The Edredesign Lab at Harvard Graduate School of Education reports on how Leslie County Schools in rural Kentucky implemented the federal program that blends social and health services with academics.  The application cycle for the next cohort of the Full-Service Community Schools program closes on September 12. (See the link in Approaching Deadlines below.)

This case series from the University of Minnesota Rural Health Research Center offers three examples of rural hospitals offering high-quality support during pregnancy, childbirth, and the postpartum period.

 Last week, the Centers for Medicare & Medicaid Services CMS awarded $98.9 million in grant funding to help consumers navigate enrollment through the Marketplace, Medicaid, and the Children’s Health Insurance Program (CHIP). Navigator organizations will focus on outreach to people who identify as racial and ethnic minorities, people in rural communities, the LGBTQ+ community, American Indians and Alaska Natives, refugee and immigrant communities, low-income families, pregnant women and new mothers, people with transportation or language barriers or lacking internet access, veterans, and small business owners.  The Navigator funding can play a key role in addressing coverage gaps in rural areas. An HHS report shows that while the uninsured rate in rural areas has fallen in recent years, it continues to be about 2-3 percentage points higher than in urban areas over the 2018-209 period.

On August 19, the Departments of Labor, Health and Human Services, and the Treasury issued final rules concerning standards related to the arbitration process implementing the No Surprises Act, a bipartisan law to protect consumers against surprise medical bills. The increased transparency required under these final rules is designed to help providers, facilities and air ambulance providers engage in more meaningful open negotiations with plans and issuers. They will help inform the offers they submit to certified independent entities to resolve claim disputes. Parties or providers (including air ambulance providers), facilities, plans, and issuers may use an arbitration process known as the Independent Dispute Resolution (IDR) process to determine the total payment amount for out-of-network healthcare services for which the act prohibits surprise billing. The final rules include guidance for certified IDR entities on how to make payment determinations and instructs these entities that they must provide additional information and rationale in their written decisions.

Since 1989, the Substance Abuse and Mental Health Services Administration (SAMHSA) has increased efforts to raise awareness, promote new evidence-based treatment and practices, and celebrate individuals during their long-term recoveries.  Promotional materials, including social media content, are available on SAMHSA’s National Recovery Month website. At HRSA, nearly every bureau and office has a program focused on the opioid crisis, including an array of ongoing projects in the Rural Communities Opioid Response Program.

It’s been a rough couple of years for the Centers for Disease Control and Prevention. Facing a barrage of criticism for repeatedly mishandling its response to the covid-19 pandemic and more recently monkeypox, the agency has acknowledged it failed and needs to change.

CDC Director Dr. Rochelle Walensky has tapped Mary Wakefield — an Obama administration veteran and nurse — to helm a major revamp of the sprawling agency and its multibillion-dollar budget. Making the changes will require winning over wary career CDC scientists, combative members of Congress, and a general public that in many cases has stopped looking to the agency for guidance.

“If she can’t fix it, she’ll say, ‘It’s not fixable, here’s why, and here’s what needs to be done next,’” said Eileen Sullivan-Marx, dean of the New York University Rory Meyers College of Nursing, who has known Wakefield professionally for decades.

Other former colleagues said Wakefield’s experience as a nurse, congressional staffer, policy wonk, and administrator give her the perspective and leadership tools to rise to the occasion, even as they acknowledged the magnitude of the job ahead.

“She has high standards, and she’ll expect people to perform,” said Brad Gibbens, a former employee and the acting director of the Center for Rural Health at the University of North Dakota School of Medicine and Health Sciences. “She’s very fair, but you need to know what you’re doing.”

Wakefield will have to navigate rough waters in the wake of a series of missteps by the agency. The CDC botched the covid testing rollout early in the pandemic, issued confusing guidance on prevention measures such as masking and quarantining, and has been slow to release scientific findings on the fast-moving coronavirus.

Walensky has stressed that, as part of the reset, she wants the CDC to give Americans clear, accurate, and timely guidance on community health threats.

“I am confident that the appointment of Mary Wakefield will be instrumental in accomplishing our goals to modernize and optimize CDC,” Walensky said in a written statement. “It is clear that Mary is an action-oriented leader who can lead effective change.”

Following an internal audit, Walensky announced plans to restructure how the agency communicates with the public, to eliminate bureaucratic redundancies, and to help the CDC better interact with other parts of the federal government.

Wakefield’s first day on the job was in mid-August. She declined to speak to KHN for this article, but those who know her painted a rich picture of her management philosophy and style.

