Rural Health Information Hub Latest News

CMS Awards Navigator Grants and Releases Annual Enrollment Assistance Bulletin

Since 2013, Navigators have helped Americans understand their health insurance options and facilitated their enrollment in health insurance coverage through the Federally-facilitated Marketplace (FFM). As trusted community partners, their mission focuses on assisting the uninsured and other underserved communities.

On August 25, 2023, CMS awarded $98.6 million in Navigator cooperative agreement awards to 57 returning organizations who will continue serving as Navigator awardees in states with a FFM. These awards support the work of organizations that offer assistance to consumers navigating, shopping for, and enrolling in health insurance coverage for plan year 2024. At this link are the 57 organizations receiving 2023-2024 CMS Navigator cooperative agreement awards for the FFM(s) they have received cooperative agreements to serve: https://www.cms.gov/files/document/2023-2024-navigator-awardee-summaries.pdf. All 29 FFM states for PY 2024 have at least one Navigator awardee organization.

Additionally this week, CMS published the annual guidance on training for navigators, CMS Enrollment Assistance Bulletin, 2023-01: Guidance Regarding Training, Certification, and Recertification for Navigators and Certified Application Counselors in Federally-facilitated Exchanges.  This bulletin provides annual guidance on the training, certification, and recertification requirements and procedures for Navigators, certified application counselors (CACs), and CAC designated organizations (CDOs) in the Federally-facilitated Marketplaces (FFMs). You can access the bulletin at:  https://www.cms.gov/files/document/2023-cms-assister-bulletin-final-508.pdf.

CDC Announces Director of Office of Rural Health

The Centers for Disease Control and Prevention (CDC) is pleased to announce that Diane M. Hall, PhD, MSEd, has been selected to serve as the permanent director of the CDC Office of Rural Health. She has served as the Office’s acting director since March of this year. As director, Dr. Hall will continue to lead and coordinate CDC’s rural health work and strategy to strengthen the delivery of rural public health services across the U.S.

Prior to coming to the Office of Rural Health, located in CDC’s Public Health Infrastructure Center, Dr. Hall served in CDC’s Office of the Associate Director for Policy and Strategy, Office of the Director, as CDC’s rural health lead, led the office’s Strategic Engagement and Capacity Building work, and oversaw training activities focused on using policy to improve the population’s health. As a recognized expert in knowledge synthesis and translation, she led the development of the office’s policy portal, the Policy Analysis and Research Information System (POLARIS).

Throughout the COVID-19 pandemic, Dr. Hall held several leaderships positions within CDC’s response. She also held various positions in CDC’s Division of Violence Prevention where she worked on research related to the prevention of teen dating violence, intimate partner violence, sexual violence, and youth violence. Prior to coming to CDC, she held an academic appointment at the University of Pennsylvania, serving as the lead coordinator for a master’s program in psychology.

Dr. Hall earned her B.A. in Psychology from Hollins College (now Hollins University), and obtained her MSEd in psychological services and PhD in school, community, and child clinical psychology from the University of Pennsylvania.

Dr. Hall and the CDC Office of Rural Health look forward to strengthening our relationships with all who have an interest in improving the health and well-being of rural America!

Pennsylvania Announces Partial Implementation of Interstate Nurse Licensure Compact

The Pennsylvania Department of State is pleased to announce that Pennsylvania will take a big step by partially implementing the interstate Nurse Licensure Compact, an agreement among 41 states and U.S. territories and administered by National Council for State Boards of Nursing, that recognizes the practicing privileges for nurses licensed under the compact.

Starting Sept. 5, 2023, registered nurses (RNs) and licensed practical nurses (LPNs) who hold multistate licenses through the compact will be permitted to practice in the commonwealth without obtaining a Pennsylvania license. This step should help ease Pennsylvania’s severe nursing shortage, alleviate burdens on overworked nursing staffs, make conditions safer for both patients and healthcare workers, and increase patients’ access to in-person and telehealth care.

November 2022 industry survey by The Hospital and Healthsystem Association of Pennsylvania showed vacancy rates of 30% for RNs providing direct care, and it cited a U.S. Health Resources and Services Administration report projecting that, by 2030, demand for LPNs in Pennsylvania will exceed the number of available workers by 27.8%.

The Department of State continues to work diligently with its state and federal partners to satisfy the preconditions necessary to allow the State Board of Nursing to issue multistate licenses to Pennsylvania nurses who want to be able to practice in compact member states.

Among the preconditions we must meet is being able to certify to other compact states that Pennsylvania’s State Board of Nursing has performed an FBI criminal background check on Pennsylvania applicants, a process that requires FBI authorization. The Department of State is actively seeking this authorization and is awaiting a response.

Meanwhile, we are ensuring that Pennsylvania meets other technical and regulatory requirements so that the commonwealth can fully implement the compact as quickly as possible once we receive FBI and statutory approval to access the FBI’s criminal background database.

