New Brief Released: Increasing Telehealth Use During the COVID-19 Public Health Emergency and Healthcare Disparities: An Updated Systematic Review

The COVID-19 public health emergency (PHE) led to a dramatic increase in telehealth use owing to relaxed policies to facilitate healthcare access, but early studies demonstrated variability in telehealth utilization patterns across demographic groups. COVID-19 disproportionately affected communities of color and the socially disadvantaged, highlighting existing disparities in access and quality of care in the U.S. health system.  In early 2023, an RTRC research team conducted a systematic review to summarize available evidence from early in the COVID-19 pandemic and concluded that most available evidence showed that telehealth did not reduce disparities in access to health care during the PHE. In December 2023, the prior systematic review was updated with contemporary data using the same search strategy and methods.

Of the 523 references in our updated search, 32 met final inclusion criteria for the study. Most studies were retrospective cohort studies using before-after methodology, and telehealth utilization was the most common study outcome. Compared to the initial search, more of the papers included in this search focused on total health care utilization (instead of telehealth-only utilization), but overall, conclusions were similar. Telehealth utilization, in aggregate, increased more slowly among disadvantaged groups, such as older, more rural, Black, and economically disadvantaged populations than in less disadvantaged populations over the course of the PHE.

Please click here to read the brief.

Pennsylvania Governor Shapiro Opens Application Window for $500,000 in PA Farm Bill Grants to Strengthen Agriculture Education, Healthy Foods in Schools

Pennsylvania Agriculture Secretary Russell Redding announced that Pennsylvania’s Farm-to-School Grant program is offering schools and childhood centers to apply for up to $15,000 for eligible projects. This program, funded by Governor Josh Shapiro’s budget, support healthy eating habits and future careers in agriculture. To date, more than $2.6 million has been awarded to 237 projects across 50 counties.

“These grants are an investment in our children’s health and their future,” said Secretary Redding. “Introducing kids to fresh, local food enriches the connection between families and local producers and imparts meaningful changes in the lives of our youth while strengthening their bond with their communities. Funded Farm-to School Grant programs enable students to learn about local farmers, make healthy choices, and explore exciting career opportunities.”

Eligible applicants include school districts, charter schools, private schools, or centers with pre-kindergarten through 8th grade that participates in the Federal Child Nutrition Program. Funded projects can involve partnering with local farmers to source fresh produce or building and improving school gardens, with the goal of incorporating hands-on educational activities about agriculture and encouraging healthy eating.

“The PA Farm Bill’s Farm to School grant has made it possible for hundreds of schools across the Commonwealth to enhance and strengthen their farm to school programs,” said Samantha Gibb, Senior Associate at The Food Trust and Coordinator for the PA Farm to School Network. “School food service professionals are able to procure local food to serve in school meals from farmers in their area for the first time – opening up valuable market opportunities for Pennsylvania growers. Educators are able to provide kids with hand-on experiences in school gardens, through in-classroom taste tests and taking kids on farm field trips.” The PA Farm to School Network stands ready with resources to support schools and farmers in their efforts to ensure kids are connected to and nourished by thriving and resilient community food systems.

“Access to nutritious food is a critical component of ensuring students can focus, learn, and achieve in school, and the Farm-to-School grants help make that access more readily available to learners across the Commonwealth,” said Secretary of Education Dr. Khalid N. Mumin. “This funding complements the Shapiro Administration’s commitment to keeping students healthy and fed through universal free breakfast while supporting Pennsylvania’s farmers and agriculture industry as a whole.”

Grant applications must be submitted online through the PA Department of Community and Economic Development Electronic Single Application. Applications are due by 4:00 p.m. on Friday, June 7, 2024.

Full grant guidelines are published in the April 27th edition of the PA Bulletin.

Visit our recently-launched Farm-to-School Network Dashboard, built in collaboration with Saint Joseph’s University, to learn about the programs that have already been implemented across the Commonwealth.

Find a map of previous Farm to School and other PA Farm Bill grant recipients in your area as well as details of initiatives to grow and sustain Pennsylvania agriculture at agriculture.pa.gov/pafarmbill.

USDA and EDA Update Resources in Joint Guide to Boost Economic Development in Rural Communities

U.S. Department of Agriculture (USDA) Rural Development Under Secretary Dr. Basil Gooden announced that USDA and the U.S. Economic Development Administration (EDA) updated resources in the joint guide originally released in 2022 to help rural communities build strategies to boost local economic development.

Both agencies made several key updates to ensure communities can access new webpages and resources.

The announcement reinforces USDA’s commitment to strengthening partnerships that ensure rural Americans have the most up-to-date resources to compete in a modern economy and to create economic growth that lasts for generations to come.

