Rural Health Information Hub Latest News

Report Compares Rural and Urban Hospital Uncompensated Care

A new report, A Comparison of 2017-19 Uncompensated Care of Rural and Urban Hospitals by Net Patient Revenue, System Affiliation, and Ownership, demonstrates several key factors that contribute to rural hospital uncompensated care.  A summary of the key findings is highlighted below.

Uncompensated care are services provided that are never reimbursed, including charity care and unanticipated bad debt. High uncompensated care burden is a concern because it may contribute to smaller operating margins and rural hospital closures.

The purpose of this study is to better understand patterns of uncompensated care. It extends a 2018 study of geographic variation in uncompensated care between rural and urban hospitals. In the current study, researchers use 2017-2019 Medicare Cost Report data to study the association of uncompensated care with net patient revenue, system affiliation, and ownership among Critical Access Hospitals (CAHs), Rural Prospective Payment System (PPS) hospitals, and Urban PPS hospitals.

Key Findings:

  • Rural PPS hospitals had the highest uncompensated care median, and urban PPS hospitals had the lowest.
  • Furthermore, rural PPS hospitals with less than $20 million in net patient revenue had the highest median uncompensated care, and urban PPS hospitals with less than $20 million had the lowest.
  • Hospitals affiliated with a health system had higher median uncompensated care than hospitals not affiliated with a health system.
  • Government-owned hospitals had the highest median uncompensated care for rural PPS and urban PPS, while a small number of for-profit CAHs had the highest median uncompensated care across all groups.

Findings suggest that changes to policies and reimbursement that affect uncompensated care could have a differential effect on hospitals, particularly related to Medicare payment designation, size (as measured by net patient revenue), and ownership.

Contact Information:

George H. Pink, PhD
North Carolina Rural Health Research and Policy Analysis Center
Phone: 919.966.5011
gpink@email.unc.edu

Additional Resources of Interest:

SDOH Infographics and Data on People with Medicare Now Available

CMS is pleased to announce the availability of a new public use file on Socio-demographic and Health Characteristics of Medicare Beneficiaries Living in the Community by Dual Eligibility Status in 2021.  This public use file uses data from the Medicare Current Beneficiary Survey and contains estimates on socio-demographic characteristics, functional limitations, chronic conditions, mental health, and oral health of people with Medicare living in the community as well as those with both Medicare and Medicaid.

New infographics are available as well:

Pennsylvania Community Facilities Program Now Accepting Applications!

The Pennsylvania Broadband Development Authority (PBDA) has opened the application period for the COVID-19 ARPA Multi-Purpose Community Facilities (Facilities) Program and it will close 4.20.24 at 12:00 PM. We’d like to remind you as well that the PBDA and the Department of Community & Economic Development (DCED) Customer Service team are hosting two Office Hour Sessions to review FAQs for the Facilities Program and the DCED Electronic Single Application (ESA) System, next week.

Details to attend the Office hours as well as the recording of the Facilities Program overview and the DCED Electronic Single Application (ESA) system walkthrough can be viewed at the links below. The presentation is also available on this same page.

CMS Announces New Actions to Help Hospitals Meet Obligations under EMTALA

Today, the Department of Health and Human Services (HHS) announced that, together with the Centers for Medicare & Medicaid Services (CMS), it will launch a series of actions to educate the public about their rights to emergency medical care and to help support efforts of hospitals to meet their obligations under the Emergency Medical Treatment and Labor Act (EMTALA). As part of this comprehensive plan, the Department will:

  • Publish new informational resources on CMS’s website to help individuals understand their rights under EMTALA and the process for submitting a complaint if they are denied emergency medical care;
  • Partner with hospital and provider associations to disseminate training materials on providers’ obligations under EMTALA;
  • Convene hospital and provider associations to discuss best practices and challenges in ensuring compliance with EMTALA; and
  • Establish a dedicated team of HHS experts who will increase the Department’s capacity to support hospitals in complying with federal requirements under EMTALA.

The Department developed this comprehensive plan in response to a growing number of inquiries from patients and providers to CMS about how they can ensure that federal obligations were being met. CMS remains committed to helping all individuals—including patients who are experiencing pregnancy loss and other pregnancy-related emergencies—have access to the emergency medical care required under federal law.

The Biden-Harris Administration remains focused on working with doctors, hospitals, and patients to promote patient access to the care that they are entitled to under federal law and has long taken the position that this required emergency care can, in some circumstances, include abortion care. The U.S. Department of Justice is currently defending that understanding before the Supreme Court.

Updated Population Health Toolkit Now Available

The National Rural Health Resource Center’s recently updated Population Health Toolkit — which includes the newest population health data from a half-dozen publicly available data sets — is now available online.

Developed and maintained with support from the Federal Office of Rural Health Policy, the Population Health Toolkit is designed to assist State Offices of Rural Health (SORHs), state Flex Programs and individual health care facilities as they seek to better understand, manage and improve population health in their communities and state.

The toolkit, which was first created in 2016 and is updated annually, includes:

  • population health readiness assessment that allows health care facilities to gauge their preparedness for population health
  • Tools and resources to support health care facilities as they build their population health management capabilities
  • web-based dashboard that displays county, state, national and, when available, facility-level data on a range of population health measures, organized into more than a dozen scenarios that explore health conditions, health inequities and the leading causes of death in rural America
  • Tutorial videos that offer step-by-step guidance on conducting population health analytics

Have any questions about the Population Health Toolkit? Interested in a walk through of the toolkit? Please contact Tracy Morton, Director of Population Health, at tmorton@ruralcenter.org.

Updated Population Health Toolkit

The National Rural Health Resource Center’s recently updated Population Health Toolkit — which includes the newest population health data from a half-dozen publicly available data sets — is now available online.

