The Impact of Medicaid Expansion on Rural to Urban Migration

The Affordable Care Act’s Medicaid expansion provision allows states to expand coverage to able-bodied adults earning up to 138 percent of the Federal Poverty Level. Initially, only twenty-four states chose to expand Medicaid, with another fifteen states expanding coverage since 2014. Hospitals in rural areas have advocated for expansion, arguing that expansion benefits both rural Medicaid recipients and the entire community as decreased health insurance coverage makes it more difficult for providers to profitably serve their communities. This paper finds that under Medicaid expansion, rural residents are less likely to migrate to urban areas. This effect was larger for younger and more educated residents and those with children. The results hold when the sample is limited to those with private health insurance coverage, further suggesting that the impact comes through a healthcare amenity effect. Educated urban residents in expansion states are also more likely to move to rural areas.