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A public health crisis is growing more acute in rural America, disproportionately impacting individuals with both Medicaid and Medicare (the “dually eligible”).
Rural residents suffer a “rural mortality penalty,” with rurality and poverty as predictors of mortality. In one study, researchers found that the U.S. rural-urban age-adjusted mortality disparity rate for adults had widened, nearly tripling from 62.3 per 100,000 in 1999 to 169.5 per 100,000 in 2019. Among the social determinants underlying this rural health crisis are hospital closures, workforce shortages, migration to urban centers, food deserts, inadequate transportation infrastructure, and limited access to broadband internet. Perhaps most affected are cultural minority populations and indigenous peoples.
The rural health crisis is a health equity concern that affects all rural residents, including dually eligible individuals. There are 47 to 60 million people residing in rural areas. Twenty-one percent of dually eligible individuals live in rural areas—that’s about 2.6 million people. Based on these numbers, the authors calculate that the dual eligible population residing in rural communities accounts for about 5 percent of the total rural population. Dually eligible individuals living in rural areas are at risk of falling through the cracks.