Rural Health Information Hub Latest News

Medicaid Expansion Alone Not Associated with Improved Finances, Staffing or Quality at Critical Access Hospitals

From Health Affairs

Critical access hospitals are important providers of care for rural and other underserved communities, but they face staffing and quality challenges while operating with low margins. Medicaid expansion has been found to improve hospital finances broadly and therefore may have permitted sustained investments in staffing and quality improvement at these vulnerable hospitals. In this difference-indifferences analysis, we found that critical access hospitals in Medicaid expansion states did not have statistically significant postexpansion increases in operating margins relative to hospitals in nonexpansion states. Nor did we see evidence of statistically significant differential improvement at critical access hospitals in expansion versus nonexpansion states on either staffing measures (physicians and registered nurses per 1,000 patient days) or quality measures (percentage point changes in readmissions and mortality within thirty days of admission for pneumonia or heart failure).

These findings suggest that critical access hospitals may need to take additional measures to bolster finances to provide continued support for the delivery of high-quality care to rural and other underserved communities.

Access the full article at CAH Medicaid Study – 2021

KFF COVID-19 Vaccine Monitor: Differences in Vaccine Attitudes Between Rural, Suburban, and Urban Areas

Throughout the past year, the Kaiser Family Foundation (KFF) COVID-19 Vaccine Monitor has provided a look into how the coronavirus pandemic has impacted people living in different areas of the U.S., including analyses of the vaccine intentions of rural residents. This latest report draws on two surveys conducted in November (before news of the omicron variant) – one of adults and one of parents – and shows that those living in different types of communities hold very different views of COVID-19 vaccines, particularly when it comes to children. In addition, parents living in different community types report getting different levels of information regarding COVID-19 vaccines from their children’s schools and pediatricians.

  • Rural and suburban adults continue to lag somewhat behind those living in urban areas in terms of vaccine uptake. As of November, eight in ten urban residents (79%) say they have gotten at least one dose of a COVID-19 vaccine compared to seven in ten suburban adults and 67% of rural adults. One in five (21%) of those living in rural areas and one in six (16%) of those living in suburban areas say they will “definitely not” get a COVID-19 vaccine, at least twice the share of urban residents who say the same (8%).
  • The rural-urban gap in vaccination intention is even larger when it comes to children. About half of rural parents say they will definitely not get their 12-17 year-old children or their 5-11 year-old children vaccinated for COVID-19. A quarter of rural parents (26%) say they have vaccinated their 12-17 year-old, compared to nearly two-thirds of parents in urban areas (64%) and about half of those living in suburban areas (47%) areas. One in ten rural parents and a similar share of suburban parents (14%) report that their 5-11 year-old child is vaccinated, compared to about a quarter (23%) of urban parents who say the same.
  • Four in ten parents overall say they have spoken to their child’s pediatrician about the COVID-19 vaccine. Yet, those living in rural areas are more likely than those living in suburban or urban areas to report their child’s pediatrician did not recommend the vaccine for their child. More than one-third of rural parents say they had a conversation with their child’s health care provider and the provider did not recommended they get their child vaccinated (compared to around one in ten urban and one in seven suburban parents).
  • Around half of all parents say their child’s school has provided them with information on how to get a COVID-19 vaccine for their child, but smaller shares of rural than urban parents say their child’s school has encouraged parents to get their child vaccinated (36%) compared to parents in suburban (44%) and urban (50%) areas.
  • Views on COVID-19 vaccine mandates also differ across communities. A majority of urban residents support the federal government requiring large employers to either have their employees be vaccinated or get tested weekly, while rural and suburban residents are more divided on this Biden administration guideline. In addition, most workers living in urban areas say their employer already requires employees to be vaccinated for COVID-19 or that they support such a requirement, while six in ten rural workers and half of suburban workers do not want their employer to issue a vaccine mandate. Opposition to schools requiring eligible students to be vaccinated for COVID-19 is also higher among rural and suburban parents compared to urban parents.
  • While differing partisanship and demographics may contribute to differences in vaccine attitudes between people living in urban, suburban, and rural communities, multivariate analysis suggests that there is a relationship between community type and COVID-19 vaccine uptake that exists even when controlling for party identification and demographics. Using a statistical technique called logistic regression, we find that rural and suburban adults are less likely than urban adults to report being vaccinated for COVID-19, even after controlling for age, race, ethnicity, education, income, party identification, and ideology.

To access the full set of findings and methodology, click here.

NIH Report Details 20 Years of Advances and Challenges of Americans’ Oral Health

Despite important advances in the understanding and treatment of oral diseases and conditions, many people in the U.S. still have chronic oral health problems and lack of access to care, according to a report by the National Institutes of Health. Oral Health in America: Advances and Challenges, is a follow-up to the seminal 2000 Oral Health in America: A Report of the Surgeon General. The new report, which is intended to provide a road map on how to improve the nation’s oral health, draws primarily on information from public research and evidence-based practices and was compiled and reviewed by NIH’s National Institute of Dental and Craniofacial Research (NIDCR) and a large, diverse, multi-disciplinary team of more than 400 experts.

