With so much going on in the world of health care and beyond, it would be easy to have missed what’s happened. Pennsylvania Partnerships for Children (PPC) has developed highlights of the latest on Public Charge, CMS’ proposed “Fiscal Accountability” Rule and CMS’ issued guidance on Block Grants. Additionally, PPC released new fact sheets on Medicaid and CHIP enrollment in Pennsylvania by Congressional, State Senate and State House legislative districts (the first time we’ve ever presented enrollment datPreview (opens in a new tab)a at this state level!). Read on…

Saddled with chronic health workforce shortages, widespread substance misuse and high HIV transmission rates, rural care networks – often staffed by volunteers and peer counselors – increasingly are the backbone of care delivery in small town America, HRSA Administrator Tom Engels told some 500 conference attendees at the Rockville Hilton last month.

The audience consisted of participants in three outreach programs run by HRSA’s Federal Office of Rural Health Policy. The programs have infused some $29 million in seed money into remote pockets of the country to help advocates and providers form local healthcare partnerships.

Read about the Rural Partnership Development Meeting.

It can be difficult to communicate the benefits of living and working in a rural area. Even though Pennsylvania’s rural regions are often within an hour or two of a large town or city, it’s still a commitment for a physician, dentist or other clinician to work in rural areas. EduMed.org, a web-based organization that connects students with educational opportunities, has produced the page “Why You Should Work in Rural Healthcare, and How to Thrive When You Do“ to help you tell your story and make candidates more comfortable with and accepting of working in a rural setting. Some of the articles relate to working in any underserved area.

The Nurse Corps Loan Repayment Program is now accepting applications through Thursday, March 12, 2020. Nurse Corps supports registered nurses (RNs), advanced practice registered nurses (APRNs) and nurse faculty by paying up to 85% of their unpaid nursing education debt. In exchange, participants serve for at least two years at a health care facility with a critical shortage of nurses or an eligible school of nursing in the case of nurse faculty. Before you apply, learn about application details including eligibility and service requirements in the 2020 Application and Program Guidance. Program highlights for 2020 include:

• To combat the nation’s opioid crisis, special funding has been provided for psychiatric nurse practitioners. Learn more by listening to a previously recorded webinar
• To increase the field strength of nurses that provide maternity care to women living in rural and underserved communities, there is a percentage of Nurse Corps funds dedicated to nurses specializing in women’s health

Before you apply, read the annually updated Application and Program Guidance. Make sure you understand the terms and conditions of the Nurse Corps contract, which outlines the requirement for fulfilling your minimum two years of service at an eligible critical shortage facility.

National research has revealed it and rural research suggests it: over 40% of today’s physicians are burned out. This in-depth story reviews information about burnout in healthcare professions and for physicians in particular. Along with reviewing causes and impact, a medical school wellness-advocate, a researcher, and a large healthcare organization with a rural footprint shared interventions and solutions.

On January 31, 2020, the Trump the Administration released a new tool to assist rural community leaders in building an effective local response to the crisis of addiction, the Rural Community Action Guide: Building Stronger, Healthy Drug-Free Rural Communities.  The Guide was developed by the Office of the National Drug Control Policy (ONDCP).

The purpose of the Guide is to arm rural leaders with information they can put into immediate action to create change. It provides background information, recommended action steps, and promising practices to help manage the impact of substance use disorder on local communities and help persons with the disease of addiction. The topics are based on lessons learned from Department of Agriculture rural roundtable discussions held in over a dozen states, as well as the experiences of several rural stakeholder partners.

At the launch, ONDCP Director, Jim Carroll was joined by the U.S. Department of Health and Human Services leadership: the Surgeon General, Dr. Jerome Adams; Admiral Brett Giroir, Assistance Secretary for Health; Dr. Elinore McCance-Katz, Assistance Secretary, SAMHSA; and, Brian LeClair, Deputy Administrator, HRSA.

