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Close to half of North Carolina children living in rural areas or small towns use Medicaid as their health insurance, according to a new report.
As Republicans in the U.S. House of Representatives contemplate major cuts to Medicaid, a public policy group is highlighting the importance of the government health insurance program outside cities and suburbs.
In most states, children and adults younger than 65 living in rural areas and small towns are more likely to have Medicaid coverage than their metro-area counterparts.
Medicaid covered nearly 238,000 North Carolina children from rural areas or small towns in 2023, more children than in every other state except Texas, according to the Center for Children and Families at the Georgetown University McCourt School of Public Policy.
Children in North Carolina’s rural areas and small towns were more likely to rely on Medicaid for health insurance than children in metro areas. Medicaid covered nearly 49% of children in rural areas, while covering about 40% of children in metro areas. That nine-point difference ranked third in the nation.
Last week, Politico reported on a menu of potential budget cuts that originated from the House Budget Committee. It leans heavily on capturing savings from Medicaid and the Affordable Care Act to help pay for President-elect Donald Trump’s priorities.
Capping Medicaid is on the list. A Medicaid cap would give states a set amount of money for each person enrolled, rather than maintaining an open-ended program that helps pay for all eligible medical expenses.
The list of potential cuts also includes work requirements for Medicaid enrollees.
The Trump administration approved state requests to add work requirements during his first term, but they were struck down by courts.
Health care advocates consider work requirements a tool for kicking people off Medicaid.
Medicaid work requirements were in effect in Arkansas for less than a year before a court order ended them in 2019.
Researchers found that some people didn’t know about the requirement. Others were confused about the rules or were unable to report their work because they did not have internet access. People lost insurance coverage and reported they had problems paying off medical debt and delayed seeking medical care more often than people who kept their coverage.
The 2013 North Carolina law expanding Medicaid requires state health officials to pursue work requirements if there is any indication the federal government would approve.