Nearly half of rural pharmacies are independently owned retail stores and are susceptible to closing due to financial hardship. This policy brief from the RUPRI Center for Rural Health Policy Analysis builds on the history of Rural Policy Research Institute projects examining the provision of pharmacy services and updates on pharmacy closure in rural areas of the United States. Monthly data on all institutions providing pharmacy services in the 50 states and the District of Columbia were obtained from the National Council for Prescription Drug Programs.

Nearly a quarter of rural Appalachians have medical debt in collections, compared to 17 percent nationally.  This comes from an in-depth investigation by the federal Consumer Financial Protection Bureau, an agency created in 2011 to monitor the practices of banks, debt collectors, and other financial companies.  The report finds that the rural Appalachians with medical debt have more than double the rates of other types of delinquencies, including mortgages, auto loans, credit cards, and student loans.  Higher debt increases the likelihood that a consumer uses higher-interest services such as payday, pawn, or auto title loans.  This report is part of the CFPB’s Rural Initiative, which is focused on financial issues facing rural America.  TODAY, at 2:00 pm ET, CFPB Director Rohit Chopra will host a virtual discussion with advocates, service providers, community leaders, and members of the public on nursing home debt collection. The field hearing is a chance for the CFPB to hear from consumers and their advocates from

The Centers for Medicare & Medicaid Services (CMS) released a Request For Information (RFI) seeking public input on accessing healthcare and related challenges, understanding provider experiences, advancing health equity, and assessing the impact of waivers and flexibilities provided in response to the COVID-19 Public Health Emergency.

The Make Your Voice Heard: Promoting Efficiency and Equity Within CMS Programs RFI furthers CMS’ commitment to engaging and learning from partners, communities, and individuals across the health system to inform how we can better support the populations we serve. In alignment with Executive Order 13985, Advancing Racial Equity and Support for Underserved Communities Through the Federal Government, the CMS Strategic Plan Pillar: Health Equity and the CMS Framework for Health Equity (2022-2032), this RFI aims to gather feedback and perspectives related to challenges and opportunities for the Agency to embed health equity into our efforts encouraging innovation, reducing burden, and creating efficiencies across the healthcare system.

“Advancing health equity is core work of the Centers for Medicare & Medicaid Services. That’s why I am inviting stakeholders to help achieve our goal of an equitable and efficient health system, by working with us as we transform the healthcare experience for the individuals we serve,” said CMS Administrator Chiquita Brooks-LaSure. “Health equity is embedded within the DNA of CMS and serves as the lens through which we view all of our work.”

Disparities in health and healthcare continue despite decades of research and widespread efforts to improve health outcomes in the United States. Many populations, including racial and ethnic minorities, members of federally-recognized Indian Tribes, people with disabilities, patients seeking substance use and mental health services, individuals dually eligible for Medicare and Medicaid, and those living in rural and underserved areas are more likely to experience challenges accessing healthcare services, lower quality of care, and below average health outcomes when compared to the general population.

CMS is seeking to better understand individual and community-level burdens, health-related social needs, and opportunities for improvement that can reduce disparities and promote efficiency and innovation across our programs. CMS is requesting information related to strategies that successfully address drivers of health inequities, including opportunities to address social determinants of health and challenges underserved communities face in accessing comprehensive, quality care. For example, challenges accessing care may include understanding coverage options, receiving culturally and linguistically appropriate care, accessing oral health services, and accessing comprehensive and timely healthcare services and medication.

Through this RFI, CMS also seeks to better understand the factors impacting provider wellness and learn more about the distribution of the healthcare workforce. We are particularly interested in understanding the greatest challenges for healthcare workers in meeting the needs of individuals, and the impact of CMS policies, documentation and reporting requirements, operations, and communications on provider experiences.

Comments received in response to the Make Your Voice Heard RFI will be used to identify opportunities for improvement and to increase efficiencies across CMS programs. In addition, CMS hopes to learn how specific programs have benefited providers, practices, and the people we serve. We work to continually improve our programs and build solutions that will help close gaps in healthcare quality, access, and outcomes to ensure that all those served by CMS programs have a fair and just opportunity to attain their optimal level of health.

CMS encourages comments from all interested stakeholders, in particular, patients and their families, providers, clinicians, consumer advocates, and healthcare professional associations. We also encourage comments from individuals serving and located in underserved communities, and from all CMS stakeholders serving populations facing disparities in health and healthcare. The RFI is open for a 60-day public comment period beginning September 6, 2022. Comments must be received by November 4, 2022 to be considered.

