New Report: Shows Medicaid Plays More Significant Role in Small Towns and Rural Communities than Metro Areas in North Carolina

Georgetown University study indicates federal Medicaid cuts would have an outsized impact in rural North Carolina

By: Emily Blevins | February 2025

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Emily Blevins
Emily Blevins

Communications Director

RALEIGH— Medicaid plays a larger role in providing health coverage to people living in small towns and rural communities in North Carolina than it does in metropolitan areas, a trend that is particularly striking among children, according to an extensive analysis by the Georgetown University Center for Children and Families (CCF).

The report found that in North Carolina, non-elderly adults and children living in rural areas and small towns are more likely than those living in metro areas to rely on Medicaid for their health insurance. Report findings included:
  • Nearly 49 percent of children in North Carolina small towns and rural areas rely on Medicaid/CHIP for their coverage, compared to about 40 percent in metro areas.
  • Among North Carolina adults younger than 65, about 16 percent of those in small towns and rural areas get their coverage through Medicaid/CHIP, compared to about 12 percent in metro areas.
  • The number of North Carolina children living in small towns and rural areas that rely on Medicaid is higher than the national average of 41 percent for children.
  • Among seniors, 16 percent of those living in North Carolina’s small towns and rural areas were covered by Medicaid compared to 14 percent in urban areas.

“Every child in North Carolina deserves to reach their full potential,” said NC Child Executive Director Erica Palmer Smith. “And Medicaid helps ensure that no matter where a child lives—whether in a big city, small town, or in a rural community—they are able to grow up healthy, happy, and ready for the future.”

For the full report, as well as interactive maps featuring a county-level breakdown of Medicaid coverage, visit https://ccf.georgetown.edu/2025/01/15/medicaids-role-in-small-towns-and-rural-areas/. This report primarily relies on data from the Census Bureau’s 2023 American Community Survey (ACS).
The Center for Children & Families (CCF), part of the McCourt School of Public Policy at Georgetown University, is an independent, nonpartisan policy and research center founded in 2005.