Rural Health Information Hub Latest News

CMS Proposes to Update Medicare Enrollment and Eligibility Rules

On April 22, CMS issued a proposed rule to implement sections of the Consolidated Appropriations Act, 2021 (CAA) that would simplify Medicare enrollment rules and extend the coverage of immunosuppressive drugs for certain beneficiaries.  Section 120 of the CAA makes changes to Original Medicare by revising the effective dates of coverage and allowing for the establishment of new special enrollment periods (SEPs) for individuals who meet exceptional conditions.  Section 402 of the CAA extends immunosuppressive drug coverage under Part B for certain individuals whose Medicare entitlement based on end-stage renal disease (ESRD) would otherwise end.  This rule also proposes other non-CAA-related changes to improve state payment of Medicare premiums, and a technical change related to how enrollment forms are referenced in regulations. According to MedPAC, about one-fifth of Medicare beneficiaries live in rural areas.  Comment by June 27. 

Comments Requested on the New Questions for the Census Survey 

In April 2020, the U.S. Census Bureau launched a new project to inform on a range of topics experienced by households during the COVID-19 pandemic.  New questions for the Household Pulse Survey are being formulated, for example,  changing the focus of one vaccination question from reasons for not receiving the vaccine to reasons for not receiving a vaccine booster dose. The Department of Commerce invites the general public and other Federal agencies to comment on proposed and continuing information collections. Comments Requested by May 18. 

The Centers for Medicare & Medicaid Services Focus on Health Equity

The Centers for Medicare & Medicaid Services, CMS, has a new, proactive plan to bring more equitable health outcomes to people in underserved and disadvantaged communities.  The CMS Framework for Health Equity calls for improved data collection, more culturally appropriate services, and broader access to health-related social services for those who receive care paid for by the nation’s largest health insurer.  This public health insurance covers nearly 64 million enrolled in Medicare and more than 83 million beneficiaries of Medicaid and the Children’s Health Insurance Plan. Health equity goals for the 2022 Strategic Plan include incentivizing other insurers to enter single-issuer rural counties in the individual market.  CMS will host a Health Equity Symposium today at 1:00 pm to provide more details on the health equity plan.

Biden Harris Administration Proposes Rule to Fix “Family Glitch” and Lower Health Care Costs

President Biden and Vice President Harris believe that health care is a right, not a privilege. They promised to protect and build on the Affordable Care Act (ACA), lowering costs and expanding coverage so that every American has the peace of mind that health insurance brings.

The Biden-Harris Administration continues to deliver on that promise. Thanks to the landmark American Rescue Plan, ACA premiums are at an all-time low, while enrollment is at an all-time high. Four out of five Americans can find quality coverage for under $10 a month, and families are saving an average of $2,400 on their annual premiums—$200 in savings every month back to families. The Administration has lowered costs and increased enrollment to a record high of 14.5 million Americans—including nearly 6 million who newly gained coverage. With the addition of Missouri and Oklahoma, two states that expanded Medicaid last year, nearly 19 million low-income Americans are enrolled in the ACA’s Medicaid expansion coverage, adding up to a record nearly 80 million children, pregnant women, seniors, people with disabilities, and other low-income Americans covered by Medicaid.

Read more.

The ‘Massive’ Task Awaiting State Medicaid Agencies

From Route Fifty, March 23, 2022

The end of a public health emergency would mean states losing hundreds of billions in funding for the health care program, and verifying whether millions of enrollees are still eligible.

State Medicaid officials around the country are growing increasingly worried about the mammoth and high stakes task of reevaluating who among roughly 80 million people will still be eligible for Medicaid when the Biden administration declares the national Covid-19 public health emergency to be over—a move expected in July.

With health advocates and state officials acknowledging a lot could go wrong, they are worried people will be mistakenly thrown off of the program, which provides health coverage to low-income Americans.

“It’s a pretty massive undertaking for us,” Nicole Comeaux, New Mexico’s Medicaid director said in an interview. “Really our goal is that everybody stays in the coverage who are eligible for it.”

On top of that challenge, state officials face added pressure because the end of the public health emergency, which began in January 2020, would mean roughly $90 billion a year in increased federal Medicaid funding states have been receiving would suddenly screech to a halt. That could happen as soon as the end of September.