The report updates the findings of the 2000 publication and highlights the national importance of oral health and its relationship to overall health. It also focuses on new scientific and technological knowledge – as well as innovations in health care delivery – that offer promising new directions for improving oral health care and creating greater equity in oral health across communities. Achieving that equity is an ongoing challenge for many who struggle to obtain dental insurance and access to affordable care.

“This is a very significant report,” said NIH Acting Director Lawrence A. Tabak, D.D.S., Ph.D. “It is the most comprehensive assessment of oral health currently available in the United States and it shows, unequivocally, that oral health plays a central role in overall health. Yet millions of Americans still do not have access to routine and preventative oral care.”

The newly issued report provides a comprehensive snapshot of oral health in America, including an examination of oral health across the lifespan and a look at the impact the issue has on communities and the economy. Major take-aways from the report include:

  • Healthy behaviors can improve and maintain an individual’s oral health, but these behaviors are also shaped by social and economic conditions.
  • Oral and medical conditions often share common risk factors, and just as medical conditions and their treatments can influence oral health, so can oral conditions and their treatments affect other health issues.
  • Substance misuse and mental health conditions negatively affect the oral health of many.
  • Group disparities around oral health, identified 20 years ago, have not been adequately addressed, and greater efforts are needed to tackle both the social and commercial determinants that create these inequities and the systemic biases that perpetuate them.

“This is an in-depth review of the scientific knowledge surrounding oral health that has accumulated over the last two decades,” said Rena D’Souza D.D.S., Ph.D., director of NIDCR, which oversaw and funded the project’s three-year research program. “It provides an important window into how many societal factors intersect to create advantages and disadvantages with respect to oral health, and, critically, overall health.”

The COVID-19 pandemic emerged while the report was being written. The science around SARS-CoV-2 continues to come into focus in real-time, and, although data were only starting to surface about the oral implications of the disease, the authors included a preliminary analysis of it to assess initial impacts.

The authors make several recommendations to improve oral health in America, which include the need for health care professionals to work together to provide integrated oral, medical, and behavioral health care in schools, community health centers, nursing homes, and medical care settings, as well as dental clinics. They also identify the need to improve access to care by developing a more diverse oral health care workforce, addressing the rising cost of dental education, expanding insurance coverage, and improving the overall affordability of care.

“Although there are challenges ahead, the report gives us a starting point and some clear goals that offer reasons to be hopeful, despite those challenges,” added D’Souza. “It imagines a future, as I do, in which systemic inequities that affect oral health and access to care are more fully addressed, and one in which dental and medical professionals work together to provide integrated care for all.”

Scientists and public health professionals will use the report to identify areas of scientific inquiry and research as well as develop and implement programs that ultimately will improve the oral health of individuals, communities, and the nation.

To view or download the report, please visit the NIDCR website at

Questions about the report? Email or call NIDCR at 1-866-232-4528.

COVID-19 Vaccine Access in Long-term Care Settings

The federal government is committed to ensuring that residents and staff in long-term care settings, such as nursing homes, assisted living, residential care communities, group homes and senior housing, have access to COVID-19 vaccines to receive primary series and booster shots.

Long-term care providers are encouraged to consider the option that works best for their residents and staff when coordinating access to COVID-19 vaccines, either in the local community or on-site. The CDC has additional details on these options. Find Medicare billing and payment information.

As a reminder, through enforcement discretion, CMS will allow Medicare-enrolled immunizers, including but not limited to pharmacies working with the United States, to bill directly and receive direct reimbursement from the Medicare program for vaccinating Medicare skilled nursing facility residents.

Introducing the Patient-Provider Dispute Resolution Process: Guidance Available

The patient-provider dispute resolution (PPDR) process is meant to protect uninsured (or self-pay) individuals from unexpectedly high medical bills. Effective January 1, 2022, providers, facilities, and providers of air ambulance services will need to give an uninsured (or self-pay) individual, or their authorized representative, a good faith estimate of expected charges after an item or service is scheduled, or upon request. The good faith estimate will include a list of items and services expected to be provided as part of the primary care, and items and services expected to be provided in conjunction with the primary care, for that period of care.

If an uninsured (or self-pay) individual receives a bill that is at least $400 more than the expected charges on the good faith estimate, they can choose to initiate the PPDR process, engaging a third-party entity certified by the Department of Health and Human Services (HHS) to arbitrate their dispute. This company will decide how much the uninsured (or self-pay) individual will pay to the provider or facility: the amount on the good faith estimate, the billed amount, or another amount in between the estimated amount and billed amount. To utilize this dispute process, there is a $25 administrative fee that the individual has to pay at the start of the process.

This PPDR process provides important consumer protections for the uninsured (or self-pay) individual from billed charges that are substantially in excess of the expected charges in the good faith estimate.

