Policy experts say 10 rural hospitals in Virginia are 'at risk' of closure. What does that mean?

A rural hospital can be listed as 'at risk' and never close.
(Canva photo via Cardinal News)

As rural hospitals across the U.S. grapple with fewer federal Medicaid reimbursement dollars, some, including 10 in Virginia, have been flagged as "at risk" of closure, reports Emily Schabacker of Cardinal News. But the formulas used by policy centers to determine financially strained hospitals can't predict which hospitals will close.

For instance, the Public Citizen, a non-profit that tends to lean left, released an analysis that looked specifically at "Medicaid policy changes tied to the federal funding bill," Schabacker explains. Based on their focus, Public Citizen policy experts "identified 10 Virginia hospitals as at risk of closure," including six in Southwest and Southside Virginia:

• Buchanan General Hospital, Grundy
• Carilion Tazewell Community Hospital, Tazewell
• Twin County Regional Hospital, Galax
• Dickenson Community Hospital, Clintwood
• Sentara Halifax Regional Hospital, South Boston
• Centra Southside Community Hospital, Farmville
• VCU Health Tappahannock Hospital, Tappahannock
• Bon Secours Southern Virginia Regional Medical Center, Emporia
• Sentara Northern Virginia Medical Center, Woodbridge
• VCU Health Community Memorial Hospital, South Hill

While not all policy centers will focus on Medicaid payment changes to determine a hospital's future financial difficulties, most centers will consider past financial standing, operating margins, and whether the hospital was already operating at a deficit before the Medicaid cuts were announced. 

According to Michael Shepherd, an assistant professor with the Department of Health Management and Policy at the University of Michigan, "Each research group uses slightly different methods to evaluate hospital finances," Schabacker reports.

Shepherd said he’s "concerned that reports like the one from Public Citizen border on being alarmist," Schabacker adds, "signaling with too high a degree of certainty that hospitals with negative operating margins will close as Medicaid changes take shape."

Financial vulnerability doesn't mean that "the hospital is going to close tomorrow, but it could over the next few years," Shepherd told Cardinal News. "There is some uncertainty there. Not every hospital that’s at risk of closing will close. The truth is somewhere in the middle.”

When dialysis treatment centers close, rural patients have no choice but to drive further for care

After the Chadron dialysis center closed, Pieper's 
treatment travel time tripled. (KFF Health News photo)

Rural residents who require dialysis treatment to stay alive are having to drive longer distances for care as smaller hospitals and clinics shed unprofitable services to stay afloat, reports Ariella Zionts of KFF Health News.

When Chadron Hospital shuttered its dialysis center, which served Nebraska residents in the state's far western panhandle, Mark Pieper became one of the many displaced patients who would have to find another dialysis center for treatment.

Because the human body cannot survive without kidney-like functions that filter toxins, remove excess fluid and balance electrolytes, dialysis cannot be rescheduled or skipped. When faced with the closure of their dialysis center, renal patients like Pieper have two choices: Travel for treatment or die.

"Pieper eventually found treatment in Scottsbluff, which, with about 14,000 residents, is the biggest city in the rural Panhandle region," Zionts writes. "The hour-and-a-half drive will triple his time on the road to more than nine hours each week."

Chadron Hospital discontinued its dialysis service despite the $219 million in federal money Nebraska will receive this year from the Rural Health Transformation Program. But RHTP awards aren't meant to "help existing services stay afloat," Zionts explains. Instead, they are earmarked to help rural medical centers "explore new, creative ways to improve rural health." Only 15% of RHTP funds can be used to pay for patient care.

Chadron Hospital was "losing $1 million a year on its dialysis service due to low reimbursement rates that didn’t cover operational costs," Zionts reports. Nephrologist Mark Unruh said the "dialysis closure in Chadron reflects a wider trend of staffing and funding challenges."

Preventing kidney failure is one of the best ways rural areas can change what rural dialysis patients like Pieper are facing now, Unruh told KFF Health News. "He pointed to a tele-education program that helps primary care doctors in rural and other underserved areas prevent end-stage renal failure."

Kansas fitness centers focus on providing exercise care to rural residents with Parkinson's disease

Kansas has the second-highest rate of 
Parkinson's disease cases in the U.S.

Among the nearly 1 million Americans living with Parkinson's disease, rural residents face more challenges accessing the exercise and support programs that could improve their quality of life.

In rural Kansas, some fitness centers have opened or expanded care to help area patients work out more regularly, according to Bek Shackelford of NPR. Regular exercise is one of the few proven ways Parkinson's disease sufferers can lessen the muscle stiffness, tremors, sleep problems and brain-health issues that often accompany the disease.

