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Understanding HRSA Modifications to the Definition of Rural for FORHP Grants

– Comment by May 28. On April 26th, the Federal Office of Rural Health Policy (FORHP) announced a proposed modification to the definition of ‘rural’ used to designate eligible areas for rural health grants. Because access to needed health care is likely to be reduced when roads are most difficult to traverse, FORHP proposes to modify the definition of rural areas by integrating the new Road Ruggedness Scale (RRS) released in 2023 by the Economic Research Service (ERS) of the U.S. Department of Agriculture. The proposed modifications are based on a data-driven methodology to identify areas with difficult mountainous terrain.  All areas included in the current definition of rural would remain included.

HHS Releases Nondiscrimination in Health Program and Activities Final Rule

Effective May 6.  The U.S. Department of Health and Human Services (HHS) Office of Civil Rights issued a final rule under Section 1557 of the Affordable Care Act advancing protections against discrimination in health care. At a minimum, the rule will restore protections against discrimination on the basis of race, color, national origin, sex, age, and disability. It will also reduce language access barriers, expand physical and digital accessibility, and address bias in health technology. With the restoration of the rule, HHS aims to increase meaningful access to health care for communities across the United States.

Navigating the Application Guide for HRSA Rural Healthcare Provider Transition Project

-Apply by August 15. Five small rural hospitals and certified Rural Health Clinics will be selected to receive one year of focused, virtual technical assistance designed to strengthen their organization’s understanding of the key elements of value-based care. Project focus areas include quality, efficiency, patient experience, and safety. Details on the application process can be found in the 2024-2025 Application Interview and Process Guide. Selected applicants will be notified in September, and project activities begin in October 2024.

Using the Updated Financial Distress Index to Describe Relative Risk of Hospital Financial Distress

Researchers at the North Carolina Rural Health Research and Policy Analysis used a recent revision of the Financial Distress Index (FDI) model to describe the relative risk of experiencing financial distress for rural hospitals and selected urban hospitals. Among the findings: over 60 percent of hospitals at highest relative risk of financial distress are in seven states:  Texas, Oklahoma, Tennessee, Alabama, Kansas, Mississippi, and Georgia.

Research Demonstrates Non-Urgent Use of Emergency Departments by Rural and Urban Adults

Among findings from the Maine Rural Health Research Center: rural adults aged 18-64 are more likely than their urban counterparts to visit the emergency department in a given year; socio-demographics associated with higher rates of non-urgent ED use by rural residents include younger age, fair or poor mental and physical health, low income, public insurance coverage, and lower access to primary care.

New Data from the CDC Released on Preventable Premature Death

New Data from the CDC on Preventable Premature Death. The new study from the Centers for Disease Control and Prevention (CDC) is an extension of an earlier CDC study, which showed a higher percentage of early death from the five leading causes in rural counties compared with urban counties during 2010-2017.  More recent data show that the rural-urban gap in all-cause mortality continues to widen.  In 1999, the death rate in rural areas was 7 percent higher than in urban areas; by 2019, it was 20 percent higher.  View CDC’s rural health website and  Rural Public Health At-a-Glance to find out what CDC is doing to improve the health and well-being of rural communities.

Volunteer Opportunities Open for 2024 Pop-Up Dental Clinics in Pennsylvania

Looking to volunteer at a dental event in 2024? The PA Coalition for Oral Health compiled a list of pop-up clinics happening across the state. Click on the locations/dates for more information on each clinic. Looking to make a difference year-round? Free clinics rely on volunteers to provide quality, accessible healthcare in their communities. The Free Clinic Association of Pennsylvania can connect you with clinics in your region.

Click here for more info on volunteering with free clinics that see patients year-round.