The web-based public comment form was specifically designed to provide easy access and an improved user experience for submitting information. For more information on the Make Your Voice Heard: Promoting Efficiency and Equity Within CMS Programs RFI and to access the web-based public comment form, please visit: https://www.cms.gov/request-information-make-your-voice-heard

The U.S. Department of Homeland Security (DHS) issued a final rule applicable to noncitizens who receive or wish to apply for benefits provided by the U.S. Department of Health and Human Services (HHS) and States that support low-income families and adults. The rule, which details how DHS will interpret the “public charge” ground of inadmissibility, will help ensure that noncitizens can access health-related benefits and other supplemental government services to which they are entitled by law, without triggering harmful immigration consequences. By codifying in regulation the “totality of the circumstances” approach that is authorized by statute and which has long been utilized by DHS, the rule makes it clear that individual factors, such as a person’s disability or use of benefits alone will not lead to a public charge determination.

The final rule applies to noncitizens requesting admission to the U.S. or applying for lawful permanent residence (a “green card”) from within the U.S. When assessing whether a noncitizen is “likely to become primarily dependent on the government for subsistence,” DHS will not penalize individuals who choose to access the vast majority of health-related benefits and other supplemental government services available to them, including most Medicaid benefits (except for long-term institutionalization – such as residing in nursing home – at government expense) and the Children’s Health Insurance Program (CHIP). DHS will also not consider non-cash benefits provided by other government agencies including food and nutrition assistance such as the Supplemental Nutrition Assistance Program (SNAP); disaster assistance received under the Stafford Act; pandemic assistance; benefits received via a tax credit or deduction; and government pensions or other earned benefits. Receipt of cash-based benefits, such as Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), and other similar programs, will not automatically exclude an individual from admission or green card eligibility, and will instead be considered in a “totality of the circumstances” analysis.

“People who qualify for Medicaid, CHIP, and other health programs should receive the care they need without fear of jeopardizing their immigration status,” said HHS Secretary Xavier Becerra. “As we have experienced with COVID, it’s in the interest of all Americans when we utilize the health care and other services at our disposal to improve public health for everyone.”

“This final rule reinforces a core principle of the Biden-Harris Administration: that healthcare is a right, not a privilege, and no one should be deterred from accessing the care they need out of fear,” said CMS Administrator Chiquita Brooks-LaSure. “Today’s final rule is an important step toward achieving this goal for many Medicaid and CHIP enrollees and their families, and CMS will continue to do everything in our authority to make sure people have access to programs that keep them safe and healthy.”

“Federal civil rights laws require that all people be afforded fair and just decisions when applying for health benefits and other supplemental government services, free of bias, stigma, and discrimination,” said Office for Civil Rights Acting Director Melanie Fontes Rainer. “Today’s rule sets up safeguards to help ensure that people with disabilities and older adults who are not U.S. citizens can access health care without fear.  OCR will continue our robust enforcement of civil rights laws to ensure the rights of historically marginalized groups are upheld and defended.”

“People with disabilities and older adults who are not U.S. citizens no longer have to fear that using services that can help them maintain their health, live independently and contribute to their communities will cost them legal residency in our country,” said Alison Barkoff, Acting Administrator of the Administration for Community Living. “The rule explicitly rejects stereotypes that people with disabilities are more likely to become a public charge and is in keeping with the civil rights protections that are the bedrock of American values.”

This final rule is the product of action first taken by the Biden-Harris Administration in 2021 to reverse the previous administration’s 2019 public charge rule, which had the harmful effect of discouraging many immigrants from seeking benefits, such as CHIP and other government services for which they, their children, or their families were eligible, out of fear of jeopardizing their immigration status. This chilling effect extended even to those categories of noncitizens who, by law, are exempt from the public charge ground of inadmissibility, including refugees, asylees, noncitizens applying for or re-registering for temporary protected status (TPS), special immigrant juveniles, T (trafficking victims) and U (crime victims) nonimmigrants, and self-petitioners under the Violence Against Women Act (VAWA). With the publication of today’s final rule, the Biden-Harris Administration is continuing its efforts to reverse these harmful effects and ensure that these programs remain accessible for eligible individuals and families in need.

The final rule does not expand eligibility for Medicaid, CHIP, or other benefits to more people but clarifies DHS policy regarding recipients.

The final rule will be effective on December 23, 2022.

Over 28 minutes, the Freakonomics podcast examines the outcomes of rural hospital closures.

 The National Rural Health Association (NRHA) guide provides federal, state, and local resources and an interactive map linking to each state’s emergency response website.