State-Level Medicaid Expansion and Hospital, Federally Qualified Health Center, and Rural Health Clinic Availability

Area of Science:

• Health Services Research
• Public Health Policy
• Healthcare Economics

Background:

• Medicaid expansion's impact on healthcare access is well-documented in early adopter states.
• Longer-term effects, outcomes for later adopters, and rural-urban disparities remain less understood.

Purpose of the Study:

• To investigate the long-term association between state Medicaid expansion and the availability of hospitals, FQHCs, and RHCs.
• To assess these associations in states expanding Medicaid in 2014-2016.
• To examine differences in availability between rural and urban counties.

Main Methods:

• Difference-in-differences analysis for staggered policy adoption across U.S. counties (2010-2019).
• Controlled for county-level covariates including population, income, age, and demographics.
• Analyzed total numbers of hospitals, FQHC sites, and RHC sites in expansion vs. non-expansion counties, including rural/urban subsamples.

Main Results:

• Medicaid expansion correlated with a slight increase in hospitals (4.9% county-level increase) and FQHCs (26.7% county-level increase).
• No significant change was observed in the number of RHCs.
• Effects were present in both rural and urban counties, with proportionally larger increases in FQHCs in rural areas.

Conclusions:

• Medicaid expansion promotes sustained growth in hospital and FQHC availability, particularly benefiting rural areas.
• Lack of change in RHCs may indicate supply-side limitations.
• Policymakers should anticipate gradual strengthening of stabilization effects post-expansion.