While details of rural health transformation requests aren't available yet, some states are sharing their information

KFF News RHTP tracking map as of Dec. 2. Click to enlarge.

The newly formed federal Rural Health Transformation Program has $50 billion to distribute to states that met its Nov. 5 application deadline; however, a complete picture of which states applied and what they asked for isn't clear because the Centers for Medicare & Medicaid Services have "declined to publicly release the applications," report Sarah Jane Tribble and Arielle Zionts of KFF Health News.

CMS said it isn't allowed to "release grant applications to the public during the merit review process,” KFF News reports. "They've pledged to announce the allocations by Dec. 31."

RHTP was passed as part of the One Big Beautiful Bill Act in July, which drastically cut Medicaid spending and will disproportionately impact rural areas. But RHTP can't be used to "bail out" rural hospitals or clinics. KFF News explains, "The money [must] be spent on transformational ideas."

Although CMS isn't sharing application details, some states have been transparent about their applications. According to the article, a health strategy team at Princeton University tasked with tracking state application summaries found "themes including expansion of home-based and mobile services, increased use of technology, and workforce development initiatives . . ."

KFF Health News is collecting state-by-state application materials and adding them to its mapped repository, which will be updated as information arrives. 

Analysis: Rural women are more likely to face domestic violence or be killed by an intimate partner

Physical and social isolation can keep abused women from 
asking for help. (Getty Images photo via Conversaiton CC)

Not only are rural women more likely to face violence or be killed by a partner, they also face fewer intervention options and stigmas that discourage them from asking for help. Regional acceptance of violence against women, social and physical isolation, and gun ownership can all be contributing factors.

"I analyzed aggregate 1992 to 2005 National Crime Victimization Survey data, and this data conclusively shows that rural women across the U.S. report physical and sexual violence at higher rates than those in more densely populated areas," explains rural violence expert Walter S. DeKeseredy for The Conversation.

While many people may think rural living is safer, for many women, it's often the opposite. "Rural women in the U.S. are more likely to be killed by their current or former male partners compared to their urban and suburban counterparts," DeKeseredy writes. "A study looking at data from 2005 to 2017 across 16 states, for example, found that female homicide rates are higher in rural places."

Why rural women are more at risk for violence is a complex mix of shared misogyny, fewer witnesses, higher gun ownership rates and social stigmas. DeKeseredy writes, "In rural sections of Ohio and other states, as my research uncovered, there is common acceptance of abuse of women. In many rural areas, community norms often prohibit survivors from publicly talking about their experiences and from seeking help."

Gun ownership is more common in rural places, but it has been correlated to "intimate partner violence in rural parts of the U.S.," DeKeseredy explains. "Moreover, firearms are used in 54% of all rural domestic homicides. . . .Gun ownership can create safety concerns for social workers, many of whom work alone."

So far, efforts to prevent violence against rural women has been focused on gun control or firearm background checks. And rural libraries "have proven to be a vital resource in the struggle to end interpersonal forms of abuse of women," DeKeseredy writes. "They are more accessible in many U.S. rural communities than are shelters, public transportation and other services."

'On the Front Porch' discussions return on Aug. 21. Pipa and Orrell begin with big change in northern Appalachia.

Tony Pipa (left) and Brent Orrell return on Aug. 21

After a summer of traveling to rural destinations, Tony Pipa from Reimagine Rural and Brent Orrell of the American Enterprise Institute are back 'on the front porch,' discussing the trials, successes and ongoing challenges of rural communities across the United States.

The new season dives in with Pennsylvania activist and author Tataboline Enos, who discusses her latest book, “Proudly Made: A Story of Reinvention in the Big Woods and Small Towns of the Pennsylvania Wilds.”

Set in northern Appalachia, Enos' memoir recounts the story of a region rich in public lands that was struggling to survive decades of depopulation and business decline. Through hard work, planning and collaboration, the community forged a new and brighter path forward by harnessing the spirit of the land and the people.

Enos will share details of how this community created change.

