A few weeks ago, I attended a conference exploring policies and interventions that support thriving families in the American South. The conversations focused on supporting parents in making ends meet and improving the odds for children born into low-income households.

It’s undeniable that a child’s socioeconomic status, the quality of their education, and the environment in which they grow up strongly influence their adult income, health and stability. By improving children’s economic mobility, we aim to break the cycle of poverty, sparking intergenerational change.

But as I sipped my lukewarm hotel coffee, I couldn’t shake one burning question: Are we leaving adults behind?

Our discussions of benefits, education and economic empowerment focused almost exclusively on families with children. Whether accidental or by design, we have constructed a system of support that excludes childless adults — a growing demographic here in the South, and a group dismissed in policy debates nationwide as though they don’t matter.

Why we must care about childless adults

The South’s economic vitality depends on the contributions of millions of nonelderly adults without children, who form a critical pillar of our workforce, communities and economy. This group shoulders immense responsibilities, from providing childcare for neighbors or relatives to supporting aging parents, all while filling indispensable roles in healthcare, education, technology and construction.

Yet their unique challenges are too often overlooked. The poverty rate for childless adults has stagnated since 1993, even as government programs have significantly reduced poverty for families with children. Adults without children are often excluded from many economic supports, limiting their access to skill-building, education and even basic healthcare.

This oversight is unsustainable. Nonelderly adults without children are the backbone of the labor force, driving economic growth and innovation. Their financial health fuels local economies, from housing markets to retail sectors. Many serve as caregivers or volunteers, strengthening families and neighborhoods. Without support, poverty traps them in cycles of instability, undermining economic progress for everyone.

Supporting childless adults also serves as a family planning tool by creating an environment where individuals can make informed, independent decisions about if and when to have children. Addressing their needs removes barriers that complicate family planning.

And, as the South’s population ages, the tax base and labor force contributions of childless adults will be critical for sustaining eldercare and social programs. Every day, 10,000 Americans turn 65, and the South accounts for more than half of the nation’s population growth. Fertility rates are declining, especially among white women, while people of color represent the fastest-growing demographic group. These changes, described by demographic expert James H. Johnson Jr., signal a societal transformation with far-reaching implications.

Already, many low-income, childless adults are excluded from safety-net programs like Medicaid, which often tie eligibility to family status. In states with restrictive policies, these individuals face greater risks of economic instability and poor health outcomes. The “browning and graying” of America highlights the pressing need for policies that address the intersection of race, age, and income inequality.

Medicaid expansion is a lifeline for all adults

Medicaid expansion under the Affordable Care Act has been transformative in states that adopted it, providing a safety net for millions of low-income adults. In places like Ohio and Louisiana, expansion has provided critical coverage, improving health outcomes and easing financial strain on hospitals serving low-income populations.

However, in non-expansion states, many adults — particularly childless adults — fall into the coverage gap. This gap occurs when individuals earn too much to qualify for Medicaid but too little to receive subsidies on the health insurance marketplace, leaving them without affordable health coverage. In non-expansion states, childless adults are frequently excluded from Medicaid altogether, regardless of income, forcing them to navigate an unsustainable healthcare void.

As my colleague Simon Palmore discusses in our recent MDC report “Facing South, Moving Up,” closing this coverage gap is essential to ensure that all low-income adults — not just those with children — have access to healthcare.

The Medicaid coverage gap has far-reaching effects. Preventative care is delayed, medical debt mounts and emergency rooms become the default healthcare provider. When workers struggle with untreated illnesses, businesses face rising insurance premiums and hospitals (especially in rural areas) absorb the costs of uncompensated care.

“Medicaid expansion is a win-win-win,” my colleague explains. “It cuts costs for state governments (which they can use to directly subsidize rural hospitals, if they wish), it closes the coverage gap and increases access to health care, and it reduces the financial strain that insurance gaps put on rural hospitals.”

The South bears a disproportionate burden from the lack of Medicaid expansion, with seven of the ten states refusing expansion located in the region. The consequences are staggering:

• In Texas, parents earning just $344 a month for a family of three are ineligible for Medicaid, and childless adults have no pathway to coverage.

• Nearly 80% of those caught in the coverage gap are childless adults.

• States like Georgia, Mississippi and Tennessee leave countless residents without access to affordable healthcare.

A plea to close the gap

Expanding Medicaid would grant millions access to preventative care, reduce medical debt and bring financial stability to communities across the region. (Learn more about how Medicaid expansion can support state budgets by checking out the upcoming 2025 edition of our State of the South report.)

Unfortunately, Medicaid is under attack. Proposals under Project 2025 could cap Medicaid funding, leaving states under-resourced and vulnerable populations at risk. Time-based restrictions and work requirements could also disproportionately affect low-income Southerners in unstable jobs, leading to widespread coverage losses.

What can you do? If you live in a state that hasn’t expanded Medicaid, contact your representatives to advocate for the Affordable Care Act and Medicaid Expansion. Urge policymakers to expand the definition of “family support” to include childless adults and advocate for investments in this group to foster economic resilience, particularly in the South. We must also oppose tying Medicaid eligibility to work requirements, which harm vulnerable populations and worsen health disparities.

By reducing poverty for nonelderly adults without children, we invest in a healthier, more equitable society where everyone can thrive and contribute fully, ultimately strengthening society’s overall resilience and cohesion.

This post was originally published on Next City.