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

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.