- Rural America Faces Growing Shortage of Eye Surgeons
- NRHA Continues Partnership to Advance Rural Oral Health
- Comments Requested on Mobile Crisis Team Services: An Implementation Toolkit Draft
- Q&A: What Are the Challenges and Opportunities of Small-Town Philanthropy?
- HRSA Administrator Carole Johnson, Joined by Co-Chair of the Congressional Black Maternal Health Caucus Congresswoman Lauren Underwood, Announces New Funding, Policy Action, and Report to Mark Landmark Year of HRSA's Enhancing Maternal Health Initiative
- Biden-Harris Administration Announces $60 Million Investment for Adding Early Morning, Night, and Weekend Hours at Community Health Centers
- Volunteer Opportunity for HUD's Office of Housing Counseling Tribe and TDHE Certification Exam
- Who Needs Dry January More: Rural or Urban Drinkers?
- Rural Families Have 'Critical' Need for More Hospice, Respite Care
- States Help Child Care Centers Expand in Bid To Create More Slots, Lower Prices
- Rural Telehealth Sees More Policy Wins, but Only Short-Term
- Healing a Dark Past: The Long Road To Reopening Hospitals in the Rural South
- Study: Obstetrics Units in Rural Communities Declining
- Q&A: Angela Gonzales (Hopi), on New Indigenous Health Research Dashboard
- Not All Expectant Moms Can Reach a Doctor's Office. This Kentucky Clinic Travels to Them.
CMS Releases Announcement on Federal Navigator Program Funding
The Centers for Medicare & Medicaid Services (CMS) today announced a reduction in funding for the Affordable Care Act (ACA) Navigator program to $10 million. The savings from this reduction will allow the Federally-facilitated Exchanges (FFEs) to focus on more effective strategies that improve Exchange outcomes and to reduce the user fee in future years, which would translate into a reduction in premium. This change will directly benefit people enrolled without subsidies who pay the full premium for their health insurance. In addition, lower premiums will reduce the burden on hardworking American taxpayers who fund the premium subsidies through the FFEs.
Despite receiving $98 million in the 2024 plan year, Navigators only enrolled 92,000 consumers—just 0.6 percent of plan selections through the FFEs during the open enrollment period—at a cost of $1,061 per enrollment. Additionally, the average cost per enrollment exceeded $3,000 for 12 of the 56 Navigator grantee organizations. Looking back at the grant period covering the 2019 plan year—the year before the COVID-19 pandemic under a similar regulatory approach—Navigators likewise enrolled 0.6 percent of total enrollments through the FFEs at a substantially lower cost of $10 million. This previous grant funding level reflects a far more efficient $211 per enrollment.
The Navigator program is funded by user fees, and the decrease in funding to $10 million per year will save a total of $360 million over the next four years of the five-year period of performance, which began August 27, 2024, and runs through August 26, 2029. Because the user fee is directly passed through to the premium that health insurers charge, the savings from the Navigator program supports lower premiums for consumers in the individual health insurance market. People who do not qualify for federal premium subsidies will directly benefit from lower premiums. Lower premiums will also translate to less federal spending on premium subsidies. This change is for Navigators in the states with FFEs in the next grant period for plan year 2026. States operating state-based exchanges and state-based exchanges operating on the federal platform are responsible for determining the funding available for Navigator programs in their states.
Additional performance data for Navigators further supports this reduction. Data show that for the 2019 plan year, Navigators provided post-enrollment assistance to approximately 205,000 consumers. Despite markedly more funding and substantially higher enrollment levels, the level of post-enrollment assistance dropped to approximately 86,000 consumers for the 2024 plan year.
Overall, Navigator performance data shows that the current level of funding does not represent a reasonable return on investment. These numbers indicate that Navigators are not enrolling nearly enough people to justify the substantial amount of federal dollars previously spent on the program. This reduction will ensure funding is focused on meeting the statutory goals of the program more efficiently and effectively.
In coordination with this announcement, CMS is posting updated Navigator funding, enrollment, and service-level data for the grant periods covering the 2017 plan year to the 2024 plan year.
To view the data, visit 2024 Navigator Funding and Enrollment Data.
