- Q&A: What Are the Challenges and Opportunities of Small-Town Philanthropy?
- HRSA Administrator Carole Johnson, Joined by Co-Chair of the Congressional Black Maternal Health Caucus Congresswoman Lauren Underwood, Announces New Funding, Policy Action, and Report to Mark Landmark Year of HRSA's Enhancing Maternal Health Initiative
- Biden-Harris Administration Announces $60 Million Investment for Adding Early Morning, Night, and Weekend Hours at Community Health Centers
- Volunteer Opportunity for HUD's Office of Housing Counseling Tribe and TDHE Certification Exam
- Who Needs Dry January More: Rural or Urban Drinkers?
- Rural Families Have 'Critical' Need for More Hospice, Respite Care
- States Help Child Care Centers Expand in Bid To Create More Slots, Lower Prices
- Rural Telehealth Sees More Policy Wins, but Only Short-Term
- Healing a Dark Past: The Long Road To Reopening Hospitals in the Rural South
- Study: Obstetrics Units in Rural Communities Declining
- Q&A: Angela Gonzales (Hopi), on New Indigenous Health Research Dashboard
- Not All Expectant Moms Can Reach a Doctor's Office. This Kentucky Clinic Travels to Them.
- Hawaiʻi's Physician Shortage Hits Maui Hardest
- Choctaw Nation Found a Better Way to Deliver Harm Reduction. It's Working.
- In Rural America, Heart Disease Is Increasingly Claiming Younger Lives
New Report: 2024 State of Children’s Health Finds Uninsured Rates for Pennsylvania Children Stable, Yet Remains Too High
The number of uninsured children in Pennsylvania remains stable following last year’s unwinding of the Medicaid continuous coverage provision, but no progress has been made, according to our 2024 State of Children’s Health report. The report provides the first look at the impact of resuming Medicaid renewals following a three-year federal hiatus during the COVID-19 public health emergency.
Between 2022 and 2023, the rate of Pennsylvania children without health insurance remained steady at 5.2%. However, steady rates do not mean progress. Too many children live in Pennsylvania without access to health insurance. The number of Pennsylvania children under age 19 without health insurance increased slightly from 145,000 to 147,000 from one year ago.
According to the report, factors such as age, race and ethnicity, and poverty level impact children’s access to health insurance. Demographic highlights include:
- Children under 6 are more likely to be uninsured (5.6%) than school age children (5.1%).
- Uninsured rates improved for American Indian and Alaska Native children and White children. Uninsured rates worsened for Asian children, Black children, Hispanic children, and children of multiple races.
- Children in lower-income families are more likely to be uninsured, and approximately 6.8% of PA children are financially eligible for Medicaid but not enrolled.
Accompanying fact sheets for each of the 67 counties show the local uninsured rate, race and ethnicity profiles, and public health insurance enrollment data.
The report finds that Medicaid, CHIP and Pennie™ remain significant sources of coverage with approximately 47% of Pennsylvania children relying on those programs’ health plans to meet their health care needs. A growing concern is that the Pennie™ “no wrong door” policy may not be working as intended since more than half of children enrolled through Pennie™ appear financially eligible for Medicaid or subsidized CHIP programs.
While the Medicaid unwinding process did not cause significant disruptions to children’s coverage in 2023, we will know next year if there were disruptions in 2024 as the process wrapped up in June.
Approximately 8 out of 10 children with renewals completed within Medicaid unwinding maintained public coverage. However, procedural disenrollments occurred too often with 42% of children disenrolled due to administrative reasons, not eligibility. To counter this trend, the report recommends that the state improve its poor track record of using automated “ex parte” renewals instead of enrollees submitting renewal applications.
The report also recommends strengthening the state’s continuous eligibility (CE) policy and supports DHS’ plan to provide continuous eligibility to children from birth until age 6. In a big win for kids, DHS has received federal approval last week of its plan to provide Medicaid continuous coverage for Pennsylvania’s youngest children, which is expected to start in January.
To help ensure no child is disconnected from care and to keep down costs for families and the state, the report recommends that Pennsylvania:
- Strengthen automated renewals
- Provide continuous coverage to young children
- Improve PA’s ‘no wrong door’ policy
CMS Releases New Provider Toolkit for Sickle Cell Disease
The U.S. Department of Health and Human Services (HHS) Centers for Medicare & Medicaid Services (CMS) has released a new resource: CMS Sickle Cell Disease (SCD) Health Care Provider Toolkit: Resources for Health Care Professionals to Support Individuals with SCD .
