Medicaid beneficiaries who are people of color; rural residents; lesbian, gay, and bisexual people; and individuals with disabilities may experience disparities in health outcomes and access to care compared to other beneficiaries. For example, Black, American Indian and Alaska Native, Asian American and Pacific Islander, and Hispanic pregnant individuals are more likely to experience severe maternal morbidity and mortality compared to white individuals (MACPAC 2020). Compared to urban residents with Medicaid, more rural residents report having a disability or being limited in their ability to work due to a health problem (MACPAC 2018). Lesbian, gay, and bisexual Medicaid beneficiaries reported higher rates of mental illness and substance use disorder than heterosexual Medicaid beneficiaries. Transgender and gender diverse Medicaid beneficiaries report higher of suicidal ideation and attempted suicide compared to those with private insurance (MACPAC 2021).
There are also racial and ethnic disparities in the use of services. A prior MACPAC analysis found that from 2015 to 2018, Hispanic adults were significantly more likely to report unmet or delayed care due to cost than white adults. Black and Hispanic Medicaid beneficiaries were less likely than white beneficiaries to have received primary care or mental health care in the prior 12-month period. Health screening rates among adult Medicaid beneficiaries also differed by race and ethnicity (MACPAC 2022). Among adult Medicaid beneficiaries with intellectual disabilities and developmental disabilities, the share of Black, Hispanic, Asian, and American Indian and Alaska Native beneficiaries who had a complete physical exam, dental exam, eye or vision screening in the past year was lower compared to white, non-Hispanic beneficiaries (MACPAC 2024).