Rural Health Information Hub Latest News

Thousands More People with Medicaid and CHIP Coverage Now Eligible to Access Critical Postpartum Coverage Thanks to the American Rescue Plan

The Biden-Harris Administration is announcing that as many as 720,000 pregnant and postpartum people across the United States could be guaranteed Medicaid and Children’s Health Insurance Program (CHIP) coverage for a full 12 months after pregnancy thanks to the American Rescue Plan (ARP). Medicaid covers 42 percent of all births in the nation, and this new option for states to extend Medicaid and CHIP coverage marks the Biden-Harris Administration’s latest effort to address the nation’s crisis in pregnancy-related deaths and maternal morbidity by opening the door to postpartum care for hundreds of thousands of people.

In addition to related updates in the 2023 federal budget request, for example, in December 2021, Vice President Kamala Harris hosted the first-ever federal Maternal Health Day of Action, where she announced a call to action to both the public and private sectors to help improve health outcomes for parents and infants in the United States. Today’s announcements are a part of the Biden-Harris Administration’s continued response to that call to action to support safe pregnancies and childbirth, and reduce complications and mortality in the year following birth.

“Having postpartum care can be life-saving and lead to better long-term health outcomes for new parents and newborns,” said Health & Human Services (HHS) Secretary Xavier Becerra. “Thanks to President Biden’s American Rescue Plan, we are able to make it easier for states like Louisiana to give thousands more pregnant and postpartum people across the country access to high-quality, affordable coverage for the essential first year after birth. The Biden-Harris Administration has made maternal health and equity a priority, and we are working to ensure every parent has access to the care they and their child deserve.”

Louisiana, the first state CMS is approving to take advantage of this new state plan opportunity under the ARP, today began offering its enhanced coverage to an estimated 14,000 pregnant and postpartum people. CMS is also working with an additional nine states to extend postpartum coverage. In 2021, IllinoisNew Jersey, and Virginia were the first states to use Medicaid demonstration authority to provide 12 months of continuous postpartum coverage for all Medicaid and CHIP enrollees. In addition, a number of other states have announced that they are working to extend Medicaid coverage to 12 months after pregnancy, and CMS looks forward to working those states. In order to receive federal funds and to ensure consistency with federal standards, including those set by the ARP, states must go through a formal process run by CMS.

“This is an historic step for states to partner with us to provide life-saving coverage for postpartum people—and meaningfully address the maternal health crisis. For too long, families have been left behind by a health care system that breaks connections to care when they are needed most,” said CMS Administrator Chiquita Brooks-LaSure. “Everyone deserves an opportunity to attain and maintain health. The American Rescue Plan created a pathway to connect pregnant people to vital health coverage through that first critical year after birth, and I urge every state to adopt this option to extend lifesaving postpartum coverage.”

Under existing requirements, many Medicaid and CHIP enrollees receive coverage through the end of the month in which their 60-day postpartum period ends. Maintaining Medicaid and CHIP coverage for a full year provides access to critical health care services during the first year after pregnancy, which can help to address persistent health disparities. One-third of maternal deaths occur between one week to a year after the end of pregnancy, and rates of maternal mortality are up to five times higher among Black and American Indian/Alaska Native people than their white peers.

Beginning April 1, 2022, the ARP’s new state plan option offers state Medicaid and CHIP agencies an opportunity to provide 12 months of continuous postpartum coverage. States choosing to extend postpartum coverage must elect this option in both Medicaid and their separate CHIP programs, if applicable, and submit required state plan amendments to CMS. The new ARP state plan option is currently limited to a five-year period that ends on March 31, 2027.

States like Louisiana that adopt the new extended postpartum coverage must provide coverage to all eligible individuals who were enrolled in Medicaid or CHIP while they were pregnant. This extended coverage period will last from the day the pregnancy ends through the end of the month in which their 12-month postpartum period ends.

The postpartum coverage option extends to current beneficiaries who are enrolled in Medicaid or CHIP while pregnant but are no longer pregnant when the state implements the ARP option, if the individual is within their 12-month postpartum period when their state implements the option. It also applies to individuals who were pregnant at some point during the three months prior to applying for Medicaid, if they met the eligibility requirements at that time.

Advancing this state plan option comes at a critical time for pregnant individuals and families, many of whom are relying on continued Medicaid and CHIP coverage for the ongoing care they need during the postpartum period. Continuity of coverage can help postpartum people manage chronic conditions, like hypertension and diabetes, that last well beyond the first 60 days postpartum, as well as provide access to behavioral health and other mental health care services.

Other states interested in learning about extending postpartum coverage through the ARP can contact their CMS state lead or consult the state health official letter CMS issued in December 2021.