We will keep you informed of our progress in achieving this crucial second step toward full implementation of the compact.

For answers to frequently asked questions about how the compact affects in-state and out-of-state nurses, as well as Pennsylvania patients, visit the State Board of Nursing’s webpage.

To learn more about the compact, visit nursecompact.com or email nursecompact@ncsbn.org.

Crest and Oral-B Launch Communications Campaign

Crest and Oral-B have launched their latest #ClosingAmericasSmileGap campaign focusing on oral care supplies for back-to-school for students. For every Crest or Oral-B product purchased from August 1st to September 30th, Crest and Oral-B will donate oral care supplies to a child in need.

To underscore the critical need for oral healthcare among these communities, Crest and Oral-B have released a “U.S. Kids’ Oral Health Report Card” that sheds light on the shocking discrepancies in access, affordability, and education between low and high-income families in the U.S.

Click here for more information.
Click here to view the report card.

Funding Opportunity! Pennsylvania Oral Health Plan Mini-Grants

PCOH is requesting proposals for the 2023-2024 Oral Health Plan Mini-Grant Program. The purpose of this program is to facilitate the implementation of the goals and recommendations of the 2020-2030 PA Oral Health Plan, as well as to advance the oral health of all Pennsylvanians. Requests may not exceed $4,000.

Applications are due by September 29th at 5 pm.

Click here to view the guidelines.
Click here to apply.

Funding for this project is through the Pennsylvania Department of Health through Centers for Disease and Prevention (CDC) of the U.S. Department of Health and Human Services (HHS) under the Preventive Health and Health Services Block Grant. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by CDC, HHS or the U.S. Government.

PA Data Center Provides Census Bureau Updates and More

2023 Metropolitan Statistical Areas (MSAs)

The Office of Management and Budget (OMB) released the Revised Delineations of Metropolitan Statistical Areas, Micropolitan Statistical Areas, and Combined Statistical Areas, and Guidance on Uses of the Delineations of These Areas.  Click here to view the bulletin.

The OMB Bulletin uses OMB’s 2020 Standards for Delineating Core Based Statistical Areas.  It is also the first delineation to use the 2020 Decennial Census, American Community Survey, and Census Population Estimates Program data.

2030 Census

Planning for the 2030 Census – the 25th in U.S. history – is underway. To develop the operational design, the U.S. Census Bureau will factor in past census experiences, your feedback, and new research. They will also consider evolving technologies and the changing world around us. The Census Bureau also released an updated timeline showing the lead-up to the 2030 Census. Click here to learn more.

New Report on Aging Veterans

A new report released by the U.S. Census Bureau shows U.S. veterans 65 years or older were less likely to be at risk of experiencing social isolation than other older adults. The report, Aging Veterans: America’s Veteran Population in Later Life, examines characteristics of the nation’s 8.1 million veterans ages 65 or older in 2021.

New Policy Brief Analyzes Medicare Advantage Participation Across Geographies

New from the RUPRI Center for Rural Health Policy Analysis

Distributional Analysis of Variation in Medicare Advantage Participation Within and Between Metropolitan, Micropolitan, and Noncore Counties
Dan Shane, PhD; Ufuoma Ejughemre, MD, MSc; Fred Ullrich, BA; Keith Mueller, PhD

This policy brief uses county-level information from 2017-2022 on population and MA plans to analyze relative MA participation rates by geographic classification. We use Urban Influence Codes to split counties into metropolitan, micropolitan, and noncore categories. Within each geographic classification, we order counties into quintiles by MA penetration rate (MA enrollees / Medicare-eligible enrollees) with the lowest 20% of county penetration rates comprising the first quintile. We find consistent growth in the median number of plans and median enrollment across all geographic classifications and all quintiles between 2017 and 2022, with slightly higher growth in micropolitan and noncore counties. We also find that growth rates were consistently higher in the lowest quintiles (lowest penetration rates) in each geographic classification. However, the absolute differences in median number of plans and median enrollment between these lowest-ranked counties and higher ranking counties in MA participation remained the same.

Key Findings

  • From 2017 through 2022, growth (measured as percent increase) in the number of MA plans and MA enrollment rates was higher in noncore and micropolitan counties than in metropolitan counties, but metropolitan enrollment rates remained higher than nonmetropolitan enrollment rates. The median number of MA plans in metropolitan counties is higher than that in micropolitan counties which is higher than the median number of plans in noncore counties.
  • Within each rural-urban classification, percent growth in MA penetration rates, plans, and enrollment has been highest in counties with the lowest participation rates in 2017.

Population size is closely tied to higher participation rates both within and across geographic classifications, with the important caveat that micropolitan and noncore counties with higher MA participation exceed rates that population only would suggest.

Click here to read the full report.

