 8.5 million adults aged 50 to 64 rely on Medicaid coverage. The benefits of Medicaid for America’s aging population often go unnoticed, but are essential to the health and well-being of this population. For seniors and older Americans with low incomes, Medicare premiums are paid by Medicaid, as well as deductibles and health care that requires cost-sharing. Without Medicaid’s supplements to Medicare, millions of seniors would be forced to go without needed care. 

States that expanded their Medicaid programs saw millions of additional seniors and older Americans gain coverage. By rejecting expansion, the 10 non-expansion states are limiting the care older Americans can receive. Despite Medicaid expansion’s proven role in reducing disparities in health care access and improving outcomes, Republicans have spent years undermining the expansion of Medicaid, blocking millions from coverage. Currently, an estimated four million uninsured adults are locked out of coverage in the 10 holdout states. 

By The Numbers

  • Millions of Seniors & Older Americans Rely On Medicaid Coverage. 7.2 million Americans over 65 are enrolled in Medicaid and more than 8.5 million Americans ages 50 to 64 have health coverage through Medicaid – many thanks to the Affordable Care Act’s Medicaid expansion.
  • Nearly 6 Million Older Adults Live Below The Federal Poverty Level. For millions of seniors and older Americans on fixed incomes, Medicaid is a critical lifeline.
  • Medicaid Funds Nearly Half Of Long-Term Care Nationwide. As seniors age, long-term care services become more essential, serving about 70 percent of seniors who will need some form of long-term care in their lives.
  • More Than 1.9 Million People Would Gain Coverage If Remaining States Expanded Medicaid. Over 1.9 million people would gain Medicaid coverage if the remaining states implemented expansion, roughly 324,000 of the uninsured in the coverage gap are aged 55-64.
  • Medicaid Pays For 62 Percent Of Long-Term Care Residents In Nursing Homes. Medicaid covers nursing home bills for over 60 percent of residents in nursing homes. In 2019, this totaled over $50 billion. The median private nursing home room cost over $100,000 a year in 2021.
  • 12.5 Million Medicare Beneficiaries Also Have Medicaid Coverage. Nearly 10 million of the dual eligible Medicare-Medicaid beneficiaries are “full benefit” Medicaid enrollees who have access to a range of Medicaid benefits, not otherwise covered by Medicare.

Seniors And Older Adults Depend On Medicaid For Affordable, Comprehensive Care. As of 2021, there are 3.6 million older adults going without coverage. Older Americans often have more complex health issues, requiring additional medical attention that is often costly, pushing care out of reach. For seniors on Medicare, Medicaid serves to fill many of the gaps in Medicare coverage, such as transportation to medical appointments and medical equipment. In states that have failed to expand Medicaid coverage, 15,600 older adults died prematurely due to lack of care between 2014 and 2017.

Medicaid Supplements Medicare Coverage For Millions Of Seniors. 12.5 million seniors are Medicare-Medicaid dual beneficiaries. Nearly 10 million are “full benefit” Medicaid enrollees who have access to a range of Medicaid benefits, not otherwise covered by Medicare. Over half of dual enrollees are seniors of color and nearly 4 in 10 dual enrollees suffer from long-term disabilities. 

Medicaid Helps Seniors And Older Americans Stay Retired And Out Of Poverty. Many seniors and older Americans survive off of low incomes or have chronic health conditions that prohibit them from working. Medicaid allows these individuals living on fixed incomes and often have chronic diseases to continue getting the care they need by filling in the gaps in their Medicare coverage without having to worry about choosing between food and housing or their health. 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 seniors and older adults. 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 as Americans age. 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.

Low-Income Seniors With Medicare Depend On Medicaid For Long-Term Care. It is estimated that 70 percent of seniors will need long-term care at some point and 62 percent of nursing facility residents utilize Medicaid to receive their care. Medicaid is a critical provider of home- and community-based care that are essential to keep loved ones at home with their families and neighbors. Without Medicaid, many seniors would not be able to afford these needed services with Medicare alone. 84 percent of individuals in nursing facilities covered by Medicaid in 2019 were dually eligible, with Medicaid covering costs once Medicare benefits have been depleted. 

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In Fact Sheet, Research

FACT SHEET: Medicaid Works For Rural Americans

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.

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In Research, Fact Sheet

FACT SHEET: Medicaid Benefits Communities Of Color

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.

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