Even by rural hospital standards, Keokuk County Hospital and Clinics in southeastern Iowa is small.

The 14-bed hospital, in Sigourney, doesn’t do surgeries or deliver babies. The small 24-hour emergency room is overseen by two full-time doctors.

CEO Matt Ives wants to hire a third doctor, but he said finding physicians for a rural area has been challenging since the covid-19 pandemic. He said several physicians at his hospital have retired since the start of the pandemic, and others have decided to stop practicing certain types of care, particularly emergency care.

Another rural hospital is down the road, about a 40-minute drive east. Washington County Hospital and Clinics has 22 beds and is experiencing similar staffing struggles. “Over the course of the last few years, we’ve had not only the pandemic, but we’ve had kind of an aging physician workforce that has been retiring,” said Todd Patterson, CEO.

The pandemic was difficult for health workers. Many endured long hours, and the stresses on the nation’s health care system prompted more workers than usual to quit or retire.

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In collaboration with the Rural Health Information Hub (RHIhub), the Federal Office of Rural Health Policy(FORHP)  has released a new tool to help rural hospitals and rural health clinics identify FORHP programs that provide free technical assistance to improve financial and operational performance, quality, and transition to value-based care.

Check out the new FORHP Rural Hospital Technical Assistance Finder at https://www.ruralhealthinfo.org/hospital-ta or on the RHIhub homepage.

On April 8, 2025, the Center for Rural Pennsylvania Board of Directors held a public hearing at the Capitol Building in Harrisburg to advance awareness and support for rural mental health. The hearing brought together lawmakers, mental healthcare professionals, and community leaders to discuss ongoing challenges and potential solutions related to mental health care in rural Pennsylvania.

“We know rural Pennsylvania faces a unique set of challenges when it comes to mental health care,” said Senator Gene Yaw, Chairman of the Center for Rural Pennsylvania Board of Directors. “Limited access to providers, long distances to travel for treatment, and a shortage of specialized resources all contribute to a system facing significant barriers. The Center for Rural Pennsylvania is working to find innovative solutions to address these challenges. This hearing was an important step towards building a more accessible and supportive mental health system for all Pennsylvanians, no matter where they live.”

“The testimony shared at this hearing highlights the urgent need for ongoing collaboration and solutions to address the mental health challenges facing rural Pennsylvania,” said Representative Eddie Day Pashinski, Vice Chairman of the Center’s Board. “This effort includes expanding access to services, tackling workforce shortages, and reducing stigma.”

“We want Pennsylvania to be a place where mental health services are accessible and effective, no matter where you live,” said Senator Judy Schwank, member of the Center’s Board. “But in our rural communities, people often face a unique set of challenges when it comes to getting the care they need. This hearing is an opportunity to explore some of the most common barriers to mental health care in rural Pennsylvania and begin identifying solutions.”

“I was grateful for the insight provided by mental health professionals, judges, and other officials who testified concerning the unique challenges that exist in rural communities, including homelessness,” said Representative Dan Moul, member of the Center’s Board. “Homelessness is a far more complex problem than I imagined, particularly for those with mental health and substance abuse challenges. Clearly, there is no easy fix, but as we examine this issue, I am hopeful solutions can be found that will build on the resources available.”

“The mental health struggles in our rural communities are not just data points—they’re daily realities for countless Pennsylvanians,” said Dr. Kyle C. Kopko, Executive Director of the Center. “This hearing shed vital light on the challenges and, more importantly, the opportunities to expand care, break down barriers, and ensure no one is left to face these issues alone.”

Testifiers included:

• The Honorable Judge Tiffany L. Cummings, Magisterial District Court 04-3-03, Tioga County
• Annette (Annie) L. Strite, M.A., M.H./I.D.D. Administrator and Mental Health Director
• Andrea B. Kepler, L.C.S.W., Administrator, Dauphin County Mental Health, Autism and Developmental Programs
• Chris Santarsiero, Vice President of Government Affairs, Connections Health Solutions
• Kimberly Jones, M.S., L.P.C.S., Vice President of Clinical Operations, Connections Health Solutions
• Brittney McCarthy, Strategic Account Manager, Connections Health Solutions
• Dr. Jamie Zelazny, Assistant Professor of Nursing and Psychiatry and Co-Director of the Digital Health Hub, University of Pittsburgh
• Dr. Brayden N. Kameg, Assistant Professor of Nursing, University of Pittsburgh; Director of the Mental Health Nurse Practitioner Residency Program, VA Pittsburgh Healthcare System
• Dr. Brian Schurr, Central Keystone Counseling

To access the hearing recording and testimony, visit the Center’s website at www.rural.pa.gov.

The Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2026 Rate Announcement for the Medicare Advantage (MA) and Medicare Part D Prescription Drug Programs that finalizes the payment policies for these programs. This release — combined with the CY 2026 MA and Part D final rule that was released on April 4 — makes annual routine and technical updates to the MA and Part D programs.

The actions taken by CMS help protect beneficiaries and taxpayers from waste, fraud, and abuse, while also driving access to high-quality, affordable healthcare through Medicare Advantage. By finalizing these payment policies, CMS is ensuring that Medicare Advantage continues to offer access to critical services in an efficient, accountable manner, further strengthening the program’s ability to serve beneficiaries.

Payments from the government to MA plans are expected to increase on average by 5.06% from 2025 to 2026. This is an increase of 2.83 percentage points since the CY 2026 Advance Notice, which is largely attributable to an increase in the effective growth rate. The method for setting the effective growth rate is set in statute and represents the average expected change in the benchmarks, used to determine payment for MA plans, based on the growth in Medicare per capita costs. The effective growth rate is 9.04%, which is higher than the estimate of 5.93% in the CY 2026 Advance Notice. This change is primarily due to the inclusion of additional data on fee-for-service (FFS) expenditures, including payment data through the fourth quarter of 2024, which was not included on account of the early Advance Notice publication.

In CY 2024, CMS initiated a three-year, phased-in approach for removing the medical education costs — related to services MA enrollees receive — from the historical and projected expenditures supporting the FFS costs that are included in the growth rate calculations. For CY 2026, CMS will complete the phase-in of the technical adjustment by applying 100% of the adjustment for MA-related medical education costs.

CMS is also completing a three-year phase-in of improvements to the MA risk adjustment model that the agency finalized in the CY 2024 Rate Announcement, with the first year of the three-year phase-in starting with CY 2024. CMS is committed to expanding access to affordable, high-quality care through Medicare Advantage, while also implementing measures to safeguard beneficiaries and taxpayers from waste, fraud, and abuse. These ongoing improvements support a sustainable program that benefits both current and future Medicare recipients.

CMS is concurrently releasing the Final CY 2026 Part D Redesign Program Instructions that continue to implement the redesign of the Medicare Part D program. These instructions contain a detailed description of, and guidance related to, changes to the Part D drug benefit in place for CY 2026.

The CY 2026 MA and Part D Rate Announcement may be viewed at https://www.cms.gov/files/document/2026-announcement.pdf.

A fact sheet discussing the provisions of the CY 2026 Rate Announcement can be viewed at https://www.cms.gov/newsroom/fact-sheets/2026-medicare-advantage-and-part-d-rate-announcement.

The Final CY 2026 Part D Redesign Program Instructions can be found at https://www.cms.gov/files/document/final-cy-2026-part-d-redesign-program-instruction.pdf.

A fact sheet discussing the provisions of the Final CY 2026 Part D Redesign Program Instructions can be viewed at https://www.cms.gov/newsroom/fact-sheets/final-cy-2026-part-d-redesign-program-instructions

Underscoring the massive scale of America’s medical debt problem, a New York-based nonprofit has struck a deal to pay off old medical bills for an estimated 20 million people.

Undue Medical Debt, which buys patient debt, is retiring $30 billion worth of unpaid bills in a single transaction with Pendrick Capital Partners, a Virginia-based debt trading company. The average patient debt being retired is $1,100, according to the nonprofit, with some reaching the hundreds of thousands of dollars.

The deal will prevent the debt being sold and protect millions of people from being targeted by collectors. But even proponents of retiring patient debt acknowledge that these deals cannot solve a crisis that now touches around 100 million people in the U.S.

“We don’t think that the way we finance health care is sustainable,” Undue Medical Debt chief executive Allison Sesso said in an interview with KFF Health News. “Medical debt has unreasonable expectations,” she said. “The people who owe the debts can’t pay.”

In the past year alone, Americans borrowed an estimated $74 billion to pay for health care, a nationwide West Health-Gallup survey found. And even those who benefit from Undue’s debt relief may have other medical debt that won’t be relieved.

This large purchase also highlights the challenges that debt collectors, hospitals, and other health care providers face as patients rack up big bills that aren’t covered by their health insurance.

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