432 Rural Hospitals at Risk of Closure; Breakdown By State
From Becker’s Financial Management
There are 432 rural hospitals vulnerable to closure, according to a Feb. 11 report from Chartis, a healthcare advisory services firm.
Chartis analyzed 15 vulnerability indicators and found that 10 were statistically significant in predicting hospital closures, including: Medicaid expansion status, average length of stay, occupancy, percentage change in net patient revenue and years of negative operating margin.
Of the 48 states with rural hospitals, 38 have at least one at risk of closure, according to the report. The states with the highest number of vulnerable hospitals are:
- Texas: 47
- Kansas: 46
- Mississippi: 28
- Oklahoma: 23
- Georgia: 22
Arkansas (50%) has the highest percentage of rural hospitals at risk of closure, followed by Mississippi (47%) and Kansas (47%).
The percentage of rural hospitals at risk of closure by state is as follows:
More than 41% of hospitals
- Arkansas
- Florida
- Kansas
- Mississippi
- Tennessee
31% to 40%
- Georgia
- Missouri
- Oklahoma
- South Carolina
- Texas
26%-30%
- Alabama
- North Carolina
- South Dakota
21%-25%
- Illinois
- Louisiana
- Maryland
- Nebraska
- New Mexico
- Wyoming
16%-20%
- Kentucky
- Ohio
10%-15%
- California
- Indiana
- Michigan
- Minnesota
- Montana
- New York
- Pennsylvania
- Virginia
- West Virginia
1%-9%
- Arizona
- Colorado
- Hawaii
- Idaho
- Iowa
- North Dakota
- Utah
- Wisconsin
0%
- Alaska
- Connecticut
- Delaware
- Maine
- Massachusetts
- Nevada
- New Hampshire
- New Jersey
- Oregon
- Rhode Island
- Vermont
- Washington
White House Forms ‘Make America Healthy Again’ Commission
From Becker’s Leadership and Management
President Donald Trump has signed an executive order creating the Make America Healthy Again Commission after Robert Kennedy Jr. was confirmed Feb. 13 as HHS secretary in a 52-48 Senate vote.
Mr. Kennedy will chair the commission, which is tasked with investigating “the root causes of America’s escalating health crisis,” with an initial focus on pediatric chronic disease, according to a Feb. 13 White House fact sheet on the executive order.
The commission will release its childhood chronic disease assessment in the next 100 days and will follow up with a strategy to improve children’s health within the next 180 days. The key priorities of the investigation include funding studies on what causes disease, promoting healthier food, expanding preventative treatment options and increasing health research transparency.
“The commission aims to restore trust in medical and scientific institutions and hold public hearings, meetings, roundtables and similar events to receive expert input from leaders in public health,” the release said.
The commission also has four policy directives to help reverse chronic disease:
- Ensure open access and transparency to federally funded health research data while preventing conflicts of interest.
- Focus federally funded health research on high-quality studies to help understand the cause of American illness.
- Work with U.S. farmers to ensure food in America is affordable, abundant and healthy.
- Provide flexible health coverage and expand treatment options to support lifestyle-based disease prevention.
The release pointed to information consistent with CDC data that found 6 in 10 adults in the U.S. live with at least one chronic illness, and 4 in 10 have two or more. It also touched on a spike in autism rates, childhood cancers and overmedication, with more than 3.4 million children in the U.S. on medication for attention-deficit disorder and attention-deficit/hyperactivity disorder, with diagnoses on the rise, according to Children and Adults with Attention-Deficit/Hyperactivity Disorder data.
It also pointed to information consistent with a 2023 Gallup poll that found only one-third of Americans have trust in the U.S. health system.
During his two confirmation hearings on Jan. 29-30, Mr. Kennedy frequently discussed his Make America Healthy Again agenda, which aims to cut chronic disease, tackle obesity and diabetes, and improve food policy, prevention-based care and environmental health.
In his new role, Mr. Kennedy’s portfolio will comprise HHS agency and program oversight, as well as a nearly $2 trillion budget. Among the agencies under his purview are CDC, CMS, FDA and the National Institutes of Health.
2025 ARC States’ Co-Chair Elected: Maryland Gov. Wes Moore
Elected by his fellow Appalachian state governors, Maryland Governor Wes Moore is now ARC’s 2025 States’ Co-Chair. He is the 72nd States’ Co-Chair in ARC’s history.
