- US Launches Program to Deliver Free Cybersecurity Help to Rural Hospitals
- Doctor Left Thriving Practice to Follow New Vision for Rural Healthcare
- To Keep Rural Healthcare Workers, Missouri Is Helping Cover Their Childcare Costs
- Looking Local Could Be a Solution to Rural Nursing Shortage
- CMS and States Launch $275 Million Initiative to Recruit and Retain Nurses in Nursing Homes
- HRSA Awards Nearly $13 Million to Expand Access to Healthy Foods for Pregnant and Postpartum Women
- HHS Launches Newborn Essentials Support Toolkit Program to Support Mothers and Babies
- A Rural CIO's Guide to Getting More from Technology
- Missouri Independent Hospitals Seek Strength in Numbers with New Clinically Integrated Network
- An Ambitious Financial Experiment Tried to Support Struggling Rural Hospitals in Pa. For Years. Did It Work?
- Request for Information: Data Intermediaries and Approaches to Strengthen Public Health Data Exchange
- 'Spreading like Wildfire': How One KY County Is Grappling with a National Tick-Borne Scourge
- HRSA Awards Nearly $90 Million to Expand Addiction Treatment and Recovery Services in Rural Communities
- FORHP Awards More Than $6 Million to Strengthen Rural Health Networks
- HRSA Awards Nearly $19 Million to Expand Access to Healthcare Through Telehealth and Innovative Technologies
CMS Updates CAH Rural and Distance Eligibility Review Guidance
The Centers for Medicare and Medicaid Services (CMS) issued updated guidance for evaluating whether Critical Access Hospitals (CAHs) continue to meet Medicare rural status and distance requirements, including clarification of the circumstances that trigger an eligibility review. Effective September 20, 2026, CMS will conduct reviews when a new acute care hospital is seeking Medicare certification near an existing CAH, when CMS identifies a nearby acute care hospital not considered during a prior review, or when a hospital seeks new CAH certification or conversion.
Beginning in 2033, CMS will also review all existing CAHs for compliance with rural status and distance requirements on a 10-year cycle although CMS may conduct a review of rural and distance eligibility at any time. CAHs found no longer eligible will generally have a set period of time to reclassify as rural, convert to an acute care hospital or Rural Emergency Hospital if eligible, or face termination of Medicare participation.
The guidance also recommends that CAHs seek an advance CMS determination before adding a provider-based location to ensure the location will not affect CAH eligibility and clarifies that routine recertification surveys may proceed without CMS first confirming rural and distance eligibility.
“State Survey Agency and CMS-Approved Accrediting Organization recertification surveys may be performed based on the CAH’s existing recertification schedule and no longer require confirmation from CMS of rural and distance eligibility to proceed.”
For additional information, click here or contact CAHReviewTeam@cms.hhs.gov
Pennsylvania Cost Containment Council Welcomes Experts to Technical Advisory Group
The Pennsylvania Health Care Cost Containment Council (PHC4) is pleased to announce the appointment of two new members to its Technical Advisory Group (TAG): Scott W. Cowan, MD, FACS, healthcare executive and thoracic surgeon who serves as Chief Medical Officer (CMO) and Chief Quality Officer (CQO) at Thomas Jefferson University Hospitals, Inc.; and Nancy A. Garrett, Ph.D., Vice President of Provider and Market Analytics at Highmark Health. Their appointments were formally approved by the Council on Sept. 3, 2026.
TAG plays a vital role in addressing complex analytical and methodological issues that arise from PHC4’s work. In this capacity, Cowan and Garrett will join a respected panel of physicians, researchers, biostatisticians and healthcare organization representatives committed to strengthening healthcare transparency for Pennsylvanians. The group reviews critical healthcare measurement strategies and provides guidance on research design, statistical analysis and risk‑adjustment methodology, offering rigorous recommendations to ensure the integrity of PHC4’s data and reports.
Cowan and Garrett bring deep expertise that will enhance TAG’s impact and oversight. Garrett shared that she looks forward to advancing PHC4’s mission, noting, “This is more important than ever now, and we have a huge opportunity to leverage this collaborative to make a difference.” Cowan echoed her sentiments and expressed enthusiasm about contributing his clinical and quality-improvement expertise to the group.