Remote Area Medical (RAM) Clinics
Sharon, PA – June 8 & 9
Scranton, PA – August 3 & 4
Philadelphia, PA – August 24 & 25
Erie, PA – September 7 & 8
Allentown, PA – October 19 & 20

Reading, PA – June 21 & 22

Mission of Mercy Pittsburgh
Pittsburgh, PA – November 1 & 2

PA’s Insurance Marketplace Issues RFP for Enrollment Assister Contract

Pennie, Pennsylvania’s official health insurance marketplace, has issued a Request for Proposal for Assister Services.  The awardee will collaboratively drive statewide activities to increase awareness of the financial help and health coverage available through Pennie, and work directly with community organizations to provide local, in-person enrollment assistance.  

The primary goals of this project are to:  

  • Increase awareness of affordable and high-quality coverage available through Pennie  
  • Expand the availability of direct, in-person enrollment assistance across Pennsylvania  
  • Diversify Pennie’s local partners across the Commonwealth so that assister services can be provided in a way that meets unique, local needs  
  • Increase outreach to historically marginalized communities who are disproportionately uninsured or underinsured.  

“Pennie hears every day from people looking for more support to find health coverage that works for their medical needs and their household budget.  This new contract will provide enrollment assistance and education through local and trusted partners in communities across the Commonwealth,” noted Pennie’s Executive Director Devon Trolley. “Knowing that ‘word of mouth’ is consistently how most Pennsylvanians learn of Pennie, we are excited to be expanding our network and partnerships to ensure Pennie is woven into the community fabric, and that free expert help is never too far from home.” 

Contract Details

The initial term of this contract is four years, including two optional two-year renewals. The Lead Contractor on the project will coordinate and subcontract with five to eight regional organizations across the Commonwealth. These regional offices will be responsible with the bulk of the day-to-day outreach, education, and enrollment assistance while consistently broadening their network of community-based organizations.  

Submission and Deadline 

Organizations interested in becoming the Lead Contractor can visit, All proposals must be submitted by 1 pm on June 27 

For inquiries concerning the RFP specifically, please contact Gwen Zeh, Issuing Officer, at 

Other Opportunities

The new assister services approach will rely on partnering with established regional organizations across Pennsylvania. Pennie is actively seeking information about community partners looking to support enrollment assistance and outreach efforts. For organizations that are interested in supporting Pennie’s efforts but are not interested in becoming the Lead Contractor, visit this link to provide Pennie with your information and level of interest:

About Pennie

Pennie® is the official health insurance marketplace for the Commonwealth of Pennsylvania, and the only source of financial help to lower the cost of high-quality private health insurance plans. Pennsylvanians without access to other health coverage can find affordable health plans through Pennie that meet different needs and budgets. Eligibility for financial help is based on income, family size, and other factors. Pennie is operated by the Pennsylvania Health Insurance Exchange Authority, established under state law. For more information, visit or follow us on social at and

Reimagine Rural is Back For Season 2!

The Reimagine Rural podcast is back for a new season! Join Brookings Senior Fellow Tony Pipa for a journey into the heart of rural America, where changemakers are propelling their communities toward new opportunities and equitable prosperity.

Through illuminating conversations with local leaders, Pipa explores the transformative shifts, underlying challenges, and intricate nuances shaping rural development today. This season covers the revitalization of manufacturing, innovative approaches to housing, the expansion of broadband connectivity, and more.

🎧 Listen to episodes one and two, and follow the show on your preferred listening platform to stay updated on the latest episodes.

More about the work

Reimagine Rural is more than just a podcast; The Reimagining Rural Policy initiative at Brookings brings engaging narratives and in-depth analyses that provide a comprehensive view of the policies and trends shaping real-world rural development.

About Brookings

The Brookings Institution is a nonprofit organization based in Washington, D.C. Our mission is to conduct in-depth, nonpartisan research to improve policy and governance at local, national, and global levels.

New Rules Will Help Adults and Children Enroll — and Stay Enrolled in — Medicaid and CHIP

On April 2, the Centers for Medicare and Medicaid Services (CMS) published the most significant set of eligibility regulations since the initial rule implementing the Affordable Care Act (ACA). The new rule will help eligible individuals enroll in Medicaid and Children’s Health Insurance Program (CHIP) coverage and stay enrolled as long as they remain eligible. Many of the provisions address issues that contributed to coverage losses during the unwinding of the continuous enrollment provision that has resulted in at least 13.7 million people losing Medicaid coverage, mostly for procedural reasons.

