Medicaid has a larger impact on residents of small town and rural areas than those in cities, according to a study by Georgetown University’s Health Police Institute.

In New York state, well over a third of all children in small towns and rural areas — 42 percent, in fact — rely on Medicaid health coverage.

The state-by-state report compares enrollment before and after states’ expansion of the Medicaid program in urban versus rural counties.

In rural counties, 21 percent of adults in New York are covered by Medicaid.

Before the Affordable Care Act was passed in 2010, Medicaid coverage was limited mostly to children, very low-income parents, pregnant women, and those with a qualifying disability.

The Health Policy Institute’s paper concludes that in states participating in the expansion, while there has been a dramatic decrease in uninsured residents in all areas, rural regions have benefitted the most. Small-town kids see the most total benefit from Medicaid, which is the leading insurer of children. The national uninsured rate for children reached a historic low of under 5 percent in 2015.

Nearly seven years since the ACA was signed, nearly 98 percent of New York children have health coverage of some kind — the state’s highest ever rate.

“Two million children statewide are at risk of losing coverage or benefits (if) the ACA is repealed,” Jeorge Cymon, spokesman for nonprofit advocacy group the Children’s Defense Fund — New York, wrote in an email in March.

“The Children’s Defense Fund New York compiled data of children insured by Medicaid and (Child Health Plus) who will most likely be affected by a repeal… in the North Country there are 35,733 children insured through Medicaid and 6,685 insured through CHP.”

Across the United States, about 45 percent of rural children rely on Medicaid.

Between 2009 and 2014, the rate of children in rural New York covered by Medicaid increased by 8 percent, despite qualification requirements staying the same. Kids are more likely to be enrolled in Medicaid when their parents also qualify and sign-up for coverage.

The Health Policy Institute has reported in the past that children covered by Medicaid see long-term benefits including missing fewer school days, doing better in classes and being more likely to graduate high school and attend college. These children also grow up to be healthier adults, earn more money and pay more taxes.

As of early 2017, insured rates in the north country had more than halved since 2011.

In the last seven years, the rate of uninsured adults dropped from 24 percent to 8 percent in Jefferson County, from 20 percent to 9 percent in Lewis County, from 18 percent to 9 percent in St. Lawrence County and from 16 percent to 8 percent in Oswego County.

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Medicaid benefits rural residents most, especially children, study finds