CMS Releases Inflation Reduction Act First Anniversary Fact Sheet

The Centers for Medicare & Medicaid Services (CMS) released an Inflation Reduction Act First Anniversary Fact Sheet. The fact sheet provides a summary of the milestones that CMS has met for implementing the provisions of the Inflation Reduction Act, which was signed into law on August 16, 2022.

The CMS Inflation Reduction Act Anniversary Fact Sheet is available here: https://www.cms.gov/newsroom/fact-sheets/anniversary-inflation-reduction-act-update-cms-implementation.

If you have any questions, please contact the CMS Office of Legislation.

New Report Highlights the Need for More Investments for Pennsylvania Children Birth to Age-5

A coordinated early care and education system ensures infants, toddlers, and preschoolers succeed in school and allows parents to work while knowing their children are safe and learning in high-quality care. Yet, inequities exist, causing too few children to have access and a historic early learning workforce shortage, as shown in our first-ever State of Early Care and Education report.

Working with Pre-K for PA and Start Strong PA as part of Early Learning Pennsylvania (ELPA), a statewide coalition of advocates focused on supporting young Pennsylvanians from birth to age five, the report uses data and research to show that without new investments in the child care workforce, Pre-K Counts, or the Head Start Supplemental Assistance Program, early learning providers will continue to lose teachers and close classrooms.

The growth and development of young children in high-quality early care and education is the start of a continuum with benefits that last into adulthood. Providing every child—regardless of race, ethnicity, geography or income—access to high-quality early care and education programs ensures an equitable start to their academic careers.

A coordinated child care system serving infants and toddlers is vital to the economy, allowing parents to work while knowing their children are safe and learning in high-quality care.

According to the report, inadequate funding for the child care system has led to issues of supply and demand that impact a family’s ability to find affordable, high-quality child care, and child care providers’ ability to be compensated fairly to pay their teachers and maintain business expenses:

  • Unlivable wages of less than $12.50/hour are causing a historic workforce shortage that is closing classrooms and driving up wait lists for working mothers and families.
  • Child care providers can’t raise teacher wages because families are already struggling to afford the costs of care. On average, costs for infant child care comprise approximately 17.5% of the Pennsylvania median family income.
  • Only 21% of eligible children under three are served by Child Care Works, leaving over 83,000 eligible infants and toddlers unserved.

The next step in the academic continuum for children is access to high-quality pre-k programs, but only 43% of eligible 3- and 4-year-olds participate in high-quality, publicly funded pre-k, leaving over 87,000 without access to a high-quality program.

The workforce is essential for delivering high-quality pre-k. Yet, while the level of quality expects and demands the appropriate knowledge and credentials of professionals, the compensation for pre-k teachers remains significantly lower than their colleagues in K-12 settings.

Unlike child care, publicly funded pre-k programs in Pennsylvania rely on annual state budget funding appropriations. High-quality pre-k has historically been a consensus issue, aligning political parties and enjoying a decade of growing investment. However, policymakers have flat-funded pre-k in the 2023-24 state budget, which is baffling.

The report shows inequitable access to early care and education opportunities for children in Pennsylvania:

  • As of March, only 1 in 4 income-eligible infants, toddlers, and preschoolers who are Black, Indigenous, and children of color participated in Child Care Works, with only 40% enrolled in a high-quality child care program. Of the 12% of income-eligible non-Hispanic white infants, toddlers, and preschoolers participating in Child Care Works, 51% were enrolled in a high-quality child care program.
  • Only 23% of all children served in Pre-K Counts and Head Start Supplemental Assistance Programs in Pennsylvania are Non-Hispanic Black, compared to 41% of children identifying as Non-Hispanic White.
  • Researchers at Penn State University found white preschoolers accounted for the majority of program participants in Pre-K Counts, and white children were increasingly more likely to be enrolled in a high-quality pre-k program compared to Black children. Recommendations from the report specifically called for Pennsylvania to increase funding for pre-k access and to serve more Black children from urban and high-poverty communities.

And compared to the K-12 and post-secondary education systems, the sector is the most diverse yet the lowest paid.

  • Racial disparities exist within the professional child care sector, with Black educators earning approximately 2% less than their white counterparts. Hispanic educators earn approximately 5% less than white educators, exacerbating the already low wages of the sector and deepening inequities and gaps in pay.
  • There is a pay gap between pre-k and kindergarten teachers, but an even larger wage gap between Black and non-Black educators. A $1/hour wage gap exists between Black and non-Black teachers at the preschool level.

The evidence is clear that access to a high-quality early care and education system positively impacts the lives of Pennsylvania children. Unfortunately, the state is falling short for children, families and providers across the commonwealth. Comprehensive policy solutions and increased investments are needed to change the system’s trajectory. Working together, we can build Pennsylvania’s early care and education system as a leading model.