The group will share a blueprint for other rural communities looking to leverage outdoor recreation opportunities for economic development. Virtual participants can submit questions before the event via email to events@brookings.edu

Register here for the online event on Thursday, Aug. 21, at 3 p.m. E.T.

For more rural inspiration, Pipa's Reimagine Rural podcast returns for its third season beginning on Aug. 19. The podcast's first two stops are in western North Carolina, where residents and businesses are navigating post-Hurricane Helene recovery.

Season 3, Episode 1 focuses on a community working to restore outdoor recreation in Old Fort, N.C. Episode 2 explores how Canton, N.C., is maintaining its identity and resilience after multiple disasters.

New Reimagine Rural podcast episodes are released every three weeks throughout the fall and can be accessed on platforms such as Spotify and Apple.

A mayor's death in rural Tennessee 'unleashed one of the county’s biggest political conflicts in memory'

Following the unexpected death of their mayor, residents in rural Coffee County, Tennessee, split into factions that began with arguments over real estate development and spiraled into heated debates over what it means to be politically conservative in a deeply red county.

Coffee County, in green, is nested between several
urban centers. (Caliper maps)

 

At 55 years old, Judd Matheny was a pro-growth mayor busy working to develop farm-based Coffee County as a haven for suburbanites fleeing expensive living in Nashville, Chattanooga, and Huntsville, Ala. "Rural Coffee County was poised to become Tennessee’s next boomtown, with subdivisions rapidly replacing farmland," reports Cameron McWhirter of The Wall Street Journal. 

Upon Matheny's death, his plans were diverted by county officials "pushing hard to limit development across the area’s vast farmlands. In March, the county imposed a three-month moratorium on all large subdivision projects in areas zoned for agriculture," McWhirter writes. After the moratorium expired, officials passed a ruling that limited "property owners in agricultural areas to selling land in a minimum of 5-acre-lot increments, effectively halting large subdivisions in those areas." The median lot size in Tennessee is roughly half an acre.

While county officials have sided with multi-generational farmers and residents who want to limit growth to preserve the region's rural identity, the area's strong pro-development faction isn't going quietly. McWhirter explains. "Rival camps have hired lawyers and clash on social media through dueling Facebook pages. . . . Planning commission meetings, typically mundane affairs where leaders wear jeans and work boots, now draw heated crowds and viewers on streaming.

Judd Matheny

The duel extended to what it means to be conservative. "An anti-moratorium sign at a local meeting read: 'Vote like a conservative! Less government. Less rules. Less regulations. Lower taxes," McWhirter reports. "A pro-moratorium group responded in a post that, 'Historically, conservatism has emphasized order, prudence, stewardship. . . .It’s about preserving traditional values and communities — not selling them off for short-term gain."

Even with the current restrictions, Coffee County continues to expand. "Construction crews dig and drill throughout Tullahoma and Manchester, the county seat; real estate for-sale signs line roads," McWhirter writes. 

Meanwhile, both sides seem to agree that if Matheny were still alive, things wouldn't be so contentious. McWhirter adds, "Matheny’s death unleashed one of the county’s biggest political conflicts in memory."

Heavy emotional burdens, struggles of American farmers 'need national attention and policy changes'

A worried farmer stares at his crop of wheat and weeds. 
(Adobe Stock photo)

America's farmers have a lot on their minds: Flooding, weeds, bugs, spiking fertilizer prices, bird flu, changes at the USDA, tractor repairs, extreme rain, high winds, crop insurance, tariffs and isolation. Those pressures can leave farmers deeply distressed and depressed to the point of considering suicide.

"This chronic stress puts farmers at a higher risk of developing health conditions including heart disease, hypertension, depression and anxiety disorders," reports Emily Payne of Food Tank. "Thankfully, nonprofit organizations, farmers’ coalitions and other organizations are working to remove the barriers preventing farmers from accessing suicide prevention assistance."

Part of helping farmers reach out for help means working to reduce stigmas that surround mental health that are often found in rural regions. "In 2021, 63% of farmers and farm workers surveyed by the American Farm Bureau Federation said that there is at least some stigma around stress and mental health in the agriculture community," Payne reports. Farmers and farm employees are afraid they will be recognized and shamed for seeking mental health care.