In his year-long position, Gov. Moore will work alongside ARC’s Federal Co-Chair and his fellow governors to continue investing in economic growth and innovation across the region. In fiscal year 2024, ARC invested nearly $365 million in 583 projects, which attracted an additional $5 billion in private investments across Appalachia.
Learn more about Gov. Moore and ARC’s leadership structure. And join us in thanking 2024 States’ Co-Chair Tennessee Governor Bill Lee for his leadership and contributions.
PA Oral Health Coalition Provides Update on State Legislation
The 2025-2026 legislative session in Pennsylvania commenced on January 6, 2025. Once again, the state operates under a split legislature, with Republicans maintaining control of the Senate and Democrats hoping to retain their slim majority after the special election to fill one seat.
Legislative Activity and Key Bills
Lawmakers in Harrisburg have actively introduced and advanced numerous bills. In alignment with the 2025 Policy Agenda, PCOH has been monitoring several key pieces of legislation, including:
- SCO 108 – Restoring Dental Coverage for Medical Assistance Recipients.
- HCO 284 – Advisory Opinions from Licensing Boards.
- SB 81 & HCO 721 – Legislation authorizing Pennsylvania to join the Dentist and Dental Hygienist Compact and outlining its structure.
- HCO 1412 – American Association of Dental Boards Dental & Dental Hygiene Compact Legislation.
- HB 157 – Establishing grant awards for entities in rural counties and designated medically underserved areas to address practitioner education debt. As of 2/5/2025, this bill was unanimously amended by the House Health committee to include dentists and dental hygienists as eligible awardees and passed out of committee with unanimous support.
Governor’s Budget Address
On February 4, 2025, Governor Josh Shapiro delivered his third budget address. The Governor shared that “Pennsylvania is on the rise” as he proposed a budget with dedicated funding to address healthcare workforce issues and healthcare cost transparency. While it does not appear that funding to restore the comprehensive dental benefit is openly included in the DHS program budget, PCOH will continue to advocate for this need as the General Assembly prepares to commence budget hearings and negotiate budget priorities.
Federal Developments and Impact on Pennsylvania
With the beginning of President Trump’s second term, significant federal activity has raised concerns regarding dental care access in Pennsylvania. A recent executive order freezing federal funding caused temporary disruptions in state Medicaid portal access. Although a U.S. District judge has blocked this freeze, uncertainty remains about the future of federal funding for state-funded programs. Any reductions at the federal level could impact critical services for under-resourced communities
across Pennsylvania.
Additionally, hearings are underway to determine the composition of President Trump’s cabinet, including the Secretary of Health and Human Services. President Trump has nominated Robert F. Kennedy, Jr. for the role, a decision met with opposition from various public health and medical organizations due to his controversial stance on vaccines and community water fluoridation. The Senate Finance Committee approved his nomination in a narrow 14-13 vote, sending it to the Senate floor for final consideration.
PCOH will continue monitoring these legislative and policy developments to ensure Pennsylvanians maintain access to essential dental care services.
PA Broadband Authority Encourages BEAD Applications
Despite the uncertainties surrounding potential changes to federal programs that support the PBDA’s mission to expand broadband access and bridge the digital divide across the Commonwealth, Pennsylvania remains steadfast in its commitment to delivering the transformative broadband investments that have already been secured under federal law. The PBDA, in coordination with its federal partners and the Governor’s Office, is actively monitoring developments as they unfold.
If you’re a current grantee, please continue to follow these essential grant management practices:
- Submit timely reimbursement requests. Only request reimbursement for costs that have already been incurred and ensure all required documentation is included.
- Stay in regular communication. Contact your grant manager or email pabroadbandauthority@pa.gov for general inquiries.
If you’re planning on applying for the Broadband Equity, Access, and Deployment (BEAD) program please note that Application Period One closes Friday, February 7th.
New Reports! Power of Partnership in Strengthening the Philadelphia Fed Regional Economy
On behalf of the Philadelphia Fed, thank you for your continued partnership and the important work that you do to support a strong economy. We strive to be a resource to you through our data-driven research, ongoing community engagement, and ability to convene stakeholders around shared solutions to economic challenges. Our work in 2024 included:
- a comprehensive update to the Occupational Mobility Explorer, which now includes nearly 600 job titles across more than 500 U.S. locations. This resource allows users to explore career paths and visualize how job skills needed for specific occupations can transfer to higher-paying occupations in the same geographical area.
