Rural hospital leaders are questioning whether they can continue to afford to do business with Medicare Advantage companies, and some say the only way to maintain services and protect patients is to end their contracts with the private insurers

Medicare Advantage plans pay hospitals lower rates than traditional Medicare, said Jason Merkley, CEO of Brookings Health System in South Dakota. Merkley worried the losses would spark staff layoffs and cuts to patient services. So last year, Brookings Health dropped all four contracts it had with major Medicare Advantage companies.

“I’ve had lots of discussions with CEOs and executive teams across the country in regard to that,” said Merkley, whose health system operates a hospital and clinics in the small city of Brookings and surrounding rural areas.

Merkley and other rural hospital operators in recent years have enumerated a long list of concerns about the publicly funded, privately run health plans. In addition to the reimbursement issue, their complaints include payment delays and a resistance to authorizing patient care.

But rural hospitals abandoning their Medicare Advantage contracts can leave local patients without nearby in-network providers or force them to scramble to switch coverage.

Medicare is the main federal health insurance program for people 65 or older. Participants can enroll in traditional, government-run Medicare or in a Medicare Advantage plan run by a private insurance company.

In 2024, 56% of urban Medicare recipients were enrolled in a private plan, according to a report by the Medicare Payment Advisory Commission, a federal agency that advises Congress. While just 47% of rural recipients enrolled in a private plan, Medicare Advantage has expanded more quickly in rural areas.

In recent years, average Medicare Advantage reimbursements to rural hospitals were about 90% of what traditional Medicare paid, according to a new report from the American Hospital Association. And traditional Medicare already pays hospitals much less than private plans, according to a recent study by Rand Corp., a research nonprofit.

Read more.

The Centers for Medicare & Medicaid Services (CMS) updated their Hospital Price Transparency Fact Sheet with information on compliance and enforcement. Under Hospital Price Transparency, all hospitals, including Critical Access Hospitals (CAHs) and Rural Emergency Hospitals (REHs), and hospital-based departments – which may include some Rural Health Clinics – are required to post pricing information about the items and services they provide on a publicly available website. CMS audits hospitals and investigates complaints from the public to ensure compliance. They also leverage automation to perform over 200 comprehensive hospital reviews per month. Consistent with standing policies, CMS will address non-compliance with swift enforcement, and they are planning a more systematic monitoring and enforcement approach, per the Executive Order.  A variety of resources are available to help hospitals, CAHs, and REHs comply with these requirements.

“GOP lawmakers are hunting for ways to slash federal spending, a process that could mean cuts to Medicaid programs that support more than 3.1 million Pennsylvanians.” Mike Makosky, president and CEO of the Fulton County Medical Center, spoke to the USA TODAY Network about how the loss of federal dollars might undermine his hospital’s ability to provide health care in this rural southcentral Pennsylvania community.” Source: USA Today Network

With the rash of benefit thefts from consumers utilizing the Supplemental Nutrition Assistance Program (SNAP), the PA Department of Human Services is suggesting recipients change their EBT card pins ahead of their monthly benefit distribution. The theft of benefits rarely happens right away but thieves wait until the monthly distribution occurs to steal benefits. Recipients can call DHS’ EBT Recipient Hotline at 1-888-EBT-PENN or use the mobile app ConnectEBT to change their PIN numbers. Consumers are also urged to take extra steps to ensure that where they are utilizing their cards for point-of-sale transactions do not have skimming devices attached. Read here for more tips.

Health insurance coverage is vital for families’ health and well-being. The benefits of coverage are documented from birth into adulthood and help to keep households financially stable. However, adults and children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) often experience disruptions in their health coverage when they fail to meet regular plan renewal deadlines. States are exploring ways to prevent families from churning off and on Medicaid and CHIP roles. Read more.

The National Health Service Corps (NHSC) loan repayment programs help repay part of school loan debt in exchange for service in a medically underserved area. Did you know Community Health Centers are automatically approved sites for these programs? The 2025 application is now open, and interested clinicians can now access the Application and Program Guidance documents for the NHSC, Substance Use Disorder, and Rural Community loan repayment programs. The application deadline is May 1. Share this information with your clinicians and clinician candidates!

The Drug Enforcement Administration (DEA) and HHS published a final rule to further delay the effective date of the Expansion of Buprenorphine Treatment via Telemedicine Encounter and the Continuity of Care via Telemedicine for Veterans Affairs Patients rules finalized in January 2025. In February, the DEA announced an initial delay of effective date until March 21, 2025, and accepted public comments on the decision. The DEA states that due to questions of “fact, law, and policy” both rules are delayed until Dec. 31, 2025. While these rules are delayed, rural patients receiving buprenorphine via telemedicine without an in-person visit can still do so through Dec. 31, 2025, due to the temporary extension of flexibilities that are in place.