In recent decades, Medicaid and the Children's Health Insurance Program (CHIP) have represented important sources of health insurance coverage for children, particularly those who live in rural areas. However, data suggest that the number of U.S. children covered by these public insurance sources has declined in recent years. Between 2016 and 2019, rates of public coverage among children declined slightly (39.5% to 37.1%) while the number of uninsured children increased by nearly 700 thousand. Some have speculated that changes in state health policy, particularly Medicaid eligibility shifts, have played a role in this coverage decline. However, it is unclear whether rural versus urban children have experienced comparable rates of decline or whether there have been geographic differences (by rurality or region) or disparities among specific rural populations.

This study will address that gap using the Census Bureau's American Communities Survey. Specifically, we will examine what percentage of rural and urban children was covered by Medicaid/CHIP in 2016-2020 versus 2011-2015 and whether any observed changes differ by rural-urban residence. We will also estimate who are the children eligible but unenrolled in Medicaid/CHIP and whether there are rural-urban differences.