["The Journal of Rural Health, Volume 42, Issue 2, Spring 2026. ", "\nABSTRACT\n\nBackground\nMedicaid expansion in early adopter states has been linked to reduced uncompensated care and improved financial stability of healthcare organizations; however, less is known about its longer‐term effects, outcomes among later adopters, and differences across rural and urban settings.\n\n\nObjective\nTo examine the longer‐term association between state Medicaid expansion and the availability of hospitals, federally qualified health centers (FQHCs), and rural health clinics (RHCs) in states expanding Medicaid in 2014, 2015, and 2016, and to assess differences across rural and urban counties.\n\n\nDesign\nWe applied difference‐in‐differences methods for staggered policy adoption. Covariates included county population, median age, median household income, and racial/ethnic composition. Outcomes were the county‐level total number of hospitals, FQHC sites, and RHC sites, analyzed for all counties and rural/urban subsamples.\n\n\nSetting\nU.S. counties, during 2010–2019 period.\n\n\nParticipants\nTwo thousand eight hundred and fourteen counties (1319 expansion; 1495 nonexpansion) across 44 states.\n\n\nResults\nMedicaid expansion was associated with slightly more hospitals (0.094; 95% CI –0.003 to 0.190; p <0.1) and FQHC sites (0.511; 95% CI 0.214–0.807; p <0.01), but no significant change in RHC sites (–0.032; 95% CI –0.310 to 0.247). Relative to 2013, these correspond to county‐level increases of 4.9% for hospitals and 26.7% for FQHCs. Effects appeared in both rural and urban areas, with larger relative gains in rural counties. Event‐study plots indicated that effect sizes increased over time.\n\n\nConclusion\nCounties exposed to Medicaid expansion experienced sustained growth in hospital and FQHC presence, but not in RHCs, possibly reflecting supply side constraints. Policymakers should recognize that stabilization effects may strengthen gradually following expansion.\n\n"]