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In 2023, North Carolina expanded Medicaid, allowing adults aged 19-64 with incomes up to 138 percent of the federal poverty line to enroll in the program. This expansion aimed to extend healthcare coverage to previously ineligible people with low-to-moderate incomes. While expansion was expected to expand Medicaid coverage to people throughout the state, research suggested rural areas could see higher expansion enrollment rates due to a greater target population. This analysis examines Medicaid expansion’s impact, focusing on enrollment rates in rural counties and how it compares with suburban and urban counties.