A diversity of partners (rural and urban) contributed to the work and attended the event including: Addiction Policy Forum, American Farm Bureau Federation,  Appalachian Regional Commission, Center for Court Innovation, Community Anti-Drug Coalitions of America, Faces & Voices of Recovery,  Housing Assistance Council, National Alliance for Recovery Residences, National Association of Counties, National Association of Development Organizations, National Farmers Union, National Rural Health Association, National Sheriff’s Association, NORC Walsh Center for Rural Health Analysis, NTCA- The Rural Broadband Association, National Rural Transit Assistance Program, Pew Charitable Trusts, and the U.S. Department of Agriculture (National Institute of Food and Agriculture and the Center for Faith-Based and Neighborhood Partnerships).

The guide complements both the Community Assessment Tool, which gives county specific data about deaths and factors which may make a community more vulnerable to addiction, and the Federal Rural Resources Guide, which includes comprehensive information about different federal funds for rural communities impacted by addiction.  The Guide also has a companion supplement, a listing of promising practices which you can find here: Rural Community Action Guide: Promising Practices.

ONDCP will be holding a series of rural roundtables to discuss the Guide.  The first one will be held in Cape Girardeau, Missouri on February 19, 2020.

On February 3, 2002, Pennsylvania Department of Human Services (DHS) Secretary Teresa Miller today joined representatives from anti-hunger organizations, employment and training program programs, local grocery retailers, as well as state and local officials at Philabundance to discuss the effects from the Trump Administration’s numerous attacks on the Supplemental Nutrition Access Program (SNAP). Cuts and changes to eligibility for the program will negatively affect charitable food networks across the state, thousands of vulnerable Pennsylvanians, and Pennsylvania’s economy.

“SNAP is not just the nation’s most important anti-hunger program – it helps support local farmers and small businesses and grows economies around the country,” Sec. Miller said. “If proposed federal changes to the SNAP program take effect, the negative impacts will be felt well beyond the thousands of SNAP recipients who will be hurt. Without SNAP, charitable food networks will see an increased demand that they may be unable to meet, and retailers and food producers will experience lost profits from a decreased or more constrained customer base.”

SNAP helps more than 1.7 million Pennsylvanians access food, including about 700,000 children, about 690,000 people with disabilities, and about 300,000 older adults. If people receive less SNAP benefits each month or lose eligibility altogether, they may not have flexibility to make up the cut to their food budget without missing bills or giving up other essential needs. People will turn to local food banks, pantries, and soup kitchens to help meet this need, which creates additional strain on charitable food networks that operate on limited resources.

“This new rule could have dire consequences for over 40,000 people in the Delaware Valley,” said Glenn Bergman, Philabundance Executive Director. “With 700,000+ people already facing hunger in our area, food banks like ours will not be able to make up the difference if cuts occur. This is a short-sighted move by the administration that will not help people find jobs, not make our neighbors more stable and will significantly increase the severity of the hunger crisis in our area.”

In addition to SNAP helping 1.7 million Pennsylvanians keep food on the table and avoid chronic hunger, SNAP helps local economies. More than 10,000 authorized retailers participate in SNAP across Pennsylvania, and these retailers redeemed about $2.6 billion in SNAP benefits in 2018 according to the USDA.

In May 2019, the United States Department of Agriculture (USDA) published a study on the influence of SNAP redemptions on the economy and county-level employment in the time leading up to, during, and after the Great Recession. This study found that SNAP redemptions could have a greater economic stimulus impact than many other forms of government spending per dollar spent, especially during a recession, because they are paid directly to low-income individuals. For instance, the grocery subsidies deliver food directly to tables along with a financial return into rural supermarkets and small businesses in those communities.

