Medical stability in Cleveland: Medicaid and healthcare access

Medicaid is a vital resource for Clevelanders. Close to half of the city’s residents (45 percent, or 162,359 people) reported using Medicaid coverage for their healthcare needs. But for the first time, new data from the 2025 Cleveland Health Survey^[i] offers the opportunity to develop a deeper understanding of Medicaid’s impact for Clevelanders. Statistical analyses were conducted to compare the experiences of residents who rely on private insurance for their healthcare, to the residents covered by Medicaid, and to determine if their experiences differed significantly or not. The findings are illuminating.

Clevelanders with Medicaid accessed healthcare services and addressed their needs at similar rates as residents with private health insurance.

Accessing and affording healthcare

Perhaps the most important finding: Clevelanders with Medicaid accessed healthcare services and addressed their needs at similar rates as residents with private health insurance. There were no significant differences between residents with Medicaid and residents with private insurance in the rates at which they:

• Saw a doctor for a routine health checkup in the last year
• Saw a mental health provider for any reason in the last year
• Avoided seeing a doctor because it was unaffordable

Similarly, residents with Medicaid were statistically just as likely as residents with private insurance to report having a person (or group of doctors) that they thought of as their personal healthcare provider.

These are encouraging findings because having health insurance, accessing healthcare when needed, and building relationships with primary care providers are important aspects of achieving positive health outcomes. The ability to access/afford healthcare is one of the primary drivers of health disparities by socioeconomic status. The Department of Health and Human Services identifies Medicaid as an effective tool for addressing these access disparities for lower-income Americans. These findings provide local evidence for HHS’ assessment.

Medicaid as a source of security

It is particularly meaningful that residents with Medicaid experienced similar levels of medical security as their neighbors with private insurance, because in so many other areas of their lives, residents with Medicaid were significantly more likely to be experiencing insecurity. They were more likely to be experiencing insecurity related to accessing basic needs like food, housing, and utilities, as well as insecurity around reliable transportation and employment.

One in three (35 percent) residents with Medicaid were actively providing regular caregiving for a friend or family member with a health problem/disability, a significantly higher rate than the one in four (25 percent) residents with private insurance. Caregiving without adequate support can dramatically impact one’s ability to maintain steady employment.

Caregiving without adequate support can dramatically impact one’s ability to maintain steady employment.

Addressing some of the greatest needs

Clevelanders with Medicaid reported significantly greater rates of physical, mental, and social health needs than residents with private insurance. This could be partially explained by the previously discussed disparities in health outcomes by socioeconomic status, but more importantly, it evidences the critical role that Medicaid plays for many of our neighbors who need it the most when it comes to managing their health.

It is also important to highlight that one in three residents with Medicaid (32 percent) explained that their physical and/or mental health kept them from doing their usual activities such as self-care, work, or recreation. This is insightful because it highlights how common health concerns can affect a person’s ability to work.

Medicaid as a driver of equitable access

Across Ohio, as of May 2025, 59 percent of the just over 3 million Medicaid enrollees are white, with the next largest racial group being Black at 29 percent. In Cleveland, however, those rates look different.

Clevelanders of all races are more likely to be using private health insurance, but the percentage of residents enrolled in Medicaid differed significantly by race. Amongst insured residents, 45 percent of Black non-Hispanic residents, 32 percent of Hispanic residents, 21 percent of white non-Hispanic residents, and 28 percent of residents of any other race, reported using Medicaid for their healthcare needs.

Black residents represent 58 percent of the Medicaid enrollees in Cleveland, compared to 47 percent of the city’s overall population. This means Medicaid plays an essential role in connecting many Black residents to the care they need for chronic conditions, mental health, and general well-being.

This is worth noting given the historic and active discrimination Black families have faced when it comes to treatment and access, contributing to drastic health disparities; see this 2024 Kaiser Family Foundation report on Health and Healthcare by Race and Ethnicity, and this 2022 scoping review of 213 academic studies exploring racism in healthcare. This is not to imply that Medicaid has “solved” these racialized health disparities, but instead to highlight that Medicaid is of particular importance in providing access to healthcare for Black Clevelanders. Even when the largest number of Ohioans that benefit from Medicaid are white.

Room for improvement

It is thoroughly encouraging that Clevelanders with Medicaid report accessing their routine health and mental healthcare, and building relationships with their doctors, at rates like residents with private health insurance. These findings are particularly meaningful given Cleveland’s status as the second poorest large city in the United States, and what we know about the relationship between socioeconomic status and health.

There is still room for improvement, however, found in this data. For example, Clevelanders with Medicaid accessed dental services, and had their eyes examined, at significantly lower rates than their neighbors with private insurance. They also received prostate cancer screenings and colorectal screenings at significantly lower rates.

One in five Clevelanders with Medicaid also reported being treated worse than people of other races/ethnicities in healthcare settings.

One in five Clevelanders with Medicaid also reported being treated worse than people of other races/ethnicities in healthcare settings, compared to nine percent of residents with private insurance.

This significant difference is in part due to Cleveland’s Medicaid population being majority Black (58 percent), and the private health insurance population being mostly white (45 percent). However, these significant differences in experiencing race-based discrimination did not extend to the workplace, or being treated worse in general, highlighting a concern specific to the healthcare setting. But also highlighting the importance of having someone you consider your personal healthcare provider, ideally someone you trust to treat you equitably.

Community Solutions has been advocating extensively about the importance of Medicaid.

• Testimony about the negative impacts trigger language in our laws will have on rural communities, children, and birthing moms
• Exploring Medicaid as the largest payor for mental health and substance use disorder treatment
• Defining how the program is vital for Ohioans experiencing homelessness
• Explaining how taking away healthcare from Ohioans is an ineffective way to “save” money

This new data makes it evident the importance of the role Medicaid plays in Cleveland. And aside from the obvious health benefits of having access to medical professionals and mental health specialists to provide needed care, The Center for Disease Control argues that preventing and managing chronic and mental health conditions can have significant economic benefits as well.

A special thanks to Dr. Stephanie Pike Moore for her diligent work with the Cleveland Health Survey!

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[i] Data come from the 2025 Cleveland Health Survey, which represents a collaboration between the Prevention Research Center for Healthy Neighborhoods at Case Western Reserve University (CWRU) and the Cleveland Department of Public Health (CDPH). Data were provided by Dr. Stephanie Pike Moore 6/18/2025. This report represents the views of the authors and does not necessarily represent the official position of the funding organizations, CWRU or CDPH.