Earlier in the pandemic, Congress and the Trump administration increased the federal government’s share of paying for Medicaid, known as the Federal Medical Assistance Percentage, or FMAP, by 6.2%. The move was a response to people losing health care coverage from their jobs in the early days of the pandemic.

In return for getting the extra money, approved in the March 2020 pandemic relief law known as the Families First Coronavirus Response Act, states were barred from removing anyone from their Medicaid rolls.

Meanwhile, the number of people enrolled in Medicaid and the related Children’s Health Insurance Program grew from 70.7 million in February 2020 to 84.8 million last September, according to federal figures.

When the public health emergency ends, Medicaid offices will have to return to determining whether everyone on the rolls is eligible—except with a lot more people to check compared to before the pandemic.

Recognizing the size of the task, the Centers for Medicare & Medicaid Services in March gave states up to 14 months after the end of the emergency declaration to reevaluate enrollees. But the rub for state budgets is that the increased federal help will have disappeared long before the end of those 14 months.That means it could make sense for them to get their Medicaid rolls in order ahead of the deadline.

Nearly Half of Rural Hospitals Lose Money on Childbirth Services

A large number of rural hospitals that cease obstetrics programs wind up closing later, researcher says.

About 40% of rural hospitals are losing money on their obstetrics programs, but many continue to provide the service because of its importance for community health, a new study shows.

Losing child-birth services can also be a harbinger of hard times for a rural hospital, oftentimes serving as a precursor to closure.

A study conducted by the University of Minnesota Rural Health Research Center found that some rural hospitals keep their obstetrics programs open even after they have stopped being financially viable.

In large part, researcher Julia Interrante said, rural hospitals that close their obstetrics units are more likely to close their doors for good.

“Usually the obstetrics unit will close, and then other services will start to close before the entire hospital closes,” she said. “It’s not always the case – sometimes we see things where hospitals will enter into mergers or move those services to another hospital location… But often when they end up closing OB services, then it usually kind of leads toward the hospital closing.”

A survey of obstetric unit managers or administrators at nearly 300 rural hospitals found that whether the program was in the black wasn’t as important to these leaders as how much the community needed it.

Hospitals reported they needed 200 births per year to maintain safety standards and to remain financially viable. More than 40% said they had fewer births than needed to sustain operations financially.

“I think that’s really striking,” Interrante said. “But so many of them also reported understanding the need and importance of having those services in rural communities, because people are still giving birth, and they have to have somewhere to go.”

The survey respondents said it was important to keep the obstetrics units open because of the complications patients could encounter if they had to drive long distances to give birth.

About two-thirds of survey respondents said meeting their community’s needs was the most important factor in keeping their obstetrics units open, even if there weren’t enough births in the area to warrant it financially. Only 16.5% said their top priority in making that decision was the financial aspect. Nearly 13% said their top priority was staffing.

Nationally, birth rates have been falling since 2008, according to the U.S. Census Bureau.  Birth rates tend to be higher in rural areas, around 1,900 births per every 1,000 women, compared to 1,600 births for 1,000 women in urban areas. However, because there are fewer women of child-bearing age in rural areas, hospitals tend to see fewer births per year.

“Many hospital administrators in rural communities care deeply about the health of pregnant rural residents,” Katy Backes Kozhimannil, director of the Rural Health Research Center and lead author of the study, said. “Rural hospital administrators prioritized local community needs over finances and staffing, keeping obstetric units open because local pregnant patients need care. Policy investments are needed to help rural hospitals and communities support safe, healthy pregnancies and births.”

Interrante said insurance reimbursement is one issue rural hospitals face in keeping the obstetrics units open. Rural areas tend to have more patients on Medicaid, she said, which only reimburses a percentage of what it costs hospitals to provide those services. According to the CDC, half of the women who give birth in rural areas are on Medicaid, compared to 41.9% in urban areas.

More than a quarter of those responding to the survey said they were not sure if they would continue providing obstetrics. Or they said they expected to stop offering the service, indicating a continued downward trend in health care access, researchers said.

“The responses from the rural hospital administrators strongly highlight the fact that they provide obstetric services because they are so necessary and important for the health of rural communities they serve,” Bridget Basile Ibrahim, a co-author of the study, said. “For many of the patients who give birth at these hospitals, it would be a huge burden for them to travel to the next nearest hospital to give birth.”