PHC4 is an independent council formed under Pennsylvania statute (Act 89 of 1986, as amended by Act 15 of 2020) in order to address rapidly growing health care costs. PHC4 continues to produce comparative information about the most efficient and effective health care to individual consumers and group purchasers of health services. In addition, PHC4 produces information used to identify opportunities to contain costs and improve the quality of care delivered. For more information, visit phc4.org or review PHC4 Council, Committees, and Groups here.
Pennsylvania Data Center Provides New Census, Other Data
Research Brief Highlights New ACS 1-Year Estimates
The U.S. Census Bureau released a new set of estimates from the American Community Survey (ACS) for the year 2025, providing new data for a variety of demographic and economic topics for the nation, states, and other areas with populations of 65,000 or more.
New 2025 ACS data for Pennsylvania show statistically significant increases in the 65+ and Hispanic or Latino populations, bachelor’s degrees, household income, cost of rent, owner costs, home values, and broadband access, plus a decline in labor force participation.
Read the full 1-Year Estimates release brief.
Note: This release was delayed from its typical September release timeframe due to a new Department of Commerce departmental administrative order (DAO) on disclosure avoidance for statistical products. Other ACS release dates for 2025 have yet to be announced.
Nonemployer Statistics (NES) is an annual data product that provides subnational economic data for U.S. businesses with no paid employees by industry. This series includes the number of establishments and total receipts.
States Race to Get the Word Out About New Medicaid Work Requirements
We’re entering a moment where missing a few pieces of mail could mean losing your Medicaid.
In 2027, roughly 20 million people will begin to face more eligibility checks, and need to prove they’re working, volunteering, going to school or exempt from new requirements pushed through by Republicans as part of President Trump’s Big Beautiful Bill.
Through a flurry of webinars, text messages and trainings, hundreds of health care groups are hustling to let people know what’s ahead. But they have a long way to go.
“If I spoke to 10 people about the changes, maybe one person might know that it’s coming,” said Toya Walker, an outreach worker pounding the pavement in Camden, New Jersey, a small city across the Delaware River from Philadelphia.
For this week’s story, we traveled to Camden to see those outreach efforts in action. We also spoke with more than a dozen experts — including health insurers, state Medicaid officials and researchers — about how this communications blitz is unfolding across the country.
Here are some key takeaways:
- States know what they need to do to reach people — but actually doing it is a lot tougher. Experts generally agree that training trusted messengers and getting clear information to people most affected by these policies are among the best communication strategies. But with time and money tight, states are struggling to execute. “I don’t want to say communications is a luxury item,” said Manatt consultant Kinda Serafi, “but it does feel like it’s not always at the top of the list.
- State Medicaid programs are leaning heavily on partners to get the word out. Those partners include hospitals, community clinics, advocacy groups and the insurance companies that manage many people’s Medicaid. “The state has turned to us to get to all of those groups that are in between the cracks,” said Kathleen Noonan, CEO of the Camden Coalition, a New Jersey-based nonprofit that’s worked with people who have complex medical and social needs for nearly 25 years.
- Complicated and evolving rules about who the new requirements apply to make clear communication particularly tricky. One state’s fact sheet, for example, lists 16 different exempt groups. Nearly a dozen states are offering self-screening tools to help consumers figure out for themselves whether these new rules apply to them. Federal officials have also been slow to clarify some details, like who qualifies for a medical exemption, which has left outreach workers like Toya Walker feeling frustrated. “I need clarity, and I need clarity now,” she said.
- Technology has a big role to play in minimizing coverage losses, but its adoption has been uneven. States have the power to use existing data sources, such as income and tax filings, to automatically verify many people’s Medicaid eligibility. “The best way to keep people covered is to ask as little of the enrollee as possible,” said Harvard researcher Adrianna McIntyre. While more than a dozen states now automate most of their renewals, many others are far less tech savvy. To make automation easier, some states are asking people to share more data about their income — a request that’s met significant resistance.
