Medicaid and Rural America

An Interview with the National Rural Health Association

Medicaid provides coverage to millions of Americans in rural communities. Currently, 23 percent of adults and 47 percent of children in rural areas are enrolled in the modern Medicaid program. The Modern Medicaid Alliance (MMA) spoke with Diane Calmus, Regulatory Counsel, at the National Rural Health Association (NRHA) about the impact of the program on rural communities and the health of rural Americans.

Modern Medicaid Alliance: Tell us about the impact of Medicaid on rural communities.

National Rural Health Association: Rural communities are impacted by Medicaid because a large percentage of rural adults and children rely on the program. However, access to care is always an issue among rural communities. Because there are a limited number of providers, if a provider doesn’t work with people on Medicaid, then there is often no provider that serves the Medicaid population.

MMA: How does it impact the health of people in rural communities?

NRHA: Medicaid’s impact is unique. It provides many adults and children access to care. A total of 44 percent of rural hospitals are operating at a loss, up from 41% a year ago. Rural hospitals in Medicaid expansion states are less likely to be operating at a loss than those in non-expansion states. So we see the essential role Medicaid can play in keeping providers in the community and hospital doors open.

MMA: Does the NRHA have concerns relating to Medicaid and possible policy reforms?

NRHA: We need to make sure rural providers are paid in a way that allows them to keep their doors open. We’ve seen a number of hospitals stop providing labor and delivery services. With more than half of rural births covered by Medicaid, it is important to ensure vital services like labor and delivery remain available.

MMA: What kinds of Medicaid innovations are making a difference in rural communities?

NRHA: There are many different types of innovations, and we are looking at those that help rural providers keep their doors open. More than a third of rural hospitals are vulnerable to closure, so innovations that keep hospitals open are important. Maryland has an all-payer system that ensures hospitals in rural areas stay open. Hospitals receive payment based on their needs.

MMA: What other kinds of Medicaid innovations are you looking at?

NRHA: We are also looking at innovations relative to providers and opioids – there aren’t treatment options in rural areas and more deaths are occurring. This is a space where we need more innovation because the needs are so great. One innovation we’ve come across is Lily’s Place, which has a unique model for treating babies who are born addicted which is intertwined with the overall well-being of a family.

Diane Calmus, Regulatory Counsel
National Rural Health Association