Garrett Clark estimates he has spent about six years in the Sanpete County Jail, a plain concrete building perched on a dusty hill just outside this small, rural town where he grew up.

He blames his addiction. He started using in middle school, and by the time he was an adult he was addicted to meth and heroin. At various points, he’s done time alongside his mom, his dad, his sister, and his younger brother.

“That’s all I’ve known my whole life,” said Clark, 31, in December.

Clark was at the jail to pick up his sister, who had just been released. The siblings think this time will be different. They are both sober. Shantel Clark, 33, finished earning her high school diploma during her four-month stay at the jail. They have a place to live where no one is using drugs.

And they have Cheryl Swapp, the county sheriff’s new community health worker, on their side.

“She saved my life probably, for sure,” Garrett Clark said.

Swapp meets with every person booked into the county jail soon after they arrive and helps them create a plan for the day they get out.

She makes sure everyone has a state ID card, a birth certificate, and a Social Security card so they can qualify for government benefits, apply to jobs, and get to treatment and probation appointments. She helps nearly everyone enroll in Medicaid and apply for housing benefits and food stamps. If they need medication to stay off drugs, she lines that up. If they need a place to stay, she finds them a bed.

Then Swapp coordinates with the jail captain to have people released directly to the treatment facility. Nobody leaves the jail without a ride and a drawstring backpack filled with items like toothpaste, a blanket, and a personalized list of job openings.

“A missing puzzle piece,” Sgt. Gretchen Nunley, who runs educational and addiction recovery programming for the jail, called Swapp.

Swapp also assesses the addiction history of everyone held by the county. More than half arrive at the jail addicted to something.

Nationally, 63% of people booked into local jails struggle with a substance use disorder — at least six times the rate of the general population, according to the federal Substance Abuse and Mental Health Services Administration. The incidence of mental illness in jails is more than twice the rate in the general population, federal data shows. At least 4.9 million people are arrested and jailed every year, according to an analysis of 2017 data by the Prison Policy Initiative, a nonprofit organization that documents the harm of mass incarceration. Of those incarcerated, 25% are booked two or more times, the analysis found. And among those arrested twice, more than half had a substance use disorder and a quarter had a mental illness.

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The Pennsylvania Broadband Development Authority (PBDA) has released the details of the BEAD Challenge process. Please visit the BEAD Challenge webpage for additional details to include registering for the BEAD Challenge portal, review the public map that identifies those areas deemed unserved, underserved, and statewide Community Anchor Institutions (CAIs). You can also watch the recording of the BEAD Challenge webinar that was held on March 29, 2024 and download the PowerPoint presentation used during the webinar.

The PBDA would like to remind eligible entities interested in submitting bulk challenges to consider requesting a license from CostQuest Associates. Tier D licenses are available here. Tier E licenses are available here. While a license is not required to participate and access the BEAD Challenge portal, it will help to simplify the submission of bulk challenges.

The timeline for the BEAD Challenge process is broken down into 3, 30-day windows which are as follows:

1. Challenge Submission Period: Eligible entities will be able to submit challenge for 30 days. (April 24 – May 23)
2. Rebuttal of Challenges: Entities that have been challenged will have 30 days to respond (May 24 – June 22)
3. Final Determinations: The PBDA will decided if challenges and rebuttals are valid or not within 30 days (June 23 – July 22)

As a reminder, the PBDA will be holding three Office Hour Sessions, please click on each below to obtain additional details and to register.

• Friday April 19, 2024
• Tuesday April 23, 2024
• Thursday April 25, 2024

Please don’t hesitate to reach out with questions to PABroadbandAuthority@pa.gov.

Calling current and future community leaders!  Applications for our Appalachian Leadership Institute (ALI) are now open.

This no-cost, nine-month leadership development training opportunity is centered on economic development. During six sessions in communities across the region, participants will learn how to better:

• Identify and implement strategies to strengthen their communities.
• Collaborate with a network of leaders across Appalachia.
• Recognize and utilize unique assets in their communities to build economic development plans.
• Appreciate the diversity and shared experiences of Appalachians.

Anyone living or working in Appalachia’s 423 counties is eligible to apply now. We look forward to building a stronger future for the region together!

On the April 2, 2024 episode of Managed Care Cast, we talked with Dennis Scanlon, PhD, the editor in chief of The American Journal of Accountable Care® and a health policy professor at Penn State University. Topics discussed include President Biden’s recent prescription drug proposals, prior authorization practices, price transparency, and the potential impact of health policy on the upcoming election.

Listen to the Podcast here.

In Matthew Roach’s two years as vital statistics manager for the Arizona Department of Health Services, and 10 years previously in its epidemiology program, he has witnessed a trend in mortality rates that has rural health experts worried.