Read full stakeholder announcement.

Federal Administration Finalizes Policies to Increase Access to Health Coverage for DACA Recipients

The U.S. Department of Health and Human Services, through the Centers for Medicare & Medicaid Services (CMS), finalized a rule that will expand access to health care for Deferred Action for Childhood Arrivals (DACA) recipients. Today’s rule ensures DACA recipients will no longer be excluded from eligibility to enroll in a Qualified Health Plan (QHP) through the Affordable Care Act (ACA) Health Insurance Marketplace, or for coverage through a Basic Health Program (BHP). CMS estimates that this rule could lead to 100,000 previously uninsured DACA recipients enrolling in health coverage through Marketplaces or a BHP.

“HHS is committed to making health coverage accessible for people DACA recipients – Dreamers – who have worked hard to live the American Dream. Dreamers are our neighbors and friends; they are students, teachers, social workers, doctors, and nurses. More importantly, they are fellow Americans,” said HHS Secretary Xavier Becerra. “More than one third of DACA recipients currently do not have health insurance, so making them eligible to enroll in coverage will improve their health and wellbeing, and help the overall economy.”

“The Biden-Harris Administration believes health care is a right, not a privilege, and that extends to DACA recipients who have built their lives in the United States,” said CMS Administrator Chiquita Brooks-LaSure. “Today’s rule reduces barriers for DACA recipients to obtain health care coverage and is a vital step toward making certain that it is available and accessible to all Americans.”

Individuals without health insurance are less likely to receive preventive or routine health screenings and may delay necessary medical care, incurring high costs and debts when they do seek care. DACA recipients are currently three times more likely to be uninsured than the general U.S. population. DACA recipients who qualify to enroll in a Marketplace plan may also qualify for advance payments of the premium tax credit (APTC) and cost-sharing reductions (CSRs) to reduce the cost of their Marketplace coverage, depending on their income.

As a result of this rule, DACA recipients and other newly eligible individuals will qualify for a special enrollment period to select a health plan through the Marketplace during the 60 days following the rule’s November 1, 2024, effective date. This timing also corresponds with the 2025 Open Enrollment Period, which will help ensure that newly eligible individuals are able to seamlessly enroll in coverage. Those who apply for coverage in November 2024 can have their Marketplace coverage begin as early as December 1, 2024, if they meet all other eligibility requirements. DACA recipients and others who are eligible for a BHP can apply for and receive coverage as early as November 1, 2024.

CMS also made technical modifications to the definition of “lawfully present” used to determine eligibility for coverage through a Marketplace or a BHP to promote administrative efficiency, clarity, and transparency. These changes aim to ensure complete, accurate, and consistent eligibility determinations and verification processes for health coverage for these populations.

CMS is committed to providing high-quality education regarding implementation of this rule and technical assistance for the many interested parties who assist immigrant and other communities with health coverage enrollment.

All provisions of the final rule will be effective on November 1, 2024.

For more information on the final rule, see the fact sheet at https://www.cms.gov/newsroom/fact-sheets/hhs-final-rule-clarifying-eligibility-deferred-action-childhood-arrivals-daca-recipients-and-certain.

To view the final rule, visit the Federal Register.

Report Now Available: Disparities in Health Care in Medicare Advantage by Race, Ethnicity, and Sex

The Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) released the tenth edition of the Disparities in Health Care in Medicare Advantage by Race, Ethnicity, and Sex Report. This 2024 report provides a summary of the quality of health care received by people enrolled in Medicare Advantage across the United States, focusing on differences in patient experience and clinical care quality based on race, ethnicity, and sex in 2023.

Click here to review the report.

The 2024 report highlights a range of aspects regarding the quality of patient care. It includes seven measures of patient experience from the Medicare Advantage and Prescription Drug Plan Consumer Assessment of Healthcare Provider and Systems survey, along with 41 clinical care quality measures covering nine domains of care from the Health Effectiveness Data and Information Set. These measures were stratified by race and ethnicity, sex, and the combination of race and ethnicity within sex to highlight areas where disparities exist.

For more information and to explore other recent reports, research efforts, and data, please visit our Research & Data webpage.

New School Lunch Nutrition Standards Announced

The U.S. Department of Agriculture announced new nutrition standards that limit added sugars and sodium in children’s school meals. The change will gradually phase in added sugar limits for the school lunch and breakfast program and update total sugar limits for breakfast cereals and yogurt. Program operators are not required to make any changes to their menus as a result of this rulemaking until school year 2025-26 at the earliest. As diet directly affects oral health, limiting added sugars can improve the oral health of children and youth.

Click here for more information.