NYU’s Sullivan-Marx said Wakefield’s experience as a nurse makes her well suited to solve the complex set of problems facing the CDC, which she compared to a patient in need of stabilization.

“When you look at someone in a bed in intensive care, all you see are beeps and lines and monitors going off — people moving in and out like a train station,” said Sullivan-Marx. “The nurse is central to that for the patient, pulling all of that together.”

Sullivan-Marx also said Wakefield’s perspective as a front-line health care worker could help the CDC better understand how clinicians will receive and interpret its guidelines and recommendations.

For most of the Obama administration, Wakefield led the Health Resources and Services Administration. HRSA, a division of the Department of Health and Human Services, is responsible for a wide portfolio of programs — those that serve people living with HIV, provide compensation for people injured by vaccination, and document disciplinary action against health care providers.

Former HHS Secretary Kathleen Sebelius called Wakefield a “change agent” who was able to win the trust of HRSA staff members, many of whom are full-time employees, not political appointees.

“Folks understood that they were there before she came in and they’d be there after she left,” Sebelius said. “They had to be convinced that she was a good leader and they were going to follow her. That’s pretty significant, that she did so well in that agency.”

(Sebelius is a member of KFF’s Board of Trustees. KHN is KFF’s editorially independent newsroom.)

Sebelius said such experience could be helpful to Wakefield at the CDC, which employs just over 12,000 people, some of whom could be skeptical of changes. Covid was a serious stress test for the CDC, leaving some staffers wondering if it had lost its way.

Sebelius also noted as a plus Wakefield’s experience working with the CDC as acting deputy secretary of HHS. She was nominated to be deputy secretary but never confirmed because of political squabbles over abortion.

Details about changes coming at the CDC are still trickling out, though top brass have said they’ll need the support of Congress to implement them.

Sheila Burke, head of public policy at the law firm Baker Donelson, got to know Wakefield while working in Congress. She said Wakefield’s experience on Capitol Hill will come in handy when dealing with lawmakers who sit on committees that oversee the CDC.

“She’ll be keenly aware of the role of the members who care deeply about these issues,” Burke said.

Top health officials have had a hard time justifying the federal government’s pandemic response to certain members of Congress. Walensky and Dr. Anthony Fauci, the Biden administration’s lead medical adviser, who will soon step down, faced intense questioning from legislators on several occasions.

“I think she’s uniquely positioned to understand how you navigate that relationship,” Burke said of Wakefield.

Multiple former employees pointed to what Gibbens, from the University of North Dakota, characterized as Wakefield’s “infatigable amount of energy.” He said it wasn’t uncommon for him to arrive at work to phone messages she’d left him at 4:30 in the morning.

He described Wakefield as someone who knows “when somebody is trying to play her.” But he also said she doesn’t take herself too seriously. He recalled a kitschy animatronic singing fish on her office wall, a nod to her love of fishing. And the time she declined to fly on Air Force Two from Washington, D.C., to North Dakota, choosing to take a commercial flight “like a regular person.”

“She said, ‘You gotta be really careful with that stuff. You don’t want to get used to that,’” Gibbens recalled.

The work ahead for Wakefield could be a stress test of her belief in the human value of public policy. Walensky has said the changes she hopes to implement at the CDC won’t happen overnight, and it’s likely they won’t be easy.

Much like the CDC in the current moment, in 2005 Wakefield found herself at a possible turning point. That year, Wakefield’s brother and two of his children were killed in a car accident that seriously injured her sister-in-law and young nephew.

“Health policy as a focal area of my work before, now felt of very little consequence,” Wakefield wrote at the time in the Journal of Forensic Nursing.

Then she received word that her former boss, Sen. Kent Conrad (D-N.D.), had joined with others to introduce the Wakefield Act, a bill aimed at improving emergency medical care for kids. Even though it didn’t pass, it reminded Wakefield that pulling the levers of government can have real-life consequences.

“They acknowledged my family’s loss and put their support behind legislation that can affect the lives of children of other families who may have a chance at survival,” Wakefield wrote. “Public policy is important — isn’t it?”