The Parkinson's Exercise and Wellness Center in Leawood, Kansas, which offers "gym services to around 280 people and offers classes ranging from Pilates and boxing to theater" serves as an example, Shackelford adds. The head coach and co-founder of the center, Sarrisa Curry, told Shackelford that the center's enrollment has been on the rise as more baby boomers are diagnosed with the disease.

Medical scientists are still unsure what causes Parkinson's disease to develop. Some studies indicate that the disease may have a genetic basis. Other research suggests that exposure to pesticides, such as those encountered in rural farming communities, could be partially to blame. Shackelford reports, "Recent data shows Kansas has some of the highest rates of Parkinson's diagnosis in the country." Only Nebraska has a higher rate.

Elaine Ptacek, who founded the Parkinson's Families of Northwest Kansas, a nonprofit that "offers things like physical therapy and art classes, says about 90% of her group's participants live on farms and are exposed to pesticides," Shackelford adds. "Ptacek's organization serves a rural area she says desperately needs Parkinson's support."

To reach as many patients as possible, Parkinson's Families of Northwest Kansas offers exercise classes to "groups in eight counties [who can] join Zoom calls and follow along with a fitness instructor," Shackelford adds.

Telehealth hub addresses lack of care in rural Texas

The Davis Mountain Clinic offers an exam room
for patients. (Photo by Carol Brewer, Daily Yonder)

In the midst of rural West Texas, a shipping container is giving residents of Jeff Davis County access to telehealth through reliable connectivity and a local registered nurse, reports Madeline de Figueiredo for the Daily Yonder.

The Davis Mountain Clinic was created by Texas A&M and Texas Tech universities to bring remote medical and mental health care to the area’s aging population, explains Figueiredo.

One in five residents in this mountainous county don’t have reliable broadband, and the only doctor is semi-retired, causing most of the population to drive 30 minutes for care, Figueiredo reports.

As the county has a median age of 58, the telehealth hub offers not just reliable broadband, but “digital literacy for older residents, trusted community health workers, and practical ways for clinicians to weave virtual visits into everyday care.”

The director and local registered nurse for the clinic, Carol Brewer, can monitor vital signs, execute physical exams and help patients navigate their virtual telehealth appointments. She told the Yonder, "The advantage is, when they come here to see the doctor, I manage the technology on my end, they don’t have to deal with that at all…I’m the hands of the physician via telehealth.” 

This is not the only area of Texas that struggles with internet connectivity and access to nearby health care. Communities in Erath, Hockley and Reeves counties are working on bridging the gap in services by offering private telehealth rooms, medical monitoring equipment and guidance from staff through local libraries, Figueiredo reports.

A small infusion clinic in rural Texas helps cancer patients not have to drive hundreds of miles a week for care

New Jersey and Rhode Island do not have rural hospitals and are excluded from the analysis.

(Map by Deidre McPhillips, CNN, from Chartis data)

Rural cancer patients often drive hundreds of miles for treatments only bigger cities can offer, but a smaller hospital that chose to add an infusion clinic in a rural area shows that cancer care can move closer to home, reports Caleb Hellerman of CNN News.

Childress Regional Medical Center, which serves roughly 30,000 people in a 5-county region of North Texas, did the opposite of what many smaller hospitals have been doing. They added services instead of shrinking them. Hellerman writes, "Childress [began with] opening a small infusion center in 2013 and steadily expanding its capabilities in order to serve patients."

When it comes to diagnosis, treatment and survival rates, rural cancer patients are already at a disadvantage. Hellerman reports, "Rural cancer patients tend to be diagnosed later and have worse outcomes. . . . Rural patients are also less likely to receive treatment that meets the standard of care."

Although the Childress infusion clinic started small, the need for it quickly became apparent, and its provider count grew to meet the needs of rural patients. Hellerman explains, "The infusion center started with two chairs but has since grown to encompass 10 spots for patients, three full-time pharmacists and three full-time oncology nurses."

Residents in the region are luckier than many of their rural peers. The medical consulting group Chartis "found that 448 rural hospitals – nearly a quarter of the nation’s total – stopped offering chemotherapy services between 2014 and 2024," Hellerman writes. Out of all the states, Texas lost the most.

Beyond the transportation issues, rural cancer patients will continue to face a dwindling number of oncologists willing to practice in rural regions. Some of that shortage is attributed to younger specialists preferring to live and work in more urban areas. But, according to Hellerman, the high cost of cutting-edge cancer drugs is also preventing younger oncologists from considering rural-leaning positions. 

"Oncologists and hospital administrators say pressures are likely to worsen over the next few years as provisions of the 'Big Beautiful Bill' kick in," Hellerman reports. Most of those cuts are slated to come from reducing the number of Americans who receive Medicaid.