New CDC Study Investigates Preventable Early Deaths in Rural and Urban Areas

A new study released in the CDC’s Morbidity and Mortality Weekly Report (MMWR) shows the gap in preventable premature mortality (or early death) between rural and urban America is growing wider. People living in rural areas are at a higher risk of dying early from one of the five leading causes of death when the death could have been prevented compared to people living in urban areas.  A video on premature and preventable deaths is available here.

This report is an extension of the 2019 CDC study, which showed the percentage of preventable early deaths from the five leading causes was higher in rural counties compared with urban counties during 2010–2017. It extends the study period by including mortality data for additional years (2018-2022), expanding the analysis from 2010 to 2022. Below are some of the main findings, and a brief data visualization of the report is available here.

Cancer 

  • The percentage of preventable early cancer deaths among all premature deaths declined from 21% in 2010 to 0.3% in 2022. Regardless of metropolitan status, all county categories experienced declines.
  • However, declines in urban areas were larger than those in rural areas, which widened the rural-urban disparities in early cancer deaths.
  • Differences in tobacco use and less access to lung cancer screening facilities may explain some of this gap.

Unintentional injury

  • The percentage of preventable early deaths from unintentional injury increased from 2010 through 2019 (39% to 54%), followed by a steep increase from 2019 to 2021 and a slight decrease through June 2022 to 64%.
  • Increases in the percentage of preventable early deaths from unintentional injury during 2010-2022 were statistically significant for all rural-urban county categories except micropolitan (rural counties with small towns, population of 10,000 to 50,000 person).
  • Percentages were higher in rural areas than in urban areas, but the gap narrowed.
  • The worsening and expanding drug overdose epidemic, increases in motor vehicle traffic fatalities, and increases in falls drive the growth in early deaths from unintentional injury.

Stroke

  • The percentage of preventable early deaths from stroke declined slightly from 2010 through 2019 (32% to 26%), followed by an increase to 34% through June 2022.
  • Each rural-urban county category experienced steep increases from 2019 to June 2022, except for the most rural counties, which experienced a slight decrease from 2021 to June 2022; rural counties had the highest percentage from January to June 2022 (42% in micropolitan counties and 41% in noncore counties).
  • Increases in 2020 and 2021 were likely associated with COVID-19-related conditions that contributed to risk-associated increased heart disease and stroke mortality, such as delayed or avoided emergency care treatment.
  • The highest percentages of preventable early deaths from stroke in 2022 were in southern states.

These findings can help guide local public health interventions to reduce risks of early death, while also highlighting the need to understand and address underlying social, environmental, and structural inequities contributing to disparities in preventable early deaths between rural and urban areas.

Access the full report and share this information with your network using our partner toolkit. This resource contains social media messages, graphics, and newsletter text you can use to help bring awareness of these findings and the need for more multi-sector approaches and focused interventions across the U.S. to reduce early death from the five leading causes. View CDC’s rural health website and  Rural Public Health At-a-Glance to find out what CDC is doing to improve the health and well-being of rural communities.

Fentanyl and COVID-19 Pandemic Reshaped Racial Profile of Overdose Deaths in U.S.

For as long as statistics about opioid overdose deaths have been collected in the United States, white individuals have been much more likely to die than Black individuals of the same age. With the rapidly increasing rate of fentanyl overdoses in the late 2010s, that trend began to reverse — by the start of the COVID-19 pandemic in 2020, more Black Americans began to die of opioid overdoses and from drug overdoses of any kind, according to researchers at Penn State.

New research from the Penn State College of Health and Human Development examined racial and regional differences in overdose fatalities from 2012-21, capturing the periods preceding and during the COVID-19 pandemic. In most of the nation, the researchers found that younger Black individuals died of overdose at lower rates than their white counterparts, but older Black individuals — especially men in Midwestern cities — became several times more likely to die of drug overdose than their white counterparts as the COVID-19 pandemic emerged.

The study was published in The American Journal on Addictions.

Read more.

Rural Prosperity Roundtable Signals A New Era for Our Planet, People in Rural Pennsylvania

On April 23, more than 70 academics, public officials, economic development, and agriculture stakeholders met at Pennsylvania State University’s Behrend Campus in Erie, Pa. The roundtable discussion – Investing in America Rural Prosperity Roundtable –highlighted the U.S. Department of Agriculture’s (USDA) efforts to create additional income opportunities for producers and entrepreneurs.

Agriculture Deputy Secretary Xochitl Torres Small also highlighted other Biden-Harris Administration efforts to build a stronger, more prosperous rural America through historic investments including the American Rescue Plan Act, Bipartisan Infrastructure Law, and Inflation Reduction Act. These investments are about rebuilding our economy from the middle out and the bottom up and creating new opportunities that ensure families, small businesses and family farmers throughout rural America have the opportunities and tools they need to build a good life in the communities that they love.

