Study: Arkansas tops nation for percentage of rural children on Medicaid

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Almost two-thirds of children in Arkansas’s small towns and rural areas receive health care coverage through Medicaid, according to a report released Wednesday by researchers at Georgetown University and the University of North Carolina — the highest percentage of any state in the nation.

The study, which was conducted by Georgetown’s Center for Children and Families and UNC’s North Carolina Rural Health Research Program, used county-level U.S. Census Bureau data to analyze changes in Medicaid coverage for children and adults in nonmetropolitan areas between 2008-09 and 2014-15. It found that the rate of Medicaid coverage is higher in the nation’s rural communities and small towns than in urban centers. Nationally, Medicaid covered 45 percent of children and 16 percent of adults in nonmetropolitan counties in 2014-15, compared to 38 percent of children and 15 percent of adults in metropolitan counties. (The study defines a nonmetropolitan county as one that lacks a central urban area of more than 50,000 people.)

The Medicaid figures include enrollment in the Children’s Health Insurance Program, or CHIP. In Arkansas, CHIP and Medicaid together fund ARKids A and B.

The divide between Medicaid coverage of rural and urban populations is starker in Arkansas than nationally. Among children in nonmetropolitan counties in Arkansas, 61 percent have Medicaid, compared to 46 percent of children in metropolitan counties. For Arkansan adults, the figures are 21 percent in nonmetropolitan counties and 16 percent in metropolitan counties. Arkansas experienced the nation’s eighth largest decline in the percentage of uninsured adults in nonmetropolitan counties during the years studied, from 29 percent in 2008-09 to 16 percent in 2014-15.

The findings underscore both Arkansas’s success at insuring a relatively large percentage of its population in recent decades — especially children — and the vulnerability of those gains to proposed cuts to Medicaid. The American Health Care Act, the Republican-sponsored bill passed by the U.S. House of Representatives in May to replace the Affordable Care Act, would cap federal Medicaid spending, and the Trump administration’s proposed budget includes further reductions to Medicaid and CHIP.

Joan Alker, the executive director of Georgetown’s Center for Children and Families and a co-author of the study, said such cuts would have a “disproportionately damaging effect on children in rural areas.” In a conference call with reporters, Alker noted that the cap proposed by the American Health Care Act would reach well beyond the low-income adult population covered by the Affordable Care Act’s Medicaid expansion to impact those populations covered by traditional Medicaid as well, such as children.

“It is a radical restructuring of the Medicaid finance system,” she said. “It’s nothing to do with the ACA; it’s just something they’re doing while they’re in the neighborhood.”

In Arkansas, broader cuts to Medicaid could threaten programs like ARKids. Marquita Little, health policy director at Arkansas Advocates for Children and Families, said capping Medicaid would mean “the state … would either have to cover fewer people, cut payments to providers, or reduce or change the benefits. Since we have such a high number of children in rural areas especially that rely on Medicaid, I think we can expect that those sorts of changes would have a devastating effect.” (Arkansas Advocates has provided funding to the Arkansas Nonprofit News Network.)

The study attributes the higher Medicaid coverage rates in rural counties to demographics. “Rural areas tend to have lower household incomes, lower rates of workforce participation, and higher rates of disability — all factors associated with Medicaid eligibility,” the study’s authors say. Thirty-eight percent of Arkansas’s nonelderly population lives in small towns and rural areas, compared with 14 percent nationally.

Notably, although Arkansas has the highest percentage of rural and small-town children on Medicaid, it is not among the states that have seen the largest increase in Medicaid coverage for those children in the time period covered by the study. That is because “Arkansas was ahead of the curve nationally with the ARKids program,” Alker said. ARKids, which was created 20 years ago under Republican Gov. Mike Huckabee, succeeded in extending coverage to most uninsured children in the state, including those in rural areas. In 2008-09, 7 percent of children in nonmetropolitan counties were uninsured. By 2014-15, the rate had declined to 4 percent.

Little said the Georgetown study “confirms for us that Medicaid is a lifeline in terms of having access to adequate care, especially for rural families in Arkansas.” She also said rural areas have benefited from the Affordable Care Act and its expansion of Medicaid to include low-income adults. “Those are the communities where hospitals are still open because we expanded coverage. … We’ve seen improvements in people who are actually accessing preventative care. And, in addition to low-income families, people with chronic illnesses are benefiting the most.”

Cutting Medicaid funding, Little said, could undo much of that. “Certainly, reducing access to coverage would have the opposite effect of what we’re trying to achieve in those communities … It would just be a U-turn in terms of progress in our state.”

This reporting is courtesy of the Arkansas Nonprofit News Network, an independent, nonpartisan news project dedicated to producing journalism that matters to Arkansans.

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