Quick hits: Mississippi bans lab-grown dairy; Lawyers for Reporters; pay phones help boomers and zoomers connect

State-level bans like Mississippi's can restrict access to the 
 lab-grown dairy industry. (Photo by A. Chaudhary, Unsplash)

Mississippi is the first state to ban lab-grown dairy after passing a bill effective July 1, reports Karen Bohnert for Dairy Herd Management. Lab-grown dairy is "produced through precision fermentation or cell-culturing techniques" and often referred to as "fake milk," Bohnert explains. The bill, HB 1153, requires strict labeling requirements and updated authority to state inspectors to prevent the manufacture, sale and distribution of cell-cultured dairy throughout the state, Bohnert reports.

Lawyers for Reporters, created by the Cyrus R. Vance Center for International Justice, is a free resource for American local and public-interest journalism organizations needing legal services, reports Tandy Lau for E&P Magazine. There's a five-person in-house legal team based in New York offering assistance, and they partner with outside counsel for extra support in farther areas. Managing Attorney Kay Murray told E&P they "really guide [journalists] to ensure that they've got the backup to get it right, that they are confident about getting it right [and] that their understanding with their sources is something that everybody is on the same page about." They hope to soon provide more support for investigative reporting and coverage of immigration issues as well. "If I was trying to quantify the value of [Lawyers for Reporter's assistance], it would add up to easily tens of thousands of dollars if not well into the six figures," Warwick Sabin, CEO and president of Deep South Today, told E&P.

A new study found a long-term shift in cancer death trends, with rural areas facing higher cancer death rates than urban areas in recent years, reports Dennis Thompson for U.S. News & World Report. Previously, between 1969 and 1971, “large cities had the highest overall cancer death rates, followed by small- to medium-sized cities.” However, rural areas had the highest rates in 2021 to 2023, and large cities had the lowest rates. Specifically, lung cancer deaths among rural men were 26% lower than city dwellers in 1969 to 1971, but 55% higher in 2021 to 2023. Researchers said the shift and continuously widening gap is “likely driven by limited access to health care, lower cancer screening rates, higher poverty, more smoking and other lifestyle and environmental factors” in rural communities.

In a new social experiment by Matter Neuroscience, two old payphones set up at a nursing home in Nevada and near Boston University allow "zoomers" and "boomers" to call each other from 3,000 miles apart, reports Scottie Andrew for CNN. Designed to help people feel less lonely, this pilot project will last at least a month, according to Matter Neuroscience. "Friendship could come in all ages. Wisdom can come in all forms, and we just want people to get out of their comfort zone and have a conversation," Matter Neuroscience social strategist Calla Kessler said.

GM announced it will be adding a day of factory
production to it heavy-duty truck line. 

General Motors is increasing its heavy-duty truck production, as consumer demand remains strong despite rising gas and diesel prices, reports Christopher Otts for The Wall Street Journal. GM's Flint Assembly plant in Michigan will operate six days a week now, rather than five, producing more heavy-duty versions of the Chevrolet Silverado and GMC Sierra pickups, Otts reports. Workers will be "mandated into overtime hours to cover the additional day of production," explains Otts. As gas prices have risen by about one-third since the beginning of the Iran war, GM's stock has declined about 10% so far this year, and forecasters predict new-vehicle sales to fall 6.5% in the first quarter.

Lawmakers and health groups pushback on Rural Health Transformation Program plans and limits

Nebraska State Capitol in Lincoln
(Photo by Pieter van de Sande, Unsplash)

The excitement and energy that was first attached to millions of federal dollars in awards to states for the Rural Health Transformation Program has already started to fade. Some legislatures and health groups are resisting their state's proposals and pushing for more input on how the money is spent, report Arielle Zionts and Sarah Jane Tribble of KFF Health News.

The awards, which are funded through the Centers for Medicare & Medicaid Services, impose strict timelines and rules on the use and implementation of millions of dollars. Lawmakers, who must work quickly to pass bills needed to use the funds, and rural health groups are finding themselves at odds with award restrictions.

Much of the disconnect stems from what many lawmakers thought they could use RHTP money for, based on how the program was marketed, versus what CMS will allow.

The White House promoted RHTP awards as a way to "shore up rural health care," but their use isn't aimed at saving struggling rural hospitals. Instead, the funds are to be used for "seeding innovative projects and technologies," Zionts and Tribble explain. "States can use only up to 15% of their funding to pay providers for patient care."

Some state Republican lawmakers — especially those representing more rural regions — as well as rural hospital advocates, "are upset that the political rhetoric doesn’t match what they see," KFF reports. "They’re also lobbing criticisms at specific aspects of their states’ plans, including the proposed projects, what’s not included, and the spending approval process."

State lawmakers from Wyoming, Ohio, North Dakota, Michigan, North Carolina, Nebraska and Colorado all face conflicts and competing needs to get the work done so their states can spend the money and then decide