As US Nears 1 Million COVID Deaths, One Hard-Hit Pennsylvania County Grapples With Unthinkable Loss

The United States is nearing 1 million deaths from COVID — an almost incomprehensible number of lives lost that few thought possible when the pandemic began. Pennsylvania’s Mifflin County offers a snapshot into how one hard-hit community, with over 300 dead, is coping.

Connie Houtz didn’t think  would be that bad.

She’d seen many people in this rural hamlet in central Pennsylvania get infected yet recover within a few days. She did not get vaccinated because she worried about how a new vaccine, developed in record time, might affect her heart condition.

Last October, her youngest son, 45-year-old Eric Delamarter, developed a chest cold. He put off going to the doctor because he had customers waiting at his shop where he repaired cars, she said. When he finally went to the emergency room at Geisinger Lewistown Hospital, he was diagnosed with pneumonia and COVID.

Within a few days, Houtz’s oldest son, 50-year-old Toby Delamarter, had also been admitted to the hospital with the virus and shortness of breath.

Less than two weeks later, both of her sons were dead. Neither had been vaccinated.

“Even though it does not seem fair and does not seem right, down the road we will find a reason for why things happen,” said Houtz, 71, as she sat at her kitchen table.

Eric and Toby Delamarter are two of the roughly 300 people who have died of COVID in Mifflin County, where cows grazing in pastures and Amish horse and buggies are frequent sights. The county 60 miles northwest of Harrisburg leans heavily Republican — 77% of votes cast in 2020 were for Donald Trump — and the former president’s downplaying of covid-19 found fertile ground there.

Mifflin has one of the highest COVID death rates among U.S. counties with at least 40,000 people, according to government data compiled by Johns Hopkins University — 591 deaths per 100,000 residents as of mid-March, compared with 298 deaths nationally.

The United States is nearing 1 million deaths from COVID — a number that few thought possible when the pandemic began.

In March 2020, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said that based on modeling of the pace of the coronavirus’s spread in the U.S. at that time, “between 100,000 and 200,000” people may die from COVID.

Reaching a million deaths seemed even more improbable when safe and effective vaccines came onto the market in December 2020. More than 60% of the 977,000 deaths have occurred since then.

Mifflin County offers a snapshot into how one hard-hit community moved from skepticism about the scientific reality of the COVID virus, and then about the vaccine, to coping with unbearable loss and processing the trauma. Roughly 8 in 10 deaths nationwide from April to December 2021 were among the unvaccinated, according to the latest analysis of data from 23 states and New York City and Seattle by the Centers for Disease Control and Prevention.

Read more.

Rural Hospital Profitability During the Global COVID-19 Pandemic Requires Careful Interpretation

Since the start of the coronavirus pandemic, the federal government has provided enhanced financial support for hospitals and other health care providers to compensate for revenue loss and higher costs.  This brief from the North Carolina Rural Health Research and Policy Analysis Center describes the pre-pandemic trend of rural hospital profitability and explains why possible increases in reported profitability during the pandemic may mask the long-term financial challenges of rural hospitals.

The Census Bureau Updates Criteria for Defining Urban Areas

Last week, the U.S. Census Bureau published its final criteria for defining urban areas based on the results of the 2020 Decennial Census.  Rather than distinctions for urbanized area or an urban cluster, all areas with a population of at least 5,000 and containing at least 2,000 housing units will be designated urban areas. The notice defines rural as territory not defined as urban. Some federal and state agencies use the Census Bureau’s urban-rural classification for allocating funds, setting standards, and implementing aspects of their programs. Stakeholders should be aware that the changes to the urban area criteria also might affect the implementation of these programs.

Take the Telehealth Technology Survey Today

Every two years, the HRSA-funded National Telehealth Technology Assessment Resource Center (TTAC)  asks a variety of questions about the types of technologies, roles, and future plans of organizations and individuals using telehealth technology. TTAC uses this data to 1) identify technologies of interest for future evaluations, toolkits, video series, and other resources; 2) understand trends that are affecting the telehealth landscape regionally and nationwide; and 3) o determine how TTAC can better engage with its stakeholders. The survey takes less than 10 minutes and closes today, Thursday, March 31st.

One Stop Online for COVID Prevention and Treatment in Every County

The new website, COVID.gov, asks visitors to enter their county and then provides nearby locations for masks and respirators, vaccines and boosters, and all testing and treatment options. The site also maps out clinics and pharmacies with a test-to-treat option, where one can get tested and, if positive, immediately receive anti-viral pills.  According to the White House, there are now more than 2,000 test-to-treat locations; the new website, announced yesterday, makes it easier to find them.