Researchers concluded that any policies to improve rural obstetrics care should take into account community needs, clinical safety, and rural hospital finances. How low-volume, rural hospitals are reimbursed should be investigated to ensure those hospitals’ financial viability, they said.

HHS Region 3 Director Named

Dr. Ala Stanford has been named Regional Director for HHS Region 3.

Dr. Stanford gained national recognition during the COVID-19 pandemic using the infrastructure of her pediatric surgery practice to create a grassroots organization to focus on testing, contact tracing and vaccination in communities devoid of access to care and resources. Her focus on the most vulnerable populations disproportionately impacted by COVID-19 saved lives.

Dr. Stanford is a practicing physician for over 24 years. She is board certified by the American Board of Surgery in both pediatric and adult general surgery. She is former director of the Center for Minority Health and Health Disparities of Temple University School of Medicine in Philadelphia, PA, a member of the Philadelphia Board of Health COVID-19 advisory board and trusted national leader and public health advocate. In addition to opening a Center for Health Equity to improve health outcomes in communities with the lowest life expectancy, her organization was responsible for providing nearly 100,000 COVID-19 tests and vaccinations. She was recognized by Admiral Rachel Levine and Surgeon General Vivek Murthy as demonstrating best health practices and a national model during a public health crisis.

Dr. Stanford has received many accolades, notably a: 2021 Top 10 CNN Hero, and 2021 George H.W. Bush Points of Light Award Recipient. Most recently she led a FEMA mission, Region 3 Team to vaccinate students in Philadelphia School District and a mobile vaccination unit in hard hit Southeastern Pennsylvania neighborhoods.

Dr. Stanford said, “I am humbled to be named HHS’s new Regional Director, especially at this critical time in our nation’s recovery efforts. Ensuring communities across Region 3 have access to the information and resources they need to stay safe and healthy, with a particular emphasis on advancing equity, will be my top priority, in all aspects of health care.”

Welcome Dr. Stanford!

CMS To Hold Listening Sessions on Rural Health Strategy

The Centers for Medicare & Medicaid Services (CMS) Rural Health Council is hosting public, virtual listening sessions to ensure the CMS Rural Health Strategy reflects the needs and priorities of those living and working in rural and frontier communities, including Tribal Nations and U.S. territories.

CMS invites you to join a listening session to provide your feedback on the current Rural Health Strategy and help improve CMS’s approach to advancing rural health. All listening sessions will be held virtually and dates are specific to your area. These sessions are meant for individuals with lived experience receiving health care or supporting healthcare service delivery in rural communities, including Tribal Nations and U.S. territories.

Prior to the listening session, you are encouraged to review the CMS Rural Health Strategy, and be prepared to speak to the following topic areas during the call:

  • Which of the CMS Rural Health Strategy objectives should CMS continue to prioritize?
  • What is missing from the current CMS Rural Health Strategy objectives?
  • What can CMS do to advance health equity for rural and frontier communities, including Tribal Nations and U.S. territories?

Please plan to attend the session that pertains to your CMS region, see information below. Listening sessions are open to the public to attend. If you have any questions about the CMS Rural Health Strategy listening sessions, please send to:

Listening Session #1
: CMS Regions 5, 7 and 8

Relevant States & Territories: Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin, Iowa, Kansas, Missouri, Nebraska, Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming

Date/Time: Tuesday, May 10th at 4:00pm EDT

Registration Link:…


Listening Session #2: CMS Region 4, Puerto Rico, and U.S. Virgin Islands

Relevant States & Territories: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee, Puerto Rico, Virgin Islands

Date/Time: Wednesday, May 11th at 12:00pm EDT

Registration Link:…


Listening Session #3: CMS Regions 6, 9, 10

Relevant States & Territories: Arkansas, Louisiana, New Mexico, Oklahoma, Texas, Arizona, California, Hawaii, Nevada, Alaska, Idaho, Oregon, Washington, Guam, American Samoa, Commonwealth of the Northern Mariana Islands

Date/Time: Thursday, May 12th at 6:00PM EDT

Registration Link:…


Listening Session #4: CMS Regions: 1,2,3 (excluding Puerto Rico & U.S. Virgin Islands, which will be included in Listening Session #2)

Relevant States & Territories: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont, New Jersey, New York, Delaware, Maryland, Pennsylvania, Virginia, West Virginia, District of Columbia

Date/Time: Thursday, May 19th at 4:00pm EDT

Registration Link:…