Proposed rule would reduce red tape and streamline administrative processes to help children, older adults, people with disabilities, and others from underserved communities connect to health care coverage through Medicaid and CHIP 

The Biden-Harris Administration proposed a new rule to overhaul the enrollment processes for Medicaid, the Children’s Health Insurance Program (CHIP), and Basic Health Programs (BHPs), and eliminate arbitrary coverage caps for children in CHIP. In a Notice of Proposed Rule Making (NPRM), the Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is working to reduce red tape and simplify application and verification processes to make it easier for children, older adults, and people with lower incomes with Medicaid and CHIP coverage to enroll in and retain vital health insurance. This proposed rule follows President Biden’s executive orders in April 2022 and January 2021 directing federal agencies to take action to expand affordable, quality health coverage, including by strengthening Medicaid and the Affordable Care Act.

Under the Biden-Harris Administration, thanks to the American Rescue Plan and other Administration efforts, more Americans than ever before have health insurance coverage. Today’s proposed rule will build on these efforts and support President Biden’s calls to strengthen Medicaid and access to affordable, high-quality health coverage.

“Medicaid and CHIP provide essential health care to millions of families across the country, and we are making it easier to enroll children and others in health insurance and to maintain coverage,” said HHS Secretary Xavier Becerra. “With these steps, we’re delivering on our promise to make high-quality health care more accessible and affordable for all Americans.”

“CMS is acting today to protect and strengthen health care coverage for the more than 88 million people enrolled in Medicaid, CHIP, and the Basic Health Program,” CMS Administrator Chiquita Brooks-LaSure said. “This proposed rule will ensure that these individuals and families, often from underserved communities, can access the health care and coverage to which they are entitled – a foundational principle of health equity. In addition, this proposed rule will help more people pay their Medicare premiums by making it easier for them to enroll in the Medicare Savings Programs.”

This rule, if finalized, would standardize commonsense eligibility and enrollment policies, such as limiting renewals to once every 12 months, allowing applicants 30 days to respond to information requests, requiring prepopulated renewal forms, and establishing clear, consistent renewal processes across states.

Medicaid and CHIP are critical sources of health care insurance for families across the country. Medicaid is the single largest health coverage program in the U.S., covering nearly one in four Americans and providing robust benefits with little to no out of pocket costs. Together, Medicaid and CHIP provide 51% of our nation’s children and youth – more than 40 million children – access to quality, affordable health care. However, enrollment in these programs can be jeopardized because of cumbersome application or renewal processes and lack of uniformity in states across the country. This NPRM takes aim at those concerns, and includes a suite of proposed options to provide easier access to and retention in health care coverage.

In a major transformation to the programs and a historic win for American families, the Biden-Harris Administration is proposing to end lifetime benefit limits in CHIP and allow children to enroll in coverage right away by eliminating pre-enrollment waiting periods, consistent with nearly all other health coverage. The proposed rule would also permit states to transfer children’s eligibility directly from Medicaid to CHIP when a family’s income rises, preventing unnecessary redetermination processes from causing lapses in coverage.

The NPRM proposes simplifications that would increase enrollment and retention for people age 65 and older, as well as those who have blindness or a disability. The proposed rule, if finalized, would streamline the application process for these programs by removing unnecessary administrative hurdles for people who do not have – but are eligible for – Medicaid, CHIP, or BHP coverage. These individuals are often eligible for Medicaid, but are not yet enrolled or have trouble staying enrolled because of systemic barriers, potentially missing life-saving coverage and care because of burdensome processes.

The proposed rule also includes policies that would improve access to programs that help make health coverage more affordable for older adults and individuals with disabilities. It offers ways to simplify enrollment for Medicare Savings Programs, which permit Medicaid to pay Medicare premiums or cost sharing for Medicare beneficiaries with lower incomes. The proposed rule would also allow for automatic enrollment in Medicare Savings Programs for certain individuals receiving the Social Security Administration’s Supplemental Security Income – a key goal for streamlining connections to care for those who need them most.

A recent study estimated that only about half of eligible low-income individuals enrolled in Medicare were also enrolled in Medicare Savings Programs. This proposed rule would automatically consider older adults for Medicare Savings Programs enrollment when they apply for low-income subsidies to help pay for Part D Medicare coverage, reducing the burdens of both time and expense by eliminating the need to complete multiple applications.

Lastly, proper documentation is critical to enabling appropriate oversight, identifying errors in state policies and operations, and reducing inconsistent and outdated practices across states, which contribute to improper payments. This proposed rule would update and standardize recordkeeping requirements for states, which would help to address deficiencies in outdated state recordkeeping systems and improve program integrity.

For more information on the NPRM, consult the fact sheet available at https://www.cms.gov/newsroom/fact-sheets/streamlining-eligibility-enrollment-notice-propose-rulemaking-nprm.

To review or comment on the NPRM during its 60-day public comment period, visit the Federal Register.