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Global population aging post a demand in improving the accessibility of healthcare system, while a large proportion of older adults living in developing countries are still vulnerable to illness-related income shocks. This study evaluates the impact of China’s ongoing targeted poverty alleviation program on reducing the medical burden of impoverished older adults. Employing Difference-in-Differences (DID) method and using data from the China Health and Retirement Longitudinal Survey (CHARLS), this study finds significant reductions in both the out-of-pocket expenditure to income ratio and catastrophic medical expenditure among targetedolder adults. The program’s success is attributed to the “income effect,” raising household income levels, and the “safety-net effect,” increasing the reimbursement ratio for inpatient expenses. The findings have implications for global health policy, suggesting that targeted poverty alleviation interventions can effectively alleviate medical burdens and prevent poverty due to medical expenses, offering a viable model for other developing countries facing poverty challenges.