By Adam K. Raymond, KY Center for Economic Policy · July 15, 2026

The Kentucky General Assembly recently enacted a new state budget that underfunds Medicaid relative to the agency’s request, resulting in the administration announcing 4% cuts in the payment rates to Medicaid providers.  In addition, the One Big Beautiful Bill Act (OBBBA) passed by Congress will reduce the number of people receiving Medicaid and the payments to hospitals and other providers. 

These cuts will harm Kentuckians in two ways. First, they will reduce the number of people receiving Medicaid-funded services and the types of services that are available to them. These reductions will happen as individuals are taken off the rolls and as certain providers no longer take Medicaid, are forced to reduce the services they offer or close altogether. Second, they will reduce economic activity as fewer dollars flow into communities to pay nurses, therapists, physicians and other health care workers. 

While Kentuckians across the state will be hurt by these cuts, residents of some counties will be harmed more than others. The map below contains an index of vulnerability to Medicaid cuts based on two factors: 1) the share of the population covered by Medicaid; and 2) Medicaid payments to providers located in the county as a share of county gross domestic product (GDP). In different ways, these two factors estimate a county’s risk by looking at how much the population relies on Medicaid for health care and how much the local economy depends on Medicaid dollars due to the presence of clinics, hospitals and other providers.¹

The counties with the highest vulnerability to Medicaid cuts are all in eastern and southern Kentucky. The localities listed below rank in the top 20% of Kentucky counties for the share of the population covered by Medicaid and for Medicaid spending as a share of economic activity: 

• Breathitt
• Clay
• Floyd
• Harlan
• Knox
• Lee
• Leslie
• Letcher
• Menifee
• Owsley
• Perry
• Wayne
• Whitley
• Wolfe 

While it is no surprise that these rural counties have the highest share of people covered by Medicaid, it is notable that they also rank among the highest in the economic importance of Medicaid spending. Although specialty health services tend to be located in larger cities, Medicaid providers are spread throughout the state and matter deeply to rural economies. Kentucky has 35 rural hospitals at heightened financial risk from these cuts (including closure), the most of any state. 

All counties, but especially those in rural and eastern Kentucky, face the double threat of worse health and a weaker economy if state and federal decision makers allow these cuts to continue.

