“The examples in this report highlight the journeys of the Sentinel Communities to increase access to healthcare through Medicaid expansion, as well as the tensions that have prevented expansion.”
—RAND Corporation
Culture of Health Sentinel Community Insights: Medicaid Expansion
Brief Aug-01-2022 3-min read
Table of Contents
Table of Contents
Report Publish Date: August 2022
This brief report describes the impact of Medicaid expansion in places participating in RWJF’s Sentinel Communities Surveillance project.
Primary Takeaways
Lack of access to care is a core issue in states that have not expanded Medicaid, some of which have actively blocked expansion through legislation and other means.
Health insurance coverage and access jumped dramatically in states that expanded Medicaid, including in some Sentinel Communities such as New Haven, Conn., and Oxford County, Miss. Medicaid expansion also helped enhance coverage for mental health and social determinants of health. But Medicaid recipients may still have trouble finding providers who accept Medicaid.
Overview and Objectives
Begun in 2016, RWJF’s Sentinel Communities Surveillance project tracks how a Culture of Health is developing in 29 communities across the country. The authors wanted to know the status and impact of Medicaid expansion in Sentinel Communities.
Hypothesis or Approach
The authors gathered information from phone interviews with Sentinel Community leaders; online, published, and local materials and media about the communities; and data sources including the Census Bureau’s American Community Survey, the CDC’s Behavioral Risk Factor Surveillance System, County Health Rankings, and state and local data collection systems.
How This Influences Change
“Going forward, it will be important to track new innovations enabled by Medicaid funding and successful approaches to influencing political will to close coverage gaps,” the authors write.
Research: Go Deeper
Medicaid was created in 1965 and provides stable, affordable health coverage to individuals and families with low incomes. It is jointly funded by federal and state governments, and states operate their own Medicaid programs, providing a good degree of flexibility while meeting federal guidelines. Enacted in 2014, expansion of Medicaid under the Affordable Care Act (ACA) made nearly all adults with incomes up to 138 percent of the Federal Poverty Level eligible for federal healthcare coverage and provided states with an enhanced federal matching rate for newly eligible individuals. However, expanding Medicaid is optional and 12 states (including some that are home to Sentinel Communities) have not adopted expansion.
Since Medicaid expansion, the number of uninsured individuals in the United States has fallen from 45 million to 29 million. Expansion has increased access to care; increased the number of individuals with low incomes with primary care providers; lowered medical debt; and improved chronic disease outcomes and self-rated health. Despite this evidence, some states have elected not to expand Medicaid, and some have implemented waivers to further restrict eligibility and covered benefits through time limits on coverage, work requirements, benefit restrictions, co-pay or premium requirements, healthy behavior incentives, and other features.
The decision of whether to expand Medicaid speaks to prevailing narratives at the state level about responsibility for health, the role of the government in healthcare, healthcare access as a determinant of health, and the value of health equity. This brief report describes the status of Medicaid expansion in the Sentinel Communities; some impacts of expansion; remaining gaps; and barriers and facilitators to implementing expansion, as uncovered through environmental scans and stakeholder interviews conducted for the Sentinel Communities Surveillance Project.
The report provides insight into Medicaid expansion in these communities but is not intended to be representative of the full extent of issues surrounding Medicaid expansion and access to healthcare.
Robert Wood Johnson Foundation, August 2022
Research Team
This study and report was conducted and created by the following people.
- RAND Corporation
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