Despite all of these efforts, experts still expect millions of people to lose their insurance. Harvard’s McIntyre points to Arkansas’ experience with a similar work requirement in 2018 as a cautionary tale.
Many people ended up automatically excused, but the rest needed to confirm they were working or had a valid exemption. The state sent 900,000 letters and emails to let people know what they needed to do to keep their Medicaid.
“You didn’t have to prove it. You just had to check a box,” McIntyre said. “And we still lost something like 80% of enrollment.” That’s why experts like McIntyre said in addition to trying to communicate the coming changes, states also need to prepare to catch people who will, inevitably, fall through the cracks.
To learn more about how states are trying to beat those long odds with a combination of new-school technology and old-school boots on the ground, listen to the full story or read the transcript.
DOL Finalizes Pharmacy Benefit Manager Fee Disclosure Rule
The U.S. Department of Labor’s employee benefits arm unveiled a final rule on October 28, 2026 that requires pharmacy benefit managers – which act as intermediaries between drugmakers, pharmacies and insurers – to make new disclosures on their fees and compensation to employer-sponsored group health plans.
Penn State Health Policy Researchers Publish Papers on Consolidation in U.S. Healthcare
Adding to the national conversation on consolidation in U.S. healthcare, Penn State researchers contributed to an upcoming special issue of Medical Care Research and Review (guest edited by Dennis Scanlon). Their research was also discussed at a recent meeting in Washington, D.C. involving stakeholders from federal and state government, the healthcare industry, labor unions, and academia.
Authors: Dennis Scanlon, Nima Khodokarami, and Yunfeng Shi
This article synthesizes findings from studies included in a special issue of Medical Care Research and Review (MCRR) about consolidation in U.S. health care. Articles are grouped thematically, with findings discussed relative to the existing literature on the impact of consolidation on outcomes such as price, expenditures, access, and quality of care delivered. The article highlights key limitations and offers the following suggestions to better inform public policy, regulation, and new payment models: (a) traditional market definitions should be reconsidered given the evolution of consolidation and its impact on the contestability of markets; (b) fair and efficient pricing requires knowledge of production costs, which is currently limited; (c) payment, policy, and regulatory options should better account for the unique challenges in rural markets; (d) state policy change, including examination of existing provider licensing laws, could yield market improvements; and (e) continued investments in data infrastructure are needed to mitigate the potential negative effects of consolidation.
Citation: Scanlon DP, Khodakarami N, Shi Y. Recent Evidence on Consolidation in U.S. Health Care: Integration Pathways, Impacts, and Implications for Policy, Regulation, and Research. Medical Care Research and Review. 2026;0(0). doi:10.1177/10775587261499650
Community Characteristics Associated with Health System Penetration
Authors: Haoyu Bi, Mark Ramos, Jeannette Rogowski, and Charleen Hsuan
Health systems have become a dominant form of health care organization in the United States, yet little is known about how their presence varies across communities. This study examined the association between the community-level characteristics and health system penetration, defined as the percentage of general acute care hospital beds affiliated with a health system in a geographic market. We found that communities with higher health system penetration tended to have lower levels of competition. In rural areas, greater insurance coverage was associated with greater penetration. In urban areas, communities without health system presence were more likely to have larger Black populations relative to White populations. However, among communities with some system presence, those with larger Black populations tended to have higher levels of penetration. Policymakers should adopt context-specific policies that encourage investment in underserved communities, promote equitable access to high-quality care, and guard against the potential adverse effects of consolidation.
Citation: Bi H, Ramos ML, Rogowski JA, Hsuan C. Community Characteristics Associated With Health System Penetration. Medical Care Research and Review. 2026;0(0). doi:10.1177/10775587261469029
698 Rural Hospitals at Risk of Closing, By State
From Becker’s Hospital Review
Nearly 700 rural hospitals across the country, about one-third of all rural facilities in the U.S., are at risk of closing due to severe financial problems, according to an Oct. 28 Center for Healthcare Quality and Payment Reform analysis.
