Assessing the Impact of Medicaid Policy Changes
This project has two major components. One is an analysis of enrollment into the Medicaid program in each of 40 states since the enactment of the Patient Protection and Affordable Care Act of 2010 (ACA). Using county-level data obtained from the states, the analysis will explore rural-urban differences in enrollment as a percent of total population. States that expanded the Medicaid program will be analyzed separately from those that did not, and the two groups will be compared. The other project component is an assessment of the impact of disproportionate share hospital (DSH) payments on rural hospitals, with critical access hospitals addressed as a subset of all rural hospitals. Effects are expected to vary, given variation in state policies allocating DSH payments, as the percent of revenues represented by DSH payments.
- What has been the change in Medicaid enrollment in rural counties? How do states compare based on expansion v non-expansion, and within each of those two groups?
- What are the rural/urban differences in enrollment into Medicaid since implementation of the Patient Protection and Affordability Act (ACA), within and across states (and comparing within and across categories of expansion and non-expansion)?
- What might explain differences across states, including county characteristics, state political environment and resources, and use of waivers?
- What is the impact of Medicaid DSH payment on rural hospitals, by state?
Changing Rural and Urban Enrollment in State Medicaid Programs
RUPRI Center for Rural Health Policy Analysis
Medicaid enrollment growth in 36 states is analyzed by rural and expansion status, pre- and post-ACA. Enrollment growth was larger in expansion states but did take place in most states, with significant state-level variation in both groups. Metropolitan areas generally had higher growth than micropolitan and rural areas.