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Rural families and clinics feel Medicaid cuts


Nada Hassanein | Stateline.org (TNS)

Rural children and families are having to skip vital health treatments and even ending up in the emergency room, while already struggling rural clinics are losing more patients, as states cull their Medicaid rolls.

The process began in April 2023, when pandemic-era rules that prohibited kicking people off Medicaid coverage expired and states again began checking whether families met income restrictions. Nationally, nearly 70% of people who lost coverage did so for “procedural” reasons such as incomplete paperwork.

States with the largest drops in coverage also have large rural populations. The loss of coverage compounds struggles disproportionately experienced by rural children and families, experts say, including clinician shortages, long drives to care and poorer health outcomes.

Eight states — Alaska, Arkansas, Colorado, Idaho, Montana, New Hampshire, South Dakota and Utah — had fewer children enrolled at the end of last year than before the COVID-19 pandemic, according to a recent analysis by the Georgetown University Center for Children and Families.

“Medicaid is even more of a lifeline for rural communities than it is for urban ones,” said Joan Alker, the center’s executive director. “There are quite a number of states with large rural populations where things are not going well — so that’s very problematic.”

A year into the process, frequently referred to as Medicaid “unwinding,” South Dakota, Montana, Utah, Texas and Idaho have seen the largest plunges in rates of children losing coverage, with an average of 25% fewer children enrolled in those states since April 2023.

In rural areas, which on average have higher rates of poverty, children are less likely than their urban counterparts to have had a medical checkup or dentist visit in the past year, the center reported.

These families are already so much living on the edge, and it’s hard for them. — Dr. Noreen Womack, Idaho pediatrician

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