Third-generation Wisconsin farmer Jake Beeler explained why farmers sometimes avoid dealing with any mental health struggles. He told Payne, "I’m sure there are mental health resources, but anybody that I know that ends up going down that road, money is a huge issue. Why go spend money talking to somebody when I could be at work getting stuff done? That’s the mindset that gets bred into you as a farmer.”

Katherine Un of the National Young Farmers Coalition, told Food Tank, "It’s challenging for farmers to find the time to seek or schedule treatment while working long days, or to find health care providers who understand the unique challenges of farming. . . and the inextricable link between their work, their livelihood, and their sense of purpose in the world."

Several farming organizations provide structures so farmers can support each other. "Young Farmers Cultivemos network facilitates farmer cohorts, regular farmer-led and farmer-centered events, newsletters, resource-sharing, and training to improve farmers’ mental health and well-being," Payne reports. "Un says that resources and spaces that truly build community are key in fighting isolation and addressing mental health challenges."

Outreach and counseling that follow different therapy models also are available. "Annie’s Project provides community-based mental health solutions outside of the traditional therapy model," Payne adds. "The nonprofit partners on Cultivating Resiliency Programs, which are anonymous opportunities for farmers to get together virtually and share what’s on their minds with both their peers and licensed counselors."

Along with mental health care, Un says farmers also need health and dental insurance, and that will require national attention and policy changes. Un told Food Tank, "We need to meaningfully address the top challenges facing the new generation of farmers and ranchers: affordable land access, access to capital, climate change, health insurance, student loan debt, affordable housing. . . .Until these barriers are addressed through the Farm Bill, farmers will continue to face high levels of stress, uncertainty, financial risk and a lack of safety nets.”

Find basics on what to do and say to someone experiencing mental health stress here. Find CDC agriculture health and safety tools here. 

ICE contracts help some rural jails shore up their budgets, but the money comes with strings attached

Ozark County Jail, Mo., transports and temporarily holds
detainees for ICE. (Photo by Jesse Bogan, Marshall Project)

Small, rural law enforcement offices hurting for money are signing up for Immigration and Customs Enforcement contracts, but the money to assist with national mass deportation efforts comes with added oversight and risks.

Sheriff Cass Martin from Ozark County, Missouri, "sees his prayers answered in a new contract with ICE that could boost his $1.1 million annual budget," reports Jesse Bogan of the Missouri Independent. "An enormous ramp-up in detention capacity is underway. New contracts are being negotiated. . . . Ozark County is already reaping the benefits by raising wages and hiring for new positions in law enforcement."

Martin saw the ICE contract as a possible answer to his budgeting shortfall. He told Bogan, “We were really hurting. The day after the inauguration, a federal inspector showed up here at the jail wanting to look at everything throughout the facility."

Ozark County is one example of how a small, rural law enforcement office can become an effective "arm" for ICE. "They’ve made 525-mile runs from Ozark County to the federal building in St. Louis, down to the Greene County Jail in southwest Missouri, then back home," Bogan adds. "They’ve picked up detainees 325 miles away in Oklahoma and taken them to the tarmac at Kansas City International Airport."

But the added work and money have strings attached. ICE "detention and transportation contracts come with much more scrutiny and oversight than typical jail work, especially in Missouri, which doesn’t have statewide jail standards," Bogan reports. "Still, ICE reported that eight detainees had died nationally while in custody this year, as of May 5, including one death in a rural Missouri jail."

At least in Ozark County, local input on ICE contracts has been minimal; however, local officials working on ICE details haven't broadcast their federal negotiations. "Just one [local resident] attended a recent county commissioner meeting," Bogan writes. "Two years’ worth of meeting minutes didn’t mention the ICE contract in detail. The county commissioner said he wanted to wait until federal money started coming in before listing projected revenue in the county’s $7 million annual budget."  

