Maine is particularly vulnerable to federal Medicaid cuts due to rural, aging population

Since rural communities rely on Medicaid more than urban areas, cuts to the federal program would hurt states like Maine disproportionately, potentially leaving thousands in the state without affordable health care.
That’s according to a report released this week by Georgetown University’s Center for Children and Families after U.S. House Republicans were revealed to be considering up to $2.3 trillion in cuts to Medicaid as part of their agenda.
Medicaid provides affordable health care to an estimated 82 million Americans. Cuts to the program would threaten health care for millions, the Georgetown report noted, as states would be unable to make up for federal funding losses.
Maine ranks sixth in the nation with 40.2% of the population living in rural areas, according to 2023 federal census data.
The state also has the 11th highest rate of Medicaid coverage for adults aged 19 to 64 in rural areas in the country, including people with disabilities, and the 9th highest rate of coverage for seniors, which means Mainers rely more on Medicaid than most other states, according to the report.
Overall, more than than 400,000 people are enrolled in MaineCare, the state’s Medicaid program, according to the Maine Department of Health and Human Services.
“All states have a lot to lose here, because these cuts that are being discussed are absolutely enormous,” said Joan Alker, lead author of the Georgetown report and executive director and co-founder of the Center for Children and Families. “But rural communities within those states, and of course, states that have a highly rural population have more at stake because these rural communities are already struggling with health care challenges.”
Rural residents tend to have more chronic health conditions, lower incomes and face more health care provider shortages, including hospital closures and loss of maternity care, so those factors pose additional challenges for these communities, Alker said.
Maine’s rural counties rely more on Medicaid, data shows
In Maine, 24.1% of people in rural areas or small towns rely on Medicaid, compared with 20% of people in metro areas. Small towns or rural areas include counties with no urban areas of at least 50,000 residents, according to the U.S. census definitions, which the report relied on. All but five of Maine’s 16 counties were classified as rural.
Maine’s most rural counties — including Aroostook, Piscataquis, Somerset and Washington counties — had a higher share of adults under 65, seniors and children relying on Medicaid or the Children’s Health Insurance Program, according to Georgetown data.
Cumberland County had the smallest overall share of people relying on Medicaid, with 18.4%, and Washington County had the highest, with 27.8%.
In general, a large share of children use the Children's Health Insurance Program in Maine, the report found, with 37% in rural areas and 32.6% in metro areas. Piscataquis County had the largest share of children enrolled in the program, with 39.7%.
Maine already struggling with health care cuts
Even without federal funding, the state already is struggling to keep up with Medicaid costs.
Gov. Janet Mills introduced a supplemental budget last week to address the $118 million MaineCare funding shortfall this year, warning that the state would have to withhold reimbursements to health care providers if the change package does not pass.
If federal budgets to Medicaid are slashed, states’ ability to fund affordable health care would only be further jeopardized.
The incoming Trump administration has already announced intentions to impose work requirements, or switch to a model that would put even more pressure on states to fund their Medicaid programs.
Given the increased reliance on MaineCare after expanded eligibility allowed 100,000 more people to enroll in the low-cost or free health care program, these proposed cuts may leave thousands of Mainers without coverage, most severely impacting low-income families, experts have told the Maine Morning Star.
“There's no way that states, however well intentioned, could make up these kinds of cuts that are being discussed,” Alker said.“It would be virtually impossible for states to make up that funding by raising taxes, since Medicaid is the single largest source of federal funds coming into a state.”
Correction: A previous version of this story reported the 2025 Medicaid gap in Maine to be $92 million.