Of the 698 hospitals at risk, 260 face immediate risk of closure. Rural hospitals are at risk of closing in almost every state, except four: Utah, Delaware, Maryland and New Jersey. More than 25% of rural hospitals are at risk of closure in the majority of states and 50% or more are at risk in 11 states.
The numbers are slightly lower than the July CHQPR analysis, which found 700 hospitals at risk of closure and 264 at risk of immediate closure. They are also down from the think tank’s May report, in which 720 hospitals were at risk of closure with 294 at immediate risk.
Becker’s has reported on just six planned hospital and emergency department closures so far in 2026. At this point in 2025, Becker’s had already reported on 22.
Since 2015, 110 hospitals have closed, the report found. Since 2023, 56 hospitals have ended inpatient services to qualify for grants that are available only to rural emergency hospitals. That number was 53 in July 2026.
More than 40% of rural hospitals are still losing money on delivering patient services, and more than a quarter of rural hospitals lost money overall in 2025. In July, the analysis reported nearly one-third of rural hospitals had lost money in 2024 and 2025.
The center’s report said private insurers are the primary reason rural hospitals are at risk of losing money. About half of the services at an average rural hospital go to patients with private insurance, including employer-sponsored plans and Medicare Advantage. Losses on these patients, not Medicare or Medicaid payments, determines in many cases whether a rural hospital loses money.
Increased payments enough to prevent closures of at-risk hospitals would cost about $4 billion per year, the analysis said. The July report estimated $5 billion.
“Rural hospitals should not be forced to eliminate inpatient care in order to receive higher payments for other services, as is required under the federal ‘Rural Emergency Hospital’ program,” the analysis said. “Federal programs should preserve and expand rural healthcare services, not reduce them.”
The state-by-state breakdown below shows rural hospitals at risk of closing and those at immediate risk, with the percentage of rural hospitals that number represents:
Alabama
24 hospitals at risk of closing (52%)
17 at immediate risk of closing (37%)
Alaska
2 hospitals at risk of closing (12%)
1 at immediate risk of closing (6%)
Arizona
4 hospitals at risk of closing (15%)
0 at immediate risk of closing (0%)
Arkansas
32 hospitals at risk of closing (70%)
8 at immediate risk of closing (17%)
California
16 hospitals at risk of closing (27%)
4 at immediate risk of closing (7%)
Colorado
11 hospitals at risk of closing (26%)
3 at immediate risk of closing (7%)
Connecticut
3 hospitals at risk of closing (75%)
2 at immediate risk of closing (50%)
Delaware
0 hospitals at risk of closing (0%)
0 at immediate risk of closing (0%)
Florida
9 hospitals at risk of closing (41%)
3 at immediate risk of closing (14%)
Georgia
22 hospitals at risk of closing (30%)
9 at immediate risk of closing (12%)
Hawaii
8 hospitals at risk of closing (62%)
0 at immediate risk of closing (0%)
Idaho
8 hospitals at risk of closing (30%)
2 at immediate risk of closing (7%)
Illinois
15 hospitals at risk of closing (19%)
8 at immediate risk of closing (10%)
Indiana
10 hospitals at risk of closing (18%)
5 at immediate risk of closing (9%)
Iowa
8 hospitals at risk of closing (9%)
2 at immediate risk of closing (2%)
Kansas
58 hospitals at risk of closing (58%)
21 at immediate risk of closing (21%)
Kentucky
13 hospitals at risk of closing (19%)
2 at immediate risk of closing (3%)
Louisiana
24 hospitals at risk of closing (43%)
10 at immediate risk of closing (18%)
Maine
10 hospitals at risk of closing (42%)
2 at immediate risk of closing (8%)
Maryland
0 hospitals at risk of closing (0%)
0 at immediate risk of closing (0%)
Massachusetts
1 hospital at risk of closing (14%)
0 at immediate risk of closing (0%)
Michigan
10 hospitals at risk of closing (15%)
3 at immediate risk of closing (5%)
Minnesota
15 hospitals at risk of closing (15%)
3 at immediate risk of closing (3%)