As Roach tracked the health of Arizona residents, the gap between mortality rates of people living in rural areas and those of their urban peers was widening.

The health disparities between rural and urban Americans have long been documented, but a recent report from the Department of Agriculture’s Economic Research Service found the chasm has grown in recent decades. In their examination, USDA researchers found rural Americans from the ages of 25 to 54 die from natural causes, like chronic diseases and cancer, at wildly higher rates than the same age group living in urban areas. The analysis did not include external causes of death, such as suicide or accidental overdose.

The research analyzed Centers for Disease Control and Prevention death data from two three-year periods — 1999 through 2001 and 2017 through 2019. In 1999, the natural-cause mortality rate for people ages 25 to 54 in rural areas was only 6% higher than for city dwellers in the same age bracket. By 2019, the gap widened to 43%.

The researchers found the expanding gap was driven by rapid growth in the number of women living in rural places who succumb young to treatable or preventable diseases. In the most rural places, counties without an urban core population of 10,000 or more, women in this age group saw an 18% increase in natural-cause mortality rates during the study period, while their male peers experienced a 3% increase.

Read more.

HRSA increases loan repayment amounts by 50% for primary care providers who commit to practicing in high need and rural areas

Additional loan repayment available for primary care providers who commit to serve in shortage areas, demonstrate fluency in Spanish

The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced that it has increased by 50% the initial loan repayment amount available to primary care providers—M.D.s and D.O.s, including OB-GYNs and pediatricians; nurse practitioners; certified nurse midwives; and physician assistants—who commit to practicing in areas with significant shortages of primary care providers.

With the growing cost of medical school and increased challenges in recruiting primary care providers to high need areas, today’s action will help rural and historically underserved communities attract providers to deliver critical primary care services. These providers could have as much as $75,000 forgiven in exchange for a two-year service commitment.

HRSA also is offering up to an additional $5,000 in loan repayment to all National Health Service Corps Loan Repayment Program participants who can demonstrate fluency in Spanish and who commit to practice in a high need area serving patients with limited English proficiency. Providers will demonstrate language proficiency through an oral exam administered through an accredited language assessment organization.

Individuals with limited English proficiency disproportionately experience poor health outcomes and often substandard provider experiences, including challenges understanding doctors’ questions and diagnoses and reading and using prescriptions, referrals, and follow-up directions. This announcement comes as HHS Secretary Xavier Becerra is in the midst of a Latino Health Tour, underscoring the Biden-Harris Administration’s commitment to improving the health of that community.

“At the Health Resources and Services Administration, we are committed to taking action to help ensure that everyone has access to primary health care,” said HRSA Administrator Carole Johnson. “We know the importance of having a culturally competent and consistent source of primary care for improving health and wellness, managing chronic diseases and prescriptions, and coordinating across care teams. Yet, too often in rural communities and historically underserved communities, primary care remains difficult to access. That is why we are increasing our incentives to encourage primary care providers to practice in high need communities by paying a greater share of their educational loans.”

Through HRSA’s National Health Service Corps Loan Repayment Program, primary care medical providers could previously receive a maximum of $50,000 in initial loan repayment in return for a two-year full-time service commitment to practice in an area with a shortage of health professionals. This amount is nearly the same as the program offered 30 years ago, yet average medical student debt has grown more than four-fold over that same time period.

Now, eligible primary care providers can receive up to $75,000 in initial loan repayment in return for a two-year full-time service commitment to practice in those same areas. Participants have the opportunity to receive additional funding for extending their service commitment.

Today’s actions build on a host of Biden-Harris Administration actions to grow and support the primary care workforce, including investments in:

• Training primary care providers through the HRSA community-based Teaching Health Center Graduate Medical Education Program that is training more than 1,000 residents in more than 80 community-based residency programs;
• Supporting the creation of new primary care residency programs in rural communities, which when fully accredited and operational will have up to 540 slots for physicians in specialties including family medicine, internal medicine, psychiatry, and general surgery;
• Conducting over 25,000 trainings for practicing primary care providers including pediatricians, OB-GYNs, nurse midwives, and other maternal health care providers to identify and treat mental health conditions among children and adolescents and pregnant individuals and new moms;
• Training primary care residents in the prevention, identification, diagnosis, treatment, and referral of services for mental health and substance use disorders to integrate behavioral health into primary care;
• Increasing access to care for patients with special needs by training primary care medical students, physician assistant students, and medical residents in caring for individuals with intellectual and physical disabilities; and,
• Training new primary care providers in culturally and linguistically appropriate care for individuals with limited English proficiency through language immersion programs and other methods.

To apply visit: The National Health Service Corps Loan Repayment Program.