There are significant disparities in the distribution of the New Hampshire population and median population ages between the southeastern region and more rural regions of the state, as municipalities located closer to metropolitan Boston typically have a lower median age than those in rural northern and western areas of the state. Aging demographics may prompt concerns regarding population health and health care costs, and differing income levels between different areas of the state also reflect differing service needs.
Using the January 2017 month-end count of Medicaid enrollment by municipality provided by the New Hampshire Department of Health and Human Services, the map below on the left shows the total number of residents enrolled in Medicaid by municipality. Medicaid generally seeks to provide health coverage for low-income people, with particular aspects of Medicaid focused on certain populations, including children, the elderly, and those with disabilities. The larger the number of residents enrolled in Medicaid, the darker the shade of purple. The municipalities with the largest total number of enrollees also tend to have the largest total populations, such as Manchester, Nashua, and Concord, followed by other municipalities with many residents overall but also relatively older or lower-income populations, such as Berlin, Conway, Laconia, and Rochester.
The share of the total population in each municipality that is enrolled in Medicaid provides a different indicator of the potential local needs for providing services to residents with low incomes, including certain older adults and residents with disabilities. Using the total number of enrollees in Medicaid by municipality and the 2010 Census count by municipality, the second map below shows Medicaid enrollees as a percentage of the total population. The larger the number of residents enrolled in Medicaid as a percentage of the total population of the municipality, the darker the shade of purple. Although populations have likely changed to some degree between the 2010 Census count and January 2017, the 2010 Census provides the best concrete number available for municipal populations, particularly for smaller municipalities, that does not introduce the potential error associated with small sample sizes in survey data.
The southeastern region of the state, with the exceptions of Manchester and several other smaller municipalities, appears to have smaller shares of the population enrolled in Medicaid, whereas the southwestern and, especially, the northern parts of the state have larger shares of residents enrolled.
Although Medicaid coverage is primarily paid through state and federal government dollars, certain long-term supports and services, particularly nursing home care, are paid in part by counties. Counties primarily raise tax revenue through property taxes. Differences in median ages, property values, and incomes across the state suggest that counties in the northern part of the state have less fiscal capacity but may face comparatively larger responsibilities in caring for residents.
For more on other metrics of economic activity and fiscal capacity in New Hampshire communities, see NHFPI’s Issue Brief Measuring New Hampshire’s Municipalities: Economic Disparities and Fiscal Capacities.