Racial, ethnic, and rural disparities in access to Medicaid offices

TL;DR

The study finds that access to Medicaid offices in the US varies by race, ethnicity, and rurality, with Hispanic and rural counties less likely to have offices.

Contribution

This is one of the first studies to examine racial, ethnic, and rural disparities in Medicaid office access using county-level data and geospatial analysis.

Findings

Over 75% of US counties have at least one Medicaid office, but access is uneven.

Counties with high Hispanic and rural populations are significantly less likely to have a Medicaid office.

The findings suggest a need for targeted investments in physical infrastructure and outreach in underserved areas.

Abstract

Physical Medicaid offices may play an important role in supporting beneficiaries and alleviating administrative burdens during critical enrollment or redetermination periods. Limited research has explored whether racial, ethnic, and rural disparities in access to Medicaid offices exist. Leveraging a county-level data set of geocoded Medicaid offices merged with American Community Survey data, we examined variation in Medicaid office density. We used a choropleth map to demonstrate variability within and across states and linear probability models to explore the association between demographic characteristics and having at least 1 Medicaid office in the county. Over three-fourths of US counties had an office, but access to such offices varied by race, ethnicity, and rurality. Counties with high Hispanic (≥40%) and rural (>50%) populations were associated with a 14.3 and 18.7 percentage point lower probability of having at least 1 Medicaid office (both P < 0.001), respectively. Findings can be used to prioritize areas for investment in physical infrastructure, specific group outreach, or technological advancements by state Medicaid programs. While the unwinding from the COVID-19 public health emergency may have highlighted these vulnerabilities and inequities, our findings reflect long-standing differences in investment across states that influence individuals’ access to Medicaid.

Over three-fourths of US counties had at least 1 Medicaid office, but access varied by race, ethnicity, and rurality. Counties with high Hispanic and rural populations had a lower probability of having a Medicaid office. To facilitate smooth enrollment processes and reduce administrative burdens, state Medicaid programs may consider investments into additional physical offices, community-based organizations for specific group outreach, or further advancements in technological processes such as online enrollment systems or mobile services.

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