Assistant Professor of Sociology and Center for Demography and Public Health faculty Matthew Brooks, Ph.D., received a grant from the National Institutes of Health to examine how Medicaid expansion impacts mortality rates between individuals who live in rural and urban regions.
This project began in Fall 2023 and is expected to be completed in Summer 2027. The research focuses on the period of Medicaid expansion, which refers to the state-level decision to expand Medicaid eligibility to adults living at 138% of the poverty level. To analyze the impact of this, the team utilized county-level mortality data from 2009 to 2022.
The research team that Dr. Brooks works with on this project includes Primary Investigator (PI) J. Tom Mueller, Ph.D. and Regina S. Baker Ph.D. Dr. Mueller is an assistant professor of Population Health at the University of Kansas Medical Center. Dr. Baker is an associate professor of Sociology at the University of Carolina at Chapel Hill.
The total award amount for the grant is $1,480,085 with $106,954 allotted to FSU’s portion of the research project. The primary funding recipient is the University of Kansas Medical Center.
“Our research team hopes that this project can both highlight the benefits that Medicaid expansion has had for those who live in cities and suburbs and try to inform future policy on how Medicaid expansion may need to be adapted to better fit rural communities and rural health issues,” Dr. Brooks said.
Additionally, the research examines whether White, Black, and Hispanic individuals in rural and urban counties have been particularly affected by Medicaid expansion.
In a 2024 study published in the Journal of Rural Health, the team determined that Medicaid expansion led to a reduction in mortality rates for individuals living in urban counties, with the largest declines for the urban Black population. However, they witnessed an increase in the mortality rates for individuals in rural areas, with the rural White population as the most negatively impacted population.
“As the project progressed, we found that Medicaid expansion has indeed had an impact on mortality rates, but in unexpected and opposing ways across rural and urban areas,” Dr. Brooks said. “These findings are concerning and suggest that Medicaid expansion may not be effectively addressing the major health issues facing rural America.”
In a follow-up study currently under review, the team found a correlation between the increase in mortality rates of rural individuals and an increase in drug overdoses. Most states adopted Medicaid expansion in the early and mid-2010s, during which opioid prescription rates in rural areas were at an all-time high. According to the authors, many rural residents were able to see a doctor for the first time and were more likely to receive prescriptions for highly addictive opioids.
“In other words, Medicaid expansion occurred at an unfortunate time for rural America,” Dr. Brooks said. “Fortunately, opioid prescribing by doctors has drastically decreased in recent years, and our data shows that these unfortunate negative effects of expansion for rural areas have largely subsided.”
In the same study, the team also found that urban areas in Medicaid expansion states experienced declines in cancer mortality, which was not seen in rural areas.
“We believe that this is because many rural areas are currently facing a severe shortage of doctors, hospital closures, and limited access to specialized care,” Dr. Brooks said. “Thus even though Medicaid expansion in theory allows many in rural America to receive subsidized care, there may not be any doctors in their community in which they can actually receive care from, particularly specialized doctors like oncologists.”
Dr. Brooks is the lead for the follow-up study and paper detailed above. He hopes that future research on this topic will lead to healthcare adaptations to benefit rural communities.
For more information about FSU’s Department of Sociology, visit cosspp.fsu.edu/sociology. For more information about FSU’s Center for Demography and Population Health, visit cosspp.fsu.edu/popcenter.