Medicaid Cut Vulnerability Index

County	People with Medicaid	Medicaid coverage as share of pop.	Coverage Index	Medicaid spending	Medicaid spending as share of GDP	Spending Index	Total Index
Owsley	2,752	68.8%	5	$15,827,793	23.0%	5	10
Wolfe	3,954	62.9%	5	$17,227,888	10.9%	5	10
Knox	17,941	60.2%	5	$114,268,741	13.7%	5	10
Bell	13,848	59.4%	5	$71,883,920	7.2%	4	9
Clay	11,585	59.0%	5	$74,742,629	16.4%	5	10
Harlan	14,233	56.2%	5	$75,792,967	10.0%	5	10
McCreary	9,507	55.8%	5	$26,979,964	9.3%	4	9
Magoffin	6,255	55.7%	5	$30,994,724	8.9%	4	9
Breathitt	6,802	52.5%	5	$34,659,346	11.3%	5	10
Whitley	19,285	52.4%	5	$230,276,423	14.8%	5	10
Knott	7,099	52.0%	5	$18,752,666	6.8%	4	9
Perry	14,063	51.8%	5	$267,846,276	20.7%	5	10
Clinton	4,715	51.5%	5	$14,014,952	3.0%	2	7
Floyd	17,650	51.3%	5	$229,447,514	16.4%	5	10
Leslie	5,003	50.7%	5	$24,335,506	12.4%	5	10
Cumberland	3,034	50.6%	5	$15,020,468	5.9%	4	9
Letcher	10,252	50.2%	5	$71,028,964	13.2%	5	10
Menifee	3,148	50.1%	5	$11,821,120	10.3%	5	10
Jackson	6,559	50.1%	5	$13,367,452	6.5%	4	9
Wayne	9,766	49.9%	5	$58,911,848	10.5%	5	10
Lee	3,497	48.0%	5	$14,950,753	9.3%	5	10
Adair	9,108	47.3%	5	$53,038,499	9.3%	4	9
Powell	6,021	46.4%	5	$19,479,185	5.8%	4	9
Martin	5,058	46.3%	5	$14,890,645	7.0%	4	9
Lewis	5,982	46.1%	4	$16,200,367	6.4%	4	8
Estill	6,354	45.6%	4	$23,826,448	8.2%	4	8
Rockcastle	7,314	45.2%	4	$74,966,379	17.4%	5	9
Johnson	9,945	45.0%	4	$44,389,998	7.2%	4	8
Bath	5,832	44.9%	4	$15,855,403	6.1%	4	8
Casey	6,971	43.8%	4	$55,417,209	11.5%	5	9
Metcalfe	4,587	43.8%	4	$36,124,241	14.2%	5	9
Lawrence	6,974	43.6%	4	$67,314,286	12.5%	5	9
Pulaski	28,510	43.1%	4	$403,539,278	13.3%	5	9
Russell	7,869	43.0%	4	$61,433,801	5.8%	4	8
Laurel	27,052	42.7%	4	$168,796,413	5.7%	3	7
Pike	23,853	42.6%	4	$225,590,814	8.5%	4	8
Fulton	2,689	42.4%	4	$7,962,566	2.8%	2	6
Carter	11,092	42.1%	4	$42,728,687	6.4%	4	8
Washington	5,099	41.6%	4	$24,701,836	5.3%	3	7
Butler	4,983	40.3%	4	$18,645,942	4.6%	3	7
Monroe	4,536	40.1%	4	$16,606,766	3.7%	3	7
Lincoln	9,892	39.9%	4	$31,051,247	5.2%	3	7
Mason	6,677	39.6%	4	$59,321,564	4.7%	3	7
Elliott	2,870	39.6%	4	$9,509,192	8.6%	4	8
Green	4,426	38.6%	4	$75,166,977	31.5%	5	9
Grayson	10,343	38.6%	4	$49,710,680	5.0%	3	7
Rowan	9,294	38.1%	4	$105,765,237	9.9%	5	9
Fleming	5,874	38.0%	4	$18,229,728	4.2%	3	7
Nicholas	2,919	38.0%	3	$3,982,057	3.0%	2	5
Montgomery	10,604	37.2%	3	$79,622,219	5.8%	4	7
Carroll	4,067	37.0%	3	$16,651,231	0.7%	1	4
Taylor	9,740	36.8%	3	$94,234,554	8.1%	4	7
Ohio	8,691	36.8%	3	$43,790,481	4.1%	3	6
Hickman	1,634	36.7%	3	$10,307,565	3.7%	3	6
Hart	7,244	36.7%	3	$22,127,272	2.6%	2	5
Muhlenberg	11,122	36.4%	3	$47,025,751	3.0%	2	5
Morgan	5,183	36.3%	3	$18,709,463	5.0%	3	6
Edmonson	4,448	35.7%	3	$13,798,873	5.5%	3	6
Garrard	6,346	35.6%	3	$11,361,117	2.6%	2	5
Boyd	16,860	35.3%	3	$231,013,716	6.1%	4	7
