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

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.

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.

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

• Information for Rural Stakeholders About Access to Maternity and Obstetric Care: A Community-Relevant Synthesis of Research
• Loss of Hospital-Based Obstetric Services in Rural Counties in the United States, 2010-2022

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

The Rural Health Value team is pleased to share that we have launched a redesigned website and logo. While we have a new look – you will continue to find trusted resources that facilitate the transition of rural healthcare organizations, payers, and communities from volume-based to value-based health care and payment models. Please take a look! On the new website you will find two new resources.

• Rural Value-Based Care – The Payer Perspective, Rural Health Value Summit Report. The Rural Health Value team convened professionals and executives from national and regional health care payer organizations to share and explore insights, innovations, successes, and challenges in rural health value-based care (VBC) contracting. This report summarizes challenges and solutions followed by suggestions for rural health care organization leaders from the Summit participants.
• A one-page summary of CMS’s Transforming Episode Accountability Model (TEAM). TEAM is a mandatory, episode-based, alternative payment model, in which selected acute care hospitals will coordinate care for people with Traditional Medicare undergoing one of the surgical procedures included in the model and assume responsibility for the cost and quality of care from surgery through the first 30 days after the Medicare beneficiary leaves the hospital. Of the 741 hospitals identified for mandatory participation, 124 (16.7%) are in non-metro counties. More from CMS on TEAM.

This summary is part of Rural Health Value’s Catalog of Value-Based Initiatives for Rural Providers. The catalog summarizes rural-relevant, value-based programs currently or recently implemented by the Department of Health and Human Services (HHS), primarily by the Centers for Medicare & Medicaid Services (CMS) and its Center for Medicare & Medicaid Innovation (CMMI).

Rural Health Value facilitates the transition of rural healthcare organizations, payers, and communities from volume-based to value-based health care and payment models. Visit www.ruralhealthvalue.org or contact Clint MacKinney, MD, MS, Co-Principal Investigator, clint-mackinney@uiowa.edu.