Quick hits: Medical flights increase; inflation navigation; rethinking grass-fed meat; NASA astronauts splash home

When every minute matters, a medical helicopter
can be a rural patient's best option. (WSAZ photo)

As more rural hospitals close, medical helicopter services are more likely to be called for emergency medical treatment. "Over the past decade, demand for air ambulance services has grown more than 50%. One factor experts say is a rising number of rural hospitals shutting their doors," reports Blair Miller of WSAZ in West Virginia. "As rural hospitals close and demand for medical flights grows, the healthcare industry faces another hurdle, a shortage of medical pilots."

Since late January, measles infections have spread from Texas to New Mexico to Oklahoma. As of late March, 321 people have contracted the disease, including a child who died from the infection. Even though most infections occur in unvaccinated people, it's still prudent to understand how the disease spreads and who may need a measles, MMR, vaccination, or vaccination booster, reports The Conversation. "In a Q&A, Daniel Pastula, a neurologist and medical epidemiologist, explained how and when you should take action." MedPage Today also offers measles vaccination guidance.

Some Americans skip the expensive
snacks. (Adobe Stock photo)

Amid increasing food costs and health care worries, many U.S. consumers are dropping some of their expensive habits, leaving convenience store sales feeling the pinch. "Convenience-store sales fell 4.3% by volume in the year ended Feb. 23, as consumers cut back on snacks and cigarettes due to rising prices and health concerns," report Jesse Newman and Laura Cooper of The Wall Street Journal. "The change in behavior is hurting U.S. sales of Doritos, Twinkies, Heath bars and Newports. . . . Lottery ticket sales remain strong."

At the time Isaac Newton pondered the idea that "what is up, must come down," he was observing an apple fall from a tree branch. Had he been watching U.S. food costs, he might have come to a completely different conclusion. "The USDA states that food costs have climbed over the past few years and will continue to do so in 2025," reports CaLea Johnson of Mental Floss. "More specifically, food-at-home prices (grocery store or supermarket food purchases) are expected to increase by 1.3%." To see which states people spend the most on groceries, click here.

After years of touting grass-fed burgers as healthier for the planet, some ranchers and conservationists may want to rethink their sales pitch. "A study published in the Proceedings of the National Academy of Sciences challenges found that cattle raised only on pastures do not have a smaller carbon footprint than feedlot cattle, which are quickly fattened on corn and other grains," reports Anna Phillips of The Washington Post. "This held even when the researchers took into account that healthy pastureland can help capture more carbon by pulling it out of the air and storing it in roots and other plant tissues."

NASA astronauts return home to Earth after an extended stay in outer space. (NASA photo)

Steven Speilberg's alien darling, E.T., was famously stranded on Earth and couldn't stop begging to phone home. NASA astronauts had a similar, but opposite problem. They were stuck in space wanting to get back home to Earth. "Suni Williams and Butch Wilmore set off to spend eight days at the space station. The trip lasted nine months," report Kenneth Chang and Thomas Fuller of The New York Times. SpaceX and the Coast Guard members met the astronauts as they "splashed down in calm, azure waters off the coast of the Florida Panhandle. . . . A pod of curious dolphins also greeted the astronauts."

Reporting on contentious issues in rural America: An informal discussion on what journalists should consider

Nicholas Jacobs, Sarah Melotte, Natalia Alamdari

After an election year marked by national chatter about what rural Americans believe and do, the Rural Journalism Collective is offering an informal panel conversation about how rural towns manage conflict and what journalists should consider as they report on contentious issues within their community. The event is on Thursday, Dec. 12, 2 p.m. E.T. Register here.

The panel discussion features:

• Nicholas Jacobs, an assistant professor of government at Colby College and an expert on American politics and policymaking, with a focus on the rural-urban divide, federalism, and developments in the American party system.

• Sarah Melotte, a staff writer at The Daily Yonder, an independent newsroom about rural America. Mellotte has a master’s degree in applied geography and geospatial science. She analyzes data, and plans and creates most of The Daily Yonder’s data reporting maps and graphics.

• Natalia Alamdari, a greater Nebraska reporter for the Flatwater Free Press, where she covers everything from chaos on rural village boards to shady international nonprofits to election misinformation efforts straight from the heartland. She is a graduate of the University of Missouri-Columbia and a native Texan.