- launching the Banking Deserts Dashboard to provide insight into regions and communities that do not have local bank branches. This tool is part of ongoing research by the Federal Reserve Banks of Cleveland and Philadelphia to better understand how the decline of bank branches across the nation may be impacting low-income communities.
- advancing a national conversation about the importance of hospitals and higher education institutions to local economies. The 2024 Anchor Economy Conference highlighted research on the economic impacts of anchor institutions in regions and engaged community leaders, researchers, and experts in a meaningful discussion about anchor economies. Our ongoing Anchors for Equity Research in Action Labs are also exploring how to leverage partnerships with anchor institutions in local workforce development efforts.
As we look ahead, we’re excited to host the Economic Mobility Summit in Philadelphia on April 22 and 23, 2025. We aim to bring together community leaders, policymakers, researchers, experts, advocates, and others from across the nation to highlight the importance of economic mobility to the U.S. economy; identify ways to advance research into actionable strategies; and elevate best practices for community-led, cross-sector collaboration that can increase economic opportunity and mobility in regions. We encourage you to register and reserve your seat today!
As always, we will keep you updated with the latest events, research, and ways to engage with us and the Federal Reserve System in the months ahead.
Why Oral Health Needs a Home in Medical Education
The Academy at Harvard Medical School is hosting “Why Oral Health Needs a Home in Medical Education” this Thursday, January 30th at 5 pm ET as part of their Medical Education Grand Rounds series. They will cover the importance of oral health content in undergraduate and graduate medical education, review the history of medical-dental education, and preview future opportunities.
U.S. Celebrates 80 Years of Community Water Fluoridation
The United States celebrated 80 years since water fluoridation was initiated in Grand Rapids, Michigan. Join PCOH and the 100+ reputable international health and science organizations in recognizing and celebrating the amazing impact that water fluoridation continues to have. Please consider taking action to promote the benefits of fluoridation so that we can celebrate the next milestone.
Here’s three ways you can take action:
- Join the Statewide Water Action Team (SWAT) and notify PCOH when you hear rumblings about water fluoridation in your local community.
- Review the linked talking points so that you are prepared when talking with others about water fluoridation in the news.
Share printed and electronic resources with patients, colleagues, and community members so that they are aware of the benefits of and science behind fluoridation and fluoride treatments.
Fact Sheets Show Children Enrolled in Medicaid and CHIP by Legislative District
In every community across Pennsylvania, Medicaid and the Children’s Health Insurance Program (CHIP) play a big role in keeping kids covered and healthy.
Through these public health insurance options, nearly half of all Pennsylvania children have access to check-ups, doctor recommended screenings, vaccinations and much more.
Our annual fact sheets provide a breakdown of the more than 1.3 million Pennsylvania children enrolled in Medicaid and CHIP within each legislative district.
PPC uses these fact sheets to educate members of Pennsylvania’s Congressional delegation, state House, and state Senate about the critical role of Medicaid and CHIP in providing families with high-quality, affordable health care for both physical and mental health.
Access the fact sheets here.
According to a new report from Georgetown University’s Center for Children and Families, children in Pennsylvania’s small towns and rural communities depend on Medicaid just as much as children in Pennsylvania’s urban communities. And it shows that Pennsylvania adults and seniors in rural communities are insured through Medicaid at higher rates than their urban counterparts.
This is especially important given most of Pennsylvania’s counties are considered rural. In fact, Pennsylvania ranks 5th highest in the country for the number of people living in small towns and rural areas.
Any large cuts to Medicaid that are currently being considered would pose very serious threats to residents and their health care systems in rural communities that are already struggling.
Pennsylvania relies on federal Medicaid funding to thrive. Federal cuts to Medicaid would shift the burden onto Pennsylvania’s budget and lead to higher uninsured rates among our kids, seniors, pregnant women and people with disabilities.
Read the coverage: Proposed Medicaid Cuts Threaten Rural PA Residents, Hospitals