Mississippi
35 hospitals at risk of closing (52%)
24 at immediate risk of closing (36%)
Missouri
29 hospitals at risk of closing (51%)
10 at immediate risk of closing (18%)
Montana
15 hospitals at risk of closing (29%)
3 at immediate risk of closing (6%)
Nebraska
5 hospitals at risk of closing (7%)
0 at immediate risk of closing (0%)
Nevada
4 hospitals at risk of closing (31%)
1 at immediate risk of closing (8%)
New Hampshire
5 hospitals at risk of closing (28%)
1 at immediate risk of closing (6%)
New Jersey
0 hospitals at risk of closing (0%)
0 at immediate risk of closing (0%)
New Mexico
7 hospitals at risk of closing (26%)
1 at immediate risk of closing (4%)
New York
22 hospitals at risk of closing (43%)
10 at immediate risk of closing (20%)
North Carolina
9 hospitals at risk of closing (16%)
5 at immediate risk of closing (9%)
North Dakota
13 hospitals at risk of closing (35%)
3 at immediate risk of closing (8%)
Ohio
6 hospitals at risk of closing (8%)
3 at immediate risk of closing (4%)
Oklahoma
44 hospitals at risk of closing (61%)
17 at immediate risk of closing (24%)
Oregon
7 hospitals at risk of closing (21%)
3 at immediate risk of closing (9%)
Pennsylvania
18 hospitals at risk of closing (35%)
9 at immediate risk of closing (17%)
Rhode Island
1 hospital at risk of closing (100%)
0 at immediate risk of closing (0%)
South Carolina
7 hospitals at risk of closing (32%)
2 at immediate risk of closing (9%)
South Dakota
5 hospitals at risk of closing (10%)
3 at immediate risk of closing (6%)
Tennessee
19 hospitals at risk of closing (36%)
12 at immediate risk of closing (23%)
Texas
84 hospitals at risk of closing (55%)
26 at immediate risk of closing (17%)
Utah
0 hospitals at risk of closing (0%)
0 at immediate risk of closing (0%)
Vermont
8 hospitals at risk of closing (62%)
0 at immediate risk of closing (0%)
Virginia
6 hospitals at risk of closing (18%)
3 at immediate risk of closing (9%)
Washington
19 hospitals at risk of closing (43%)
6 at immediate risk of closing (14%)
West Virginia
8 hospitals at risk of closing (24%)
4 at immediate risk of closing (12%)
Wisconsin
13 hospitals at risk of closing (16%)
6 at immediate risk of closing (7%)
Wyoming
6 hospitals at risk of closing (22%)
3 at immediate risk of closing (11%)
Pennsylvania Medicaid Launches Work Requirements (MAWR) Screen Changes
The Department of Human Services released new documents showing the COMPASS Medical Assistance Work Requirement (MAWR) screen changes for the application, renewal, and presumptive eligibility workflows.
These changes will apply to the Medicaid Expansion (MG90/91) population. Beneficiaries designated as Head of Household and who are subject to the MAWR will see their work requirements status on My Benefits screen in their myCOMPASS account on the COMPASS website and myCOMPASS mobile app.
- There are only two categories, satisfied or pending
- Individuals in compliance with work requirements or who are exempt will show “Satisfied.”
- Once a non-compliance notice is sent, the status will show as “Pending.”
- My Benefits screen is only available to currently enrolled individuals, not new applicants.
NHSC Students to Service Loan Repayment Program Now Open
The National Health Service Corps is now accepting applications for the Students to Service Loan Repayment program through November 19 at 7:30 pm. Eligible students in their last year of medical, physician assistant, nursing, or dental school can apply for up to $120,000 in loan repayment funding in exchange for 3 years of full-time service in urban, rural, or frontier communities with limited access to care.
Learn more and apply before the deadline.
Guidance for Measles in Pregnancy and Congenital Measles Health Advisory Published
In response to ongoing measles outbreaks and the first reported cases of congenital measles in decades, the Pennsylvania Department of Health (DOH) released an official advisory for the prevention and management of measles during pregnancy and in newborns. The advisory emphasizes that MMR vaccination before pregnancy remains the best protection.
For more information, review the advisory.