The new rule is effective 60 days after publication, but because most of the new regulatory requirements will necessitate significant policy, operational, and system changes, CMS has set a three-year pathway for states to come into compliance. This approach attempts to balance the competing needs of making the streamlined processes available as soon as possible and responding to states’ capacity issues.

Key changes that address Medicaid unwinding specifically include:

  • Updating address information. States took different steps during the unwinding process to update addresses and respond to returned mail. Certain actions, like relying on updated address information from managed care plans and the United States Postal Service (USPS), were permitted only under temporary authority. The final rule codifies many of these best practices and outlines actions states must take to respond to returned mail and use address information from reliable data sources, such as the USPS. States must come into compliance by December 2025.
  • Timelines for responding to requests for information. During the unwinding period, some beneficiaries lost their coverage because they did not respond to requests for information in a timely manner. The final rule allows more time for beneficiaries to respond to such requests. For example, individuals will have at least 15 days to respond to requests at the time of application and 30 days to respond to requests when they report a change in circumstances. A 30-day minimum period already exists at renewal. States must come into compliance with these changes by June 2027.
  • Transitions between Medicaid and CHIP. Children can lose coverage or have gaps in coverage when transitioning between Medicaid and CHIP programs. For example, if a child is enrolled in Medicaid and family income increases, he or she may be no longer eligible for Medicaid but eligible for CHIP. In this case, the child would still need to go through a CHIP eligibility determination. The new rule requires each agency to accept determinations of eligibility made by the other agency at both application and renewals, ensuring that children no longer “bounce” between state-run programs. States must come into compliance with these changes by June 2024.

Other key changes in the new regulations include:

  • Aligning eligibility and enrollment processes across Medicaid eligibility groups. The final rule extends streamlined, modernized processes that are already required for children, pregnant people, parents, and adults eligible under the ACA Medicaid expansion to people who are older and disabled. For example, under the new rules, individuals who seek coverage based on disability status or age (i.e., 65 or older) must be able to submit applications in person, online, by telephone, or by mail and have their eligibility determined without an in-person interview. Renewals cannot be more frequent than every 12 months, states must first attempt to renew coverage by reviewing data sources rather than requesting documentation, and individuals must have a minimum time period to respond to renewal forms. These changes will significantly ease the administrative burden on individuals who are older or disabled. These populations are more likely to live on fixed incomes and be financially eligible for coverage but disproportionately challenged with meeting enrollment and renewal requirements. States must implement these changes by June 2027.
  • Removing CHIP coverage barriers. The final rule eliminates the ability of states to lock out children who are behind in premiums for a set time period (e.g., 30 or 60 days). It also eliminates waiting periods before children can enroll and annual and lifetime benefit limits for CHIP-enrolled children. States are also no longer permitted to require payment of past-due premiums as a condition of reenrollment. Fourteen states currently lock CHIP-enrolled children out of coverage for a period for failure to pay premiums. Nine states have waiting periods, a practice dating back to the early days of CHIP to address concerns that CHIP might “crowd out” or “substitute” coverage under group health plans. Thirteen states currently impose annual or lifetime limits on CHIP benefits, most applied to dental and orthodontia services. States must implement these changes to CHIP by June 2025.

While some states have already implemented many of these policies under temporary authority granted by CMS during the unwinding period, all states will need to evaluate the policy, operational, and systems changes needed to comply with the new rule. Given the issues arising during the unwinding period, states will be developing corrective action plans following the unwinding period. The phased timing of the provisions in the new rule will allow states to combine these efforts, bringing their systems into compliance with both the new and the preexisting rules. Notably, the implementation of many of these changes will qualify for enhanced federal administrative matching funds, helping defray the cost of implementation for states. Once implemented, the changes should result in a more streamlined, efficient, and customer-focused process to determine eligibility, enroll, and renew Medicaid and CHIP coverage.