The Trump Administration has proposed two rules and has finalized a third that will jeopardize access to SNAP:

• Abled-Bodied Adults Without Dependents (ABAWDs) final rule: In December 2019, the Trump Administration published a final rule, that goes into effect April 2020, that restricts states’ ability to determine which counties can be waived from work requirements for able-bodied adults without dependents, which are waived due to local unemployment rates. The ability to waive counties is now based on federally determined Labor Market Areas and on economic factors like excess labor and high unemployment.  The new rule lowers the threshold for unemployment rates those areas must meet to qualify for a waiver and removes state flexibility to determine which counties should be waived, despite states being better positioned to determine the economic environment in the local economies.  This rule change will jeopardize access to SNAP for more than 92,000 people, many of whom struggle with mental health, substance use disorder, and other long-term conditions that would be worsened by chronic hunger.
• Broad-Based Categorical Eligibility (BBCE) proposed rule: The Trump Administration in July announced a proposal to eliminate BBCE for SNAP. BBCE is a policy that gives states, including Pennsylvania, the flexibility to determine appropriate income thresholds and extend SNAP benefits to low-income families and individuals who would otherwise struggle to afford food. With BBCE, a Pennsylvania family of four is eligible for SNAP if they earn no more than about $40,000 a year. If BBCE is eliminated, that family of four’s SNAP eligibility limit will drop from about $40,000 a year to no more than $32,000 a year. For elderly single-person households, the limit would change from approximately $24,000 a year to about $15,000.  Eliminating BBCE also impacts the ability for low-income children to receive free and reduced-price school lunches. Families whose children are eligible for SNAP receive direct certification for eligibility for free and reduced-price lunches. Additionally, in districts where 40 percent or more children receive free and reduced-price lunches, the school qualifies for the Community Eligibility Provision, which allows schools and school districts in low-income areas to provide free school lunches to the entire school. Reduction in the number of children receiving direct certification may mean entire districts lose their ability to provide free meals for all students.
• Heating/Cooling Standard Utility Allowance (SUA) proposed rule: And in October, the Trump Administration announced a proposal to alter the method Pennsylvania uses to determine the Heating/Cooling SUA for SNAP recipients, which could negatively affect approximately 775,000 households in Pennsylvania. When DHS determines that a household is eligible for SNAP, to determine the value of the grant they will receive, the SUA is used as a factor; acknowledging that money needed to pay for shelter and utilities is not available to be used to purchase food. The Trump Administration’s rule would use a standard formula to determine each state’s SUA for the entire country, ignoring costs of living and utility rates that vary from state to state. The proposed rule impacts the Northeast states more significantly than the rest of the country due to the information used in the calculation. In Pennsylvania, each reduction in the SUA of $10 equates to a $2 to $3 reduction in SNAP benefits. If the Heating and Cooling SUA was reduced by $200, for example, most households would see a reduction in SNAP benefits of $40 to $60 per month.

SNAP participants have an opportunity to gain skills through SNAP 50/50 programs that can help them get a job and excel in career paths like culinary arts, hospitality, banking, health care, and skilled labor. The programs also help with job placement and job retention skills. SNAP 50/50 partnerships come at no cost to the commonwealth and create great value by helping participants gain valuable career skills that can help them find a career path and move off public assistance like SNAP and reach self-sufficiency. By helping participants move into the workforce, SNAP 50/50 supports communities that need skilled workers and helps broaden the state’s tax base.

There are currently 19 SNAP 50/50 programs across Pennsylvania including Philabundance Community Kitchen and Project HOME at the roundtable today. DHS has seen more than 300 positive outcomes – graduations or employment placements – since the start of the SNAP 50/50 program. DHS is actively working to expand SNAP 50/50 partnerships around Pennsylvania, but without greater support from the federal government, there will not be enough employment and training programs to meet the need created by the ABAWD rule’s more stringent work requirements.

“Every one of these rule changes hurts vulnerable people and organizations in Pennsylvania and around the country,” said Secretary Miller. “Every one of these rule changes forces people who are already in difficult positions to make the unconscionable choice of paying for food or paying for other necessities like utilities, rent, or medicine. Food assistance is a simple investment in the public good for all of us. We must lift up the stories of the many Pennsylvanians for whom food assistance programs like SNAP and the help from charitable food organizations is invaluable and protect and preserve these life-saving resources.”

For more information on SNAP, visit www.dhs.pa.gov.

MEDIA CONTACT: Erin James – 717-425-7606