When a car crashed outside of tiny Tonopah, Nevada, volunteer EMS workers raced to the scene in minutes. But ever since Tonopah’s hospital closed, the town is now hours away from the nearest emergency room. Across the United States, rural hospitals are shutting their doors at a staggering rate—and many more are on the brink of closing. As rural America shrinks and ages, healthcare for millions of Americans is falling out of reach. In this video, NBC Left Field spends time with an EMS worker as she fights to help neighbors in need.

Published by NBC Left Field, April 10. 2019

Apply now to become an Appalachian Leadership Institute Fellow!

Applications are now being accepted for the inaugural class of the Appalachian Leadership Institute, a new leadership and economic development training opportunity for community leaders who currently live and/or work in Appalachia. The Appalachian Leadership Institute is an extensive nine-month program running from October–July and includes skill-building seminars, best practice reviews, and field visits during six separate sessions across the Region to be followed by a capstone graduation event held in Washington, D.C.

As part of the Appalachian Leadership Institute, participating Fellows will learn how to:

• Design effective economic development project proposals;
• Integrate community assets into long-lasting economic development strategies;
• Identify resources available to spur economic development;
• Locate and access investment capital from a variety of public and private sources;
• Prepare competitive applications for public grant opportunities;

Use expanded leadership skills to create strong coalitions; and much more!

Upon completion of the program, Appalachian Leadership Institute Fellows will automatically become part of the Appalachian Leadership Institute Network, a peer-to-peer working group committed to Appalachia’s future.

The Appalachian Leadership Institute is limited to 40 Fellows annually, drawn from Appalachia’s public, private and non-profit sectors. Fellows are chosen via a competitive application process and each class will include representatives from each of the thirteen state in the ARC footprint to reflect the region’s diverse economic development challenges, opportunities, and strategies. Apply now!

The Appalachian Leadership Institute is an advanced community capacity leadership training program developed by the Appalachian Regional Commission in partnership with the University of Tennessee, Knoxville; The Howard H. Baker Center for Public Policy; Tuskegee University; and Collective Impact.

More information about the Appalachian Leadership Institute is available at www.arc.gov/leadershipinstitute

At the Health Resources and Services Administration (HRSA), where the Federal Office of Rural Health Policy is housed, the Data Warehouse offers a wealth of information on all the factors that impact access to health care across the nation and territories, updated daily.  These data include Census tracts, Health Professional Shortage Areas, congressional districts, American Native lands and entities, Medically Underserved Areas and Populations and information about every grant administered by HRSA.  To make these data useful to as many as possible – including consumers – the Data Warehouse created a number of widgets, with quick information on local health centers, HIV/AIDS medical providers, organ donation and more, that are easy to use and share.

A new topic guide launched last month at the Rural Health Information Hub provides a comprehensive look at social determinants of health and the role that factors such as food assistance, job training, and safe housing play on the overall health of rural communities.  The guide uses data from the U.S. Department of Agriculture’s Economic Research Service (see the What’s New section above) and other federal data sources to scope social and economic well-being in rural areas, reviews federal assistance programs, and answers a list of frequently asked questions about integrating social services with health care.

The 2020 Rate Notice and Call Letter for the MA and Prescription Drug Programs details what plans and consumers can expect for the upcoming plan benefit year.  In addition to updating payment methodologies and rates, it finalizes policies to address the opioid epidemic and provides guidance on how MA plans can tailor supplemental benefits to improve or maintain the health of an enrollee with a chronic condition or illness, such as by providing meals or transportation for non-medical needs.  In 2017, about 25 percent of rural Medicare beneficiaries were enrolled in a Medicare Advantage plan and about 70 percent enrolled in a Prescription Drug plan, through either their MA plan or a stand-alone drug plan.

 CMS’ latest Health Insurance Exchange Enrollment fact sheet reports that overall enrollment in the 39 states that use the HealthCare.gov and in the 12 State-Based Exchanges (SBEs) that use their own eligibility and enrollment platforms decreased from 11.8 million in 2018 to 11.4 million in 2019. The proportion of enrollments in the Healthcare.gov states by rural residents remained at its 2018 rate of 18 percent in 2019. 

The Office on Women’s Health at the U.S. Department of Health & Human Services recognizes April as the month to raise awareness of sexual assault, and increase understanding of its effects that go well beyond targeted victims.  While prevalence of the consequences of violence is higher among women than among men, decades-old research on children who are exposed to domestic violence shows life-long impact on chronic conditions for physical and mental health.  The New England Journal of Medicine (NEMJ) notes that intimate partner violence is “more prevalent during a woman’s lifetime than conditions such as diabetes, depression, or breast cancer, yet it often remains unrecognized by health professionals.”  In the same editorial, NEMJ refers to a strategic framework to improve the response of health care systems implemented here at the Health Resources and Services Administration (HRSA).  The HRSA Strategy to Address Intimate Partner Violence includes a partnership with the Administration for Children and Families to increase coordination between clinical and social response systems.

The Economic Research Service (ERS) at the U.S. Department of Agriculture released data from its research on the economic, social, and demographic factors affecting rural poverty.  The ERS reports that there are 353 persistently poor counties in the United States, meaning that 20 percent or more of their populations were living in poverty over the course of several decades. Eighty-five percent of these counties are rural.  In 2017, more than one-third of non-metro families headed by a female with no spouse present were poor (33.8 percent), and nearly half of those with related children were poor (44.4 percent).

Experts in health management, sociology, and psychology analyzed responses to the 2017 Health Information National Trends Survey to examine characteristics of patients who do not access electronic medical records and communications from their provider through online portals.  The researchers found that of the sixty-three percent of patients who reported not using a portal during the prior year, the nonusers were more likely to be male, be on Medicaid, lack a regular provider, and have less than a college education compared to those who did access portals.  Though we don’t typically include articles requiring paid access in this space, the findings may have implications on the advancement of telehealth for rural areas

March 2019

The Centers for Medicare & Medicaid Services (CMS) has issued Frequently Asked Questions (FAQs) that provide more information to State Medicaid programs on what settings have the qualities of an institution and are ineligible for Home and Community Based Services (HCBS), which settings qualify for HCBS, and under what circumstances CMS needs to conduct a review with heightened scrutiny to determine if the setting qualifies for HCBS.  The guidance clarifies that while rural settings may appear to meet the criteria to conduct a heightened scrutiny review, States should only request such a review if a setting has the qualities of an institution and if individuals qualifying for HCBS in a rural area do not have the same access to engage in the community as enrollees not receiving Medicaid HCBS in the same area.