HHS has created PPDR guidance for different audiences. These guidance documents help providers and facilities and uninsured or self-pay individuals, and those who will help them, to better understand what information must be included in the good faith estimate, how to initiate the PPDR process, and address any questions you may have.

Guidance for Providers and Facilities: link available here

Guidance about Selected Dispute Resolution Entity: link available here

Guidance for Uninsured or (Self-Pay) Individuals: link available here

Guidance about the Administrative Fee: link available here

HHS intends to hold webinars in the future about the PPDR process. We’ll share webinar information in the coming weeks.

The Impact of Pandemics on Oral Health

An article in the latest issue of the Journal of the American Dental Association (JADA) explores the role of pandemics on societal behavior and their impact on oral health care. The analysis explores the past, present, and future of pandemic and what measures the dental community should adopt moving forward. The latest issue also features articles about ultrasonic scaler aerosol and spatter mitigation, the use of teledentistry with older patients, and the promotion of community water fluoridation.

Click here to read the article.

Highchair Dental Care: A Model for Infants and Toddlers

The American Dental Association (ADA) is offering a new interactive continuing education course, “Highchair Dental Care: A Revolutionary Practice Model for Infants and Toddlers.” The course teaches dental professionals an alternate way to provide oral health care for young children by introducing the highchair as a tool to use with children starting at 8 months old. The course is discounted for ADA members and offers 4 CEs.

Click here to learn more and take the course.

Veteran Oral Health: Expanding Access and Equity

Gaps in veteran oral health have been long overlooked. Now is the time for change. A forward-thinking white paper from the CareQuest Institute and the American Institute of Dental Public Health (AIDPH), “Veteran Oral Health: Expanding Access and Equity,” focuses on the need to better understand the significant deficits surrounding veteran oral health. The goal of the paper is to catalyze oral health professionals and policymakers toward advancing health equity for veterans. The social, structural, and individual drivers of disparate oral health outcomes experienced by veterans deserve more attention from the oral health community. This paper delineates the struggles veterans face with oral health care every day.

Click here to view the paper.

USDA Seeks Applications to Advance Equity and Expand Regional Economies in Distressed Rural Communities

U.S. Department of Agriculture (USDA) Under Secretary for Rural Development Xochitl Torres Small announced the Department is accepting grant applications that will advance equity in rural America by creating new opportunities in distressed communities.

USDA is offering priority points to projects that advance key priorities under the Biden-Harris Administration to help communities recover from the COVID-19 pandemic, advance equity and combat climate change. These extra points will increase the likelihood of funding for projects seeking to address these critical challenges in rural America.

The Rural Innovation Stronger Economy (RISE) grant program encourages a regional, innovation-driven approach to economic development by funding job accelerator partnerships in low-income rural communities. This includes communities that have been historically underserved, marginalized and adversely affected by persistent poverty and inequality.

RISE provides grants of up to $2 million to consortiums of local governments, investors, industry, institutions of higher education, and other public and private entities in rural areas. The funding may be used to support innovation centers and job accelerator programs that improve the ability of distressed rural communities to create high-wage jobs, form new businesses, and identify and maximize local assets.

USDA encourages applications that serve the smallest communities with the lowest incomes.

The deadline to submit applications is 11:59 p.m. Eastern Standard Time, April 19, 2022. Applications must be submitted through

Potential applicants may submit a concept proposal for review by the agency to no later than February 18, 2022.

For additional information, see page 71868 of the Dec. 20, 2021, Federal Register.

Applicants are encouraged to contact their nearest USDA Rural Development State Office ahead of the application deadline for more information about the program or the application process.

USDA Rural Development provides loans and grants to help expand economic opportunities and create jobs in rural areas. This assistance supports infrastructure improvements; business development; housing; community facilities such as schools, public safety and health care; and high-speed internet access in rural areas. For more information, visit

If you’d like to subscribe to USDA Rural Development updates, visit our GovDelivery subscriber page

CMS Funding 1,000 New Residency Slots for Hospitals Serving Rural & Underserved Communities

Administration takes action to address access to care, workforce shortages in high-need areas

On December 17, CMS took a critical step to advance health equity and access, issuing a final rule that will enhance the health care workforce and fund additional medical residency positions in hospitals serving rural and underserved communities.

The Fiscal Year (FY) 2022 Inpatient Prospective Payment System (IPPS) final rule with comment period establishes policies to distribute 1,000 new Medicare-funded physician residency slots to qualifying hospitals, phasing in 200 slots per year over five years. CMS estimates that funding for the additional residency slots, once fully phased in, will total approximately $1.8 billion over the next 10 years. In implementing a section of the Consolidated Appropriations Act (CAA), 2021, this is the largest increase in Medicare-funded residency slots in over 25 years. Other sections of the CAA being implemented further promote increasing training in rural areas and increasing graduate medical education payments to hospitals meeting certain criteria.

Read the full Press Release.