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Medicaid in Midlife: A Profile of Enrollees Ages 50 to 64

The Medicaid program provides health insurance coverage for millions of low-income Americans. Funded jointly by states and the federal government, states manage all aspects of the program—within federal parameters—for their eligible residents. In 2019, more than 11 million adults ages 50 to 64 (hereafter referred to as “midlife adults”) depended on Medicaid coverage for health care.

Despite the sizeable number of midlife Medicaid enrollees, little is known about how their demographics differ from the general population of midlife adults across such factors as race and ethnicity, gender and age, geographic location and population density, and disability status.

This Fact Sheet analyzes the most recent reliable Medicaid enrollment subpopulation data and establishes a profile of midlife Medicaid enrollees. It explores how Medicaid eligibility rules impact midlife adults, noting enrollment trends and calling specific attention to the differences between states that have and have not expanded Medicaid to cover previously ineligible adults—an option created by the federal Affordable Care Act (ACA). Additionally, it highlights how midlife Medicaid enrollees differ in important ways from the broader Medicaid-enrolled population, as well as from those midlife Americans who are not enrolled in the program.

Key Takeaways

  • Adults ages 50 to 64 (“midlife adults”) make up 12 percent of the Medicaid population.
  •  Midlife adult Medicaid enrollees are racially and ethnically diverse, although this age group is more homogeneous than the total Medicaid population.
  • States that expanded Medicaid as part of the Affordable Care Act enrolled an average of 23 percent of the midlife adult population in Medicaid while states that did not enrolled on average only 10 percent.
  • Nearly three-quarters of midlife adult Medicaid enrollees live in urban areas, although there is variation in expansion and non-expansion states.
  • Midlife adults who are dually enrolled in Medicaid and Medicare, most often due to a disability or chronic disease, comprise nearly half of midlife Medicaid enrollees in non-expansion states. As a result, midlife Medicaid enrollees in non-expansion states may be sicker and require more care than midlife enrollees in expansion states.

Medicaid enrollment sharply increased across the US during the COVID-19 public health emergency (PHE) that began in 2020. As the PHE is set to expire in May 2023, states once again are evaluating their resident Medicaid enrollees’ eligibility for the program, a process called “redetermination.” As this process unfolds, understanding the particular profile of midlife Medicaid enrollees in their state can help officials identify where the drop-off of midlife adults in Medicaid enrollment is likely to be more significant. This, in turn, can inform efforts to retain eligible midlife adults in Medicaid beyond the PHE. Further, this can inform long term efforts to enroll eligible midlife adults and help identify how certain policies can support the unique needs of midlife Medicaid enrollees.   

Suggested Citation:
McSpadden, James and Sari Siegel. Medicaid in Midlife: A Profile of Enrollees Ages 50 to 64. Washington, DC: AARP Public Policy Institute, May 5, 2023.