This new toolkit builds on the CMS Sickle Cell Disease Action Plan (released in September 2023) to strengthen the infrastructure for primary care and other care settings to care for people with SCD, improve care management, and assist providers with supporting the needs of people with SCD and other chronic conditions. The SCD Toolkit consists of 6 sections that equip healthcare providers in delivering quality care to individuals with sickle cell disease. This toolkit is designed to assist the care team in supporting people by introducing SCD, including the common barriers to care, and summarizing CMS program coverage for services around social determinants and drivers of health as well as and new sickle cell disease treatments.
DHHS Releases Two Studies on Rural/Urban Health Care Disparities
The first study, conducted by the RAND Corporation, highlights a range of indicators where rural residents fall below national measures. The study looks at consumer assessment data for both Medicaid FFS and Medicare Advantage populations and clinical measures for Medicare Advantage populations only. This is a limiting factor – it would be useful to have some indication of clinical inadequacies in all rural Medicare populations:
The second study examines a range of different health care access indicators in rural/urban America. Indicators include insurance coverage measures and assorted health service availability measures.
Healthcare’s Most Dangerous Workplaces
From Becker’s Hospital Review
In 2023, private industry employers reported 2.6 million nonfatal workplace injuries and illnesses, down 8.4% from 2022, the U.S. Bureau of Labor Statistics reported Nov. 8.
Nonfatal recordable workplace injuries and illnesses include cases with days away from work, job restriction or transfer, along with other recordable cases.
In 2023, total recordable injuries and illnesses decreased in the healthcare and social assistance sector to 562,500 cases, down from 665,300 in 2022. The rate of nonfatal injury or illness per 100 full-time workers was 3.6 last year, down from 4.5 the previous year.
If illnesses are removed, the healthcare and social services sector recorded 471,600 nonfatal injuries in 2023. This is up from 443,800 the previous year and higher than any other sector. By comparison, 334,700 nonfatal injuries were recorded in retail trade and 326,400 in manufacturing.
Some of the healthcare subsectors with the highest rates of nonfatal injury or illness per 100 full-time workers are:
- Ambulance services — 7.4
- Nursing care facilities (skilled nursing facilities) — 6.9
- Continuing care retirement communities and assisted living facilities for the elderly — 6.5
- Psychiatric and substance abuse hospitals — 6.3
- General medical and surgical hospitals — 5.1
Healthcare workers face physical demands and safety challenges in their jobs, including the potential to sustain injuries linked to violence. Various groups and organizations have taken steps to help ensure a safer work environment. For example, the American Hospital Association and the FBI recently partnered to mitigate targeted violence in healthcare settings.
New Webinar Available! Access to Maternity Care in Rural U.S. Communities
Leadership of the University of Minnesota Rural Health Research Center Maternity Care Team provided a timely update on critical issues impacting maternal health in rural U.S. communities. The presentation described disparities in maternal health outcomes for rural populations, the growing scarcity of obstetric care, and the far-reaching consequences of obstetric unit closures. Additionally, the presentation delved into the reasons behind these closures and examined policy solutions aimed at improving access to maternal health care and advancing health equity.
Presenters:
Katy B. Kozhimannil, PhD, MPA, is a Distinguished McKnight Professor, University of Minnesota School of Public Health, and Co-Director of the University’s Rural Health Research Center. Her research contributes evidence for clinical and policy strategies advancing racial, gender, and geographic equity.
Julia D. Interrante, PhD, MPH, is a research fellow and statistical lead at the University of Minnesota Rural Health Research Center. Her work examines the impact of health policy on reproductive and maternal health care access and health outcomes.
The webinar can be accessed here.
Additional Resources of Interest
Share Your Rural Health Story
Let your rural story be heard!
Sharing your personal stories is a vital part of advocacy. At NRHA, we want to lift-up rural voices and capture your experiences in our advocacy efforts. Please share your experiences in rural health, whether it is working in a rural hospital struggling with workforce shortages, traveling far distances to obtain healthcare access, experiencing the impact of rural hospital closures in your community, or explaining how specific rural programs and funding have benefited or harmed your rural community.
We will be tracking and saving your stories to utilize and quote in specific advocacy campaigns, messaging, social media, and Hill meetings with Congress. If you are comfortable with us sharing or quoting parts of your story, please indicate so by checking the box to allow us to share it with others!
If you have any questions, please contact our Government Affairs and Policy Coordinator, Sabrina Ho (sho@ruralhealth.us).
To add your story, click here.
