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

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. 

The U.S. Census Bureau released new statistics from the 2017-2021 American Community Survey (ACS) 5-Year Estimates, now available at https://data.census.gov/. These estimates provide data for all Pennsylvania counties, municipalities, and other geographic areas regardless of population size.

Some highlights from the Pennsylvania State Date Center include:

• Approximately 47.0% of renter households in PA spent more than 30.0% of their income on housing costs, compared to 40.0 percent of renter households nationally.
• The counties with the highest percentage of renters experiencing a housing cost burden were Centre (58.0%), Pike (57.4%), Lawrence (52.5%), Monroe (51.9%), and Philadelphia (51.9%).
• Between 2012-2016 and 2017-2021, 43 counties experienced a statistically significant increase in median household income.

Visit the Data Center’s Research Briefs page to read this brief and past releases.

The Rural Health Value team recently released a new policy brief:

Medicare Shared Savings Program: Rule Changes and Implications for Rural Health Care Organizations
A summary of the changes made to the Medicare Shared Savings Program taking effect January 2023 and 2024. This Rural Health Value analysis outlines how the changes would reduce barriers to participation for potential or reentering ACOs that operate in rural contexts.

Related resources on the Rural Health Value website:

• Catalog of Value Based Initiatives for Rural Providers – One-page summaries describe rural-relevant, value-based programs currently or recently implemented by the Department of Health and Human Services (HHS), primarily by the Centers for Medicare & Medicaid Services (CMS) and its Center for Medicare & Medicaid Innovation (CMMI).
• MaineHealth ACO – Integrating and Using Data to Support Care Delivery – A predominantly rural network of hospitals and clinics in Maine integrates clinical and claims data to support improvements in care delivery and target patient needs as part of their Accountable Care Organization.
• Vermont’s All-Payer Accountable Care Organization Model – Mt. Ascutney Hospital and Health Center’s (MAHHC) Experience – Vermont’s dominant payers have partnered to test an alternative payment model statewide that requires health care organizations like MAHHC to innovate health care delivery and achieve shared goals. Participation in the ACO has allowed MAHHC to implement strategies to better meet community needs ranging from prevention to complex care management.

The U.S. Department of Agriculture (USDA) released the Rural America at a Glance report. The report notes a change in the composition of the rural labor force over the past decade due to an overall decline in population growth, aging of the population, and changing industry structure. Rural America has become more economically diverse over time, with increasing employment in health care, hospitality, and other service industries. There is also evidence that the rural workforce is changing in terms of diversity. The report is helpful when considering new ways to strengthen the rural health pipeline.

Rural America is continuing to get older, and a new report shows the extent has hit a new high.

The U.S. Department of Agriculture’s annual Rural America at a Glance report shows more than 20% of rural residents are over age 65 compared to 16% in urban areas.

“The aging of the baby-boom generation will continue to contribute to the loss of working-age adults through the end of this decade,” the report from the USDA’s Economic Research Service stated.

The report also said there is a corresponding decrease in the working-age population, with those 18 to 64 making up 58% of non-metro residents, compared with 61% of metro residents.

Fixing the problem will take a lot of work from a lot of different areas, said Mary Hendrickson, a professor of rural sociology at the University of Missouri.

“There’s federal issues, there are state issues, there are community issues, there are regional issues. Can we start thinking about regional networks? There really is not just one thing,” she said.

Hendrickson said rural areas need to make things better for families, and that can include such improvements as better broadband access and reliable day care and preschool options, which are not only lacking but often nonexistent in rural areas.

“If we’re going to talk about wanting to be family friendly, then we’re going to need to have some policies that are helpful,” Hendrickson said.

Some rural communities have tried creative ways to attract younger people to make their home away from urban areas, including offering grants to new homeowners and establishing recruiting committees to entice former residents to move back.

“Those kinds of programs are essential,” Henrickson said. “Folks who live in these rural areas sometimes look around and think more of the challenges rather than thinking about what are the opportunities for helping and making their place attractive for a younger generation.”

Other rural advocates caution those kinds of projects won’t be enough and argue for more systemic change at the federal level.

“We learned during COVID that many people can work from anywhere, and that gave a lot of hope to rural communities looking to increase their population,” said Chris Merritt, executive director of the Illinois Institute of Rural Affairs at Western Illinois University.

“But state and federal governments need to get more involved to make sure these communities have health care, schools, transportation and grocery stores. Those things can’t happen at just the community level.”

While rural communities look to increase their younger population, they will also have to deal with new challenges of having more older residents.

“Declines in the working-age population may make it harder to meet labor demands in some rural industries and local labor markets. At the same time, many rural areas lack sufficient health care capacity, broadband service, community centers and other services to address the challenges associated with an aging population,” the USDA report said.

This story was produced in partnership with Harvest Public Media, a collaboration of public media newsrooms in the Midwest. It reports on food systems, agriculture and rural issues. Follow Harvest on Twitter: @HarvestPM.