As the Senate debates imposing work requirements and potential cuts to Medicaid, rural America stands at the front lines of risk. For millions of rural residents, Medicaid is not just a safety net – it’s a lifeline. The statistics and stories from Arkansas, the first state to implement such work requirements, demonstrated the profound damage these policies inflict – especially in rural communities where health care options are already scarce and economic stability is fragile.
When Arkansas imposed Medicaid work requirements in 2018, the consequences were rapid and severe: More than 18,160 people lost coverage in just five months before courts halted the policy. Many of these people lived in rural areas where jobs are hard to come by and transportation options are limited.
The majority of those who lost coverage were working people – fast food workers, janitors, landscapers, nursing assistants and others in low-wage jobs. Many had chronic health conditions or disabilities. In rural areas, where employment often means seasonal or unstable work, reporting requirements became insurmountable barriers. People lost coverage not because they weren’t willing to work, but because they couldn’t navigate a confusing, glitch-ridden system or because their hours fluctuated because of the nature of rural labor markets.
Rural Americans are disproportionately dependent on Medicaid compared to their urban counterparts. Medicaid and the Children’s Health Insurance Program (CHIP) cover 47% of children in rural areas, compared to 40% in metropolitan counties. In La Plata County, one in three people relies on Medicaid.
Medicaid cuts hit rural hospitals and clinics hardest, as noted by three local hospital CEOs (Herald, June 4). Nationwide, Medicaid covers 16.1 million rural residents and is a vital source of revenue for rural hospitals, which often serve as the primary – and sometimes only – health care providers in their communities.
In the past decade, 120 rural hospitals have closed or stopped offering inpatient services. More than half of rural hospitals (52%) no longer have maternity wards, compared to 36% of urban hospitals. Proposed Medicaid cuts threaten to accelerate this trend, potentially resulting in more closures, reduced services, and longer travel distances for care.
The impact of Medicaid cuts and work requirements extends beyond health outcomes. Rural hospitals are often major employers and economic anchors in their communities. Their closure or downsizing would mean job losses and diminished economic activity, further destabilizing already vulnerable areas. Nonprofits – food banks, domestic violence shelters, senior centers – must divert scarce resources to help people navigate Medicaid bureaucracy, compounding the strain on rural social services.
Attempts to automate Medicaid compliance checks with new technology have failed. Computer systems often flag small, irrelevant income differences, triggering requests for more information and resulting in lost coverage due to delays or confusion. Rural residents, who may lack reliable internet or transportation, are especially vulnerable to these bureaucratic hurdles.
Attempts by state governments to use algorithms and artificial intelligence to determine benefits eligibility in Texas and Florida, to decide how much home care disabled people need in Arkansas or to detect unemployment fraud in Michigan, have all failed. This kind of disastrous policy doesn’t come cheaply, either. A U.S. Government Accountability Office report estimated that administering work requirements in Arkansas alone cost over $24 million in state and federal funds for less than a year of operation.
What happened in Arkansas is not an isolated incident – it’s a warning. If Congress mandates Medicaid work requirements or cuts, rural communities will bear the brunt: massive coverage losses, hospital closures, overburdened social services and a sicker, less stable workforce. The statistics are clear, and the human stories are heartbreaking. Rural America cannot afford another blow to its health and economic stability. Medicaid must be protected – for the sake of rural survival. Take action by calling our senators’ offices and ask what they’re doing to avoid Medicaid chaos.
Jan Phillips, is a retired small-business owner and 35-year resident of Durango. After 45 years as a health educator, she is currently involved in advocating for health care reform.
