Researchers interviewed administrators and participants in 20 rural nurse practitioner residency programs to determine the effect of federal- and state-based programs on rural placement post-training.  Though nurse practitioners make up one-quarter of the rural primary care workforce, few studies have investigated factors supporting their transition from training to practice.

A new policy brief is available on the Flex Monitoring Team (FMT) website: Impacts of Critical Access Hospital Independence and System Ownership during the COVID-19 Pandemic. In this brief, the FMT describes findings from a survey of CAH CEOs about their response to COVID-19, with a specific focus on advantages and disadvantages of system ownership or independence as described by survey participants.

Additionally, a new webinar recording is available on the FMT website: COVID-19 Response in System-Owned and Independent CAHs. In this webinar, the FMT presents findings from their survey of CAHs including advantages and disadvantages of system ownership or independent status, support received from State Flex Programs, staff recruiting challenges, partnerships, and patient transfers.

The Bradbury-Sullivan LGBT Community Center has announced that the 2022 PA LGBTQ Health Needs Assessment Report is now available.  The report and the reports for previous years can be accessed at bradburysullivancenter.org/health_needs_assessment.

For media inquiries, please contact the Community Center’s Communications Associate, Braden Hudak, MA at Braden@BradburySullivanCenter.org.

For more information about this report or if you are interested in utilizing the findings from the PA LGBTQ Health Needs Assessment, please contact Christina Graham, MPH at Christina@BradburySullivanCenter.org.

Thriving PA’s newest report, WIC Participants Encourage Improvements to Remove Barriers to Access, highlights community feedback about the Special Supplemental Nutrition Program for Women, Infants, and Children, commonly referred to as WIC. Over the summer, Thriving PA partnered with several community organizations across the state to hold seven focus sessions with current and former WIC clients to hear directly from their experiences on the strengths and barriers of the WIC program.

The WIC program provides eligible pregnant and postpartum women and infants and children up to age 5 with access to nutritious foods, breastfeeding supports, nutritional education, and health referrals. Unfortunately, participation in PA’s WIC program has been declining in recent years, a trend that is happening nationally. From 2018-2022, the PA program saw nearly a 25% decline in participation. The pandemic also impacted these numbers, with Pennsylvania seeing the third largest decrease in participation from February 2020 to February 2022.

To address the declining participation, which impacts the federal funding Pennsylvania receives to administer the program, Thriving PA sought out direct feedback from participants to identify solutions to the WIC program’s challenges. Many of the recommendations in the report highlight opportunities to modernize the program and provide greater flexibility for participants. Some recommendations include technology improvements like moving to an online EBT card system and simplifying the application process through system integration with other state application systems like COMPASS. Others include allowing virtual visits to continue and coordinate care between health professionals, so participants do not need to provide the same information to multiple providers.

Thriving PA hopes the incoming administration and WIC Advisory, a stakeholder group formed earlier this year, will consider the recommendations from WIC clients to help improve the WIC program and increase participation statewide.

Pennsylvania’s child uninsured rate improved slightly to 4.4% from 4.6% during the COVID-19 pandemic thanks to the federal continuous coverage provision that prevents states from disenrolling children and families from Medicaid during the public health emergency, according to our recently released 2022 State of Children’s Health report.

Even more families turned to Medicaid during the pandemic when child enrollment increased by 20%. More than 1.4 million Pennsylvania children currently have Medicaid as their health insurance.

We are cautiously optimistic about the improvement in our child uninsured rate in Pennsylvania. While we have made progress, Pennsylvania has the 8th highest number of uninsured children in the nation, with 126,000 children who do not have health insurance and don’t have regular access to preventive and primary health care.

And hundreds of thousands of children are at risk of losing Medicaid coverage when the public health emergency ends and the state begins to unwind the disenrollment freeze and resume pre-pandemic operations. According to the latest estimates from DHS, 1 in 4 children enrolled in Medicaid could lose coverage when the public health emergency ends and the process to redetermine eligibility begins.

It will be imperative for DHS to implement an unwinding process that does not disconnect the children most at risk of losing coverage, particularly when Pennsylvania’s uninsured rate is starting to improve.