Developed and maintained with support from the Federal Office of Rural Health Policy, the Population Health Toolkit is designed to assist State Offices of Rural Health (SORHs), state Flex Programs and individual health care facilities as they seek to better understand, manage and improve population health in their communities and state.

The toolkit, which was first created in 2016 and is updated annually, includes:

  • A population health readiness assessment that allows health care facilities to gauge their preparedness for population health
  • Tools and resources to support health care facilities as they build their population health management capabilities
  • A web-based dashboard that displays county, state, national and, when available, facility-level data on a range of population health measures, organized into more than a dozen scenarios that explore health conditions, health inequities and the leading causes of death in rural America
  • Tutorial videos that offer step-by-step guidance on conducting population health analytics

Explore the Population Health Toolkit

The Population Health Toolkit lets SORHs and state Flex Programs:

  • gain a better understanding of local and statewide health patterns by exploring the health needs of individual communities in their state
  • gather data on state population health needs that can be included in their upcoming Flex Program applications

SORHs and state Flex Programs are also encouraged to share the toolkit with critical access hospitals and other rural health care providers in their state that can use its features and data to assess their readiness for population health, inform their community health needs assessment process and even compare their facilities’ performance with peers across the state and country.

Have any questions about the Population Health Toolkit? Interested in a walk through of the toolkit? Please contact Tracy Morton, Director of Population Health, at tmorton@ruralcenter.org.
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Medicaid Disenrollments Top 15 Million: 5 Things to Know

From Becker’s

More than 15 million people have been disenrolled from Medicaid since April 2023, surpassing HHS’ original estimates with several months left in the redeterminations process.

According to KFF, as of Jan. 16, 15,015,000 people have been disenrolled from Medicaid during the continuous coverage unwinding process. HHS estimated around 15 million people would lose coverage during the process.

States began the process of redetermining the eligibility of Medicaid recipients for the first time since 2020 in April, after continuous eligibility requirements in place during the COVID-19 pandemic expired.

Here are five things to know about where the unwinding process stands:

  1. Around one-third of people who had their coverage up for renewal were disenrolled from Medicaid, while two-thirds were reenrolled in the program, according to KFF.
  2. The majority of those disenrolled had their coverage terminated for procedural reasons, rather than being determined ineligible on the basis of income. According to KFF, as of Jan. 16, 71% of disenrollments were due to procedural reasons.
  3. Disenrollment rates vary widely by state. In Texas, 61% of those whose coverage was up for renewal were disenrolled, while in Oregon and Maine, 13% of those up for renewal were disenrolled.
  4. Children account for around 4 in 10 of those disenrolled from Medicaid, according to KFF. In December, HHS asked nine states with the highest child disenrollment rates to implement more flexibility to keep eligible kids enrolled.
  5. States were given 12 months to complete the unwinding process, though in December, HHS said it would extend flexibilities offered to states through the end of 2024. At least two states, Arkansas and Idaho, have already completed the redetermination process.

Most Kids Losing Medicaid Come from Just Nine States All Led by Republicans

From Axios

Sixty percent of kids who have lost Medicaid coverage this year came from just nine states, all of which are Republican-led, according to new data from the Biden administration.

Driving the news: And the 10 states refusing the Affordable Care Act’s expansion of Medicaid to low-income adults have disenrolled more kids than all of the expansion states combined, the administration also reported.

Why it matters: The data hints at a partisan divide in reviews of Medicaid eligibility after those checks — which were put on hold during the pandemic — resumed this spring.

  • The administration on Monday sent warnings to the nine states with large losses in kids coverage, but federal health officials said they have limited power to require those states to make changes.

Context: At least 2.2 million kids have been removed from Medicaid and its sister program, the Children’s Health Insurance Program, during the so-called “unwinding” of pandemic-era coverage protections as of September, according to data from the Centers for Medicare and Medicaid Services.

  • More recent data tracked by outside sources suggest this number is closer to 3 million.
  • Many may have been disenrolled because of a procedural issue and not necessarily because they were no longer eligible. States have been restoring coverage for over 500,000 people, many of them children, who were inappropriately booted from Medicaid because of an error in calculating income.

State of play: Health and Human Services Secretary Xavier Becerra sent letters to Arkansas, Florida, Georgia, Idaho, Montana, New Hampshire, Ohio, South Dakota and Texas on Monday urging them to better protect kids from losing Medicaid.

  • The letters note that HHS “will not hesitate to take action to ensure states’ compliance with federal Medicaid requirements,” though they don’t specify what the department might do.
  • CMS earlier this month warned it will fine states that don’t properly report data about who’s losing coverage, Modern Healthcare reported.

By the numbers: South Dakota and Idaho recorded the sharpest decreases in Medicaid enrollment among kids between March and September (27%), according to CMS data.

  • Kids’ enrollment decreased by more than 10% in most other states receiving warning letters. Enrollment shrank by 9% in Georgia and 6% in Ohio, but those states are among those with the highest number of kids removed from the program.
  • Enrollment also decreased by over 10% in New Mexico, Oklahoma and Utah, but those states did not receive warning letters.

States with the smallest decreases in kids’ enrollment were largely blue states. Enrollment actually increased slightly in New York, Oregon, Massachusetts, Rhode Island and Washington, D.C.

  • As of June, more than 20% of children who lost coverage had been re-enrolled in Medicaid or CHIP, federal data shows. It’s unclear how many may have found coverage elsewhere, such as through the ACA insurance marketplaces or a parent’s employer.

The other side: States contacted by Axios defended the coverage losses and said they had followed federal requirements for the unwinding process.

Read more.