Among USDA’s local representatives at the event were Bob Morgan, State Director for Rural Development (RD), Heidi Secord, State Executive Director for the Farm Service Agency (FSA), and Denise Coleman, Natural Resources Conservation Service (NRCS) State Conservationist.

Last week was Earth Week and people everywhere are looking for ways to make our world a better place. This includes rural Americans, who thanks to programs like those in President Biden’s historic Inflation Reduction Act, are leading the fight against climate change, while making their communities healthier and reducing their energy costs. USDA is highlighting our partnership with rural communities to sustainably cultivate the future here in Pennsylvania and around the country.

Just like the President, we at USDA believe that every person, no matter where you call home, has a right to breathe clean air, drink clean water, and live in a healthy community—now and into the future. Every single day, we work to ensure these things. And with historic investments like the Inflation Reduction Act, we’ve also created new programs to transform rural power production and create good jobs for people in rural areas across the country.

The President’s Investing in America agenda is creating good-paying clean energy jobs, lowering costs, meeting our climate goals, advancing environmental justice and conservation, and strengthening communities that for too long were left behind or left out. The President has given Native Americans a stronger voice in federal affairs, and USDA has built new land stewardship and food harvesting programs based on the knowledge and traditions indigenous people have passed down through generations.

Here in Pennsylvania and throughout the country, USDA will continue to play an important role in all these goals. The investments we’re making will bring wealth and resources to people in rural areas and ensure they have every opportunity to succeed right in their own communities.

USDA is proud to celebrate Earth Week to show how we are investing in locally driven solutions to expand access to renewable energy, clean water and wastewater systems, and essential services that create jobs, build critical infrastructure, and create sustainable futures for rural America. We are committed to unleashing the potential of all rural and Tribal communities to build a secure and successful future for all.

For more information and to contact your local USDA office.

FSA in Pennsylvania: https://offices.sc.egov.usda.gov/locator/app?state=pa&agency=fsa

NRCS in Pennsylvania: https://www.nrcs.usda.gov/contact/find-a-service-center

RD in Pennsylvania:  https://www.rd.usda.gov/pa/pennsylvania-contacts

To learn more about biobased products, go to www.biopreferred.gov. For more information on how the Inflation Reduction Act is enhancing USDA investments in clean energy, visit https://www.rd.usda.gov/inflation-reduction-act.

Federal Agencies Release New Resource to Connect People Returning to the Community to Health Care Services

The Office of Justice Programs and the Centers for Medicare & Medicaid Services Office of Minority Health have joined together to release a new Coverage to Care (C2C) resource to support individuals upon release and re-entering the community to connect to health coverage and health services.

Click here to view: Returning to the Community: Health Care After Incarceration

This guide, Returning to the Community: Health Care After Incarceration, will assist individuals upon release and re-entering the community to better understand their health care needs, including physical and behavioral health, to learn key information, terms, people, and titles to help connect to health care services pre- and post-release, learn about insurance coverage types and how to apply, and tips to get started using health coverage to receive needed services to support a successful reentry and healthy life.

Based on community and peer feedback, OJP and CMS worked together to create this resource to help  fill a gap  and give people returning to the community information that can support their ability to advocate for needed services and coverage.  Many people returning to the community may not have health coverage right away or know how to obtain health coverage, and caring for physical or behavioral health needs may have been deferred.  While the immediate needs of  housing or employment will be a priority, it is still important to consider immediate health care needs, including prescriptions, care management, or behavioral health – needs that should not wait. Connecting people to health coverage and to services is essential. This resource is specifically tailored to consider the unique considerations, concerns, and needs of individuals that are incarcerated, soon to be released, or recently released.

Returning to the community can be overwhelming. OJP and CMS encourage family members, community partners, peer support services, and justice-related programs and other stakeholders to use this resource to help start conversations about and support individuals in seeking health care coverage, services, and how to get started. Coverage to Care (C2C) is a CMS initiative meant to assist consumers in understanding their health coverage and using it to receive needed health care services.

Returning to the Community: Health Care After Incarceration is currently available in English and Spanish. Additional languages will be made available. This resource can be used alongside other Coverage to Care resources like the Roadmap to Better Care or the Roadmap to Behavioral Health.

To learn more about Coverage to Care, sign up for our listserv, visit https://go.cms.gov/c2c or email CoveragetoCare@cms.hhs.gov.

To learn more about the Office of Justice Programs, sign up for our listserv, visit https://www.ojp.gov/subscribe.