We recommend DHS:

• Reaffirm its commitment to using a 12-month unwinding period as recommended by the Centers for Medicare and Medicaid, which most other states plan to use. Using the full 12 months permitted will give Pennsylvania the best chance to minimize inappropriate terminations and disruptions in coverage (churn) that often impact children more than the adult population.
• Immediately expand the 12-month continuous eligibility policy to children ages 4 through 21 in Medicaid when the public health emergency ends to make it more equitable—Pennsylvania already provides 12-month continuous eligibility (regardless of changes in circumstances) in Medicaid for children up to age 4. All Pennsylvania children in CHIP have continuous eligibility for a full year.

According to the report, factors such as race and ethnicity, poverty level and geographic region impact children’s access to health insurance. Some additional key findings include the following:

• Hispanic or Latino children, children who identified as Some Other Race, and children who identified as Two or More Races have worse rates now than in 2019, showing they are more likely to be uninsured.
• 5% of children in PA who qualify for no-cost or reduced-cost health insurance through Medicaid, CHIP, or Pennie™ do not have health insurance.
• The uninsured rates improved in 38 counties and worsened in 29 counties over the last two years.

New to this year’s report are fact sheets for each of the 67 counties that show the local uninsured rate, race and ethnicity profiles, and public health insurance enrollment data.

Read the latest coverage:

• Pennsylvania Capital-Star
• The Bradford Era
• Keystone State News Connection

The National Institutes of Health’s “All of Us” Research Program has begun returning personalized health-related DNA results to more than 155,000 participants, with reports detailing whether participants have an increased risk for specific health conditions and how their bodies might process certain medications. This marks a major milestone for the program, delivering on its promise to share information and return value to participants. “All of Us” aims to partner with at least 1 million people who reflect the diversity of the United States to accelerate medical breakthroughs. About 80% of “All of Us” participants represent communities that have been historically underrepresented in medical research and nearly 50% of “All of Us” participants identify with a racial or ethnic minority group. The program started returning genetic ancestry and trait results to participants in December 2020. So far, the program has offered genetic ancestry and traits results to more than 175,000 participants and continues to return about 6,000 results each month. Learn more.

Published this month by the Center for Medicare & Medicaid Innovation (CMMI), this report focused on the strategic refresh that CMMI announced previously this year. As part of this strategic refresh, CMMI has indicated that all new models will include patients from diverse backgrounds, including underserved populations such as rural and historically disadvantaged communities. CMMI also included in the report feedback from stakeholders received during webinars held around the strategic refresh, including rural-specific feedback about the challenges rural providers face in joining value-based care arrangements and possible rural-specific strategies for CMMI to consider.

Rural hospitals may be geographically isolated from their urban counterparts, but when they shutter, the effects are felt for miles.

A recent study from the Hershey, Pa.-based Penn State College of Medicine has quantified those impacts. Researchers analyzed the average rate of change for inpatient admissions and emergency department visits at bystander hospitals — those within 30 miles of a selected 53 hospitals that closed between 2005 and 2016  — two years before and two years after the nearby closure.

Researchers found that two years prior to a rural hospital closure, bystander hospitals’ emergency department visits increased an average of 3.59 percent. Two years following a closure, emergency department visits increased an average of 10.22 percent.

Similarly, two years prior to a rural hospital closure, bystander hospitals’ average admissions fell by 5.73 percent. Average admissions rose by 1.17 percent in the two years following a closure.

“We know rural areas, especially regions like Appalachia, are at increased risk for diseases of despair including alcoholism, accidental poisonings and suicide,” Jennifer Kraschnewski, MD, director of Penn State Clinical and Translational Science Institute said in a Dec. 13 Penn State news article. “Increased burden at bystander hospitals and health care institutions may cause these problems to proliferate if other public health interventions aren’t identified and implemented.”

The study results were published in September in the Journal of Hospital Medicine. 

Congress has until December 16, when the current short-term government funding agreement ends, to finalize an FY23 budget or face a government shutdown. We expect Congress will extend the negotiating period until Dec. 23. That way they can complete this year’s budget before the next Congress is sworn in on Jan. 3, 2023. The current gridlock stems from disagreements on top-line annual defense and domestic spending numbers. NACHC sent a letter to House and Senate leaders who will decide on final funding amounts, asking them to use the funding levels that the House Committee approved for Community Health Centers and related primary and workforce programs earlier this year.