Report Explores Teledentistry Utilization by Oral Health Professionals
A new article published in the Journal of Public Health Dentistry explores the types of teledentistry delivery options and how to increase access to care for patients. “Teledentistry Utilization by Oral Health Professionals and Policy Considerations” was authored by the CareQuest Institute, MouthWatch, and the Virginia Commonwealth University.
Manuscript Addresses Continuing Education & Management of Acute Dental Pain
A recent manuscript was published in BioMed Central Oral Health focusing on the relationship between continuing education and dental pain. The study in the manuscript, “Evaluation of a continuing education course on guideline-concordant management of acute dental pain,” found that the continuing education course increased learners’ knowledge about the guidelines and shared decision making. Former PCOH Board Member/Board Chair Dr. Deborah Polk, University of Pittsburgh, was the lead author on this project in addition to consultants from the Association of State
and Territorial Dental Directors (ASTDD).
VA Proposes to Eliminate Copays for Telehealth & Expand Access to Telehealth for Rural Veterans
The U.S. Department of Veterans Affairs recently announced that it is proposing to eliminate copayments for all VA telehealth services and establish a grant program to fund designated VA telehealth access points in non-VA facilities, with a focus on rural and medically underserved communities.
These proposed changes would advance VA and the Biden-Harris Administration’s ongoing efforts to lower costs and expand access to care for all those who served. The proposed grant program, called Accessing Telehealth through Local Area Stations (ATLAS), would provide funding to organizations — including nonprofits and private businesses — to offer Veterans comfortable, private spaces equipped with high-speed internet access and the technology to meet with VA providers remotely. Grants would also provide designated funding to train on-site personnel to support the program.
These proposed changes are part of VA’s ongoing efforts to expand access to VA health care — at a time when VA care is outperforming non-VA care, earning Veteran trust at record rates, and delivering more appointments than ever before. In September, VA announced the availability of tele-emergency care nationwide, an important step in increasing timely access to emergency care. This year, VA also began waiving Veterans’ copays for their first three outpatient mental health care visits of each year, decreased wait times for new patient appointments to primary care and mental health, and expanded offerings of night and weekend clinics and increased the number of Veterans scheduled into daily clinic schedules.
“Waiving copays for telehealth services and launching this grant program are both major steps forward in ensuring Veterans can access health care where and when they need it,” said VA Secretary Denis McDonough. “VA is the best and most affordable care in America for Veterans — with these steps, we can make it easier for Veterans to access their earned VA health care.”
The rulemaking can be viewed in the Federal Register under public inspection, and will be published and open for a comment period (findable by searching for the rule on VA’s Federal Register webpage). VA anticipates a notice of funding opportunity for this grant program to be published following publication of the final rule.
For more information about VA telehealth, visit the VA Telehealth Services website.
To view the proposal on the Federal Register, visit Federal Register :: Telehealth Grant Program
CMS Innovation Center Reimagines Rural Health Care Approaches
CMS published Re-imagining Rural Health: Themes, Concepts, and Next Steps from the CMS Innovation Center “Hackathon” Series. The report describes lessons learned from previous Innovation Center models focused on rural health and their application to recent model development, as well as potential future areas the Innovation Center might explore to support rural communities. It also highlights themes and insights from the CMS Innovation Center-hosted 2024 Rural Health Hackathon. The Hackathon series convened rural health providers, community organizations, industry and tech entrepreneurs, philanthropies, policy experts, and patients to generate creative and actionable solutions to address the varied challenges to delivering quality health care in rural communities. The top thematic areas highlighted a need for training, regulatory changes, and collaboration to help improve access to care and support transformation.
As a next step, CMS intends to issue a Request for Application to fill the ten open spaces for the Rural Community Hospital Demonstration. The demonstration was directed by Congress and requires a test of cost-based payment for Medicare inpatient services for rural hospitals with fewer than 51 beds that are ineligible for Critical Access Hospital status. The demonstration has been operated by CMS since 2004 and is scheduled to end on June 30, 2028. The paper also outlines some possible considerations for future Accountable Care Organization-focused and other models.
The Innovation Center is committed to advancing rural health. The Center looks forward to further utilizing input from the Hackathon and robust engagement with rural health groups to design new models and innovations to address challenges facing rural, Tribal, frontier, and geographically isolated areas. Additionally, where possible, the Center may change existing models to enable greater participation by rural providers.
- Read more: Re-imagining Rural Health: Themes, Concepts, and Next Steps from the CMS Innovation Center “Hackathon” Series.
- Learn more about the CMS Innovation Center Strategy Direction