Carlisle	1,643	34.9%	3	$5,307,063	2.0%	1	4
Barren	15,615	34.7%	3	$129,689,090	6.9%	4	7
Graves	12,601	34.6%	3	$70,533,543	4.0%	3	6
Hopkins	15,449	34.4%	3	$133,759,751	5.0%	3	6
Allen	7,459	34.2%	3	$36,423,007	5.9%	4	7
Grant	8,640	33.7%	3	$30,425,490	3.9%	3	6
Owen	3,798	33.6%	3	$9,432,534	3.6%	2	5
Bourbon	6,758	33.6%	3	$40,241,023	3.1%	2	5
Breckinridge	7,047	33.4%	3	$21,239,952	3.9%	3	6
Caldwell	4,145	33.0%	3	$18,929,094	3.5%	2	5
Jefferson	254,767	33.0%	3	$2,767,838,504	3.5%	2	5
Clark	12,255	32.9%	3	$83,525,261	4.1%	3	6
Warren	46,687	32.8%	2	$435,344,686	3.9%	3	5
Robertson	754	32.6%	2	$4,396,714	10.5%	5	7
Webster	4,142	32.5%	2	$9,662,115	1.8%	1	3
McLean	2,935	32.4%	2	$8,461,666	0.5%	1	3
Larue	4,922	32.2%	2	$24,758,598	7.9%	4	6
Greenup	11,276	32.0%	2	$60,089,121	5.6%	3	5
Henderson	14,045	31.8%	2	$69,372,337	2.5%	2	4
Logan	8,928	31.6%	2	$24,504,033	1.8%	1	3
Bracken	2,654	31.5%	2	$4,503,118	2.1%	1	3
Marion	6,187	31.2%	2	$46,824,185	13.6%	5	7
Harrison	6,053	31.2%	2	$37,280,615	5.2%	3	5
Daviess	32,111	31.0%	2	$349,834,783	5.7%	3	5
Union	4,062	31.0%	2	$17,205,764	1.5%	1	3
Jessamine	16,925	30.8%	2	$79,359,993	2.6%	2	4
Livingston	2,728	30.7%	2	$11,481,794	2.2%	1	3
McCracken	20,513	30.4%	2	$218,539,943	12.4%	5	7
Simpson	6,118	30.3%	2	$28,092,200	2.3%	2	4
Mercer	6,985	30.2%	2	$25,277,506	2.2%	1	3
Todd	3,756	30.1%	2	$10,418,085	1.8%	1	3
Henry	4,777	29.9%	2	$14,388,421	3.0%	2	4
Ballard	2,261	29.8%	2	$6,404,066	1.8%	1	3
Pendleton	4,397	29.7%	2	$8,493,267	2.1%	1	3
Madison	28,416	29.4%	2	$218,892,376	3.1%	2	4
Boyle	8,884	28.7%	2	$106,001,915	6.0%	4	6
Franklin	14,643	28.4%	1	$98,899,040	2.2%	1	2
Gallatin	2,482	28.2%	1	$11,823,561	2.6%	2	3
Christian	20,296	28.2%	1	$161,993,512	2.1%	1	2
Trimble	2,423	28.2%	1	$5,657,725	0.8%	1	2
Trigg	4,037	28.1%	1	$12,016,018	2.6%	2	3
Hardin	31,263	27.8%	1	$338,115,950	4.6%	3	4
Crittenden	2,481	27.6%	1	$9,305,298	3.8%	3	4
Hancock	2,405	27.0%	1	$5,788,630	0.6%	1	2
Marshall	8,367	26.4%	1	$40,796,592	0.9%	1	2
Nelson	12,467	26.1%	1	$71,810,716	3.0%	2	3
Calloway	9,865	25.8%	1	$52,676,958	2.8%	2	3
Oldham	18,029	25.7%	1	$96,743,541	3.2%	2	3
Fayette	81,771	25.5%	1	$1,581,297,593	5.5%	3	4
Anderson	6,058	24.6%	1	$18,534,338	2.3%	2	3
Meade	7,350	24.4%	1	$15,083,930	1.5%	1	2
Kenton	38,972	22.7%	1	$374,577,736	3.0%	2	3
Scott	13,324	22.1%	1	$71,785,913	1.6%	1	2
Bullitt	18,766	22.1%	1	$47,585,938	1.2%	1	2
Shelby	10,285	20.8%	1	$50,614,692	2.1%	1	2
Woodford	5,548	20.3%	1	$20,681,387	1.3%	1	2
Lyon	1,806	19.7%	1	$7,339,579	2.2%	1	2
Boone	27,505	19.6%	1	$203,121,790	1.2%	1	2
Campbell	17,208	18.4%	1	$126,236,900	2.5%	2	3
Spencer	3,615	17.6%	1	$9,971,272	2.2%	2	3

The post Medicaid Cut Vulnerability Index Shows Which Kentucky Counties Are Most at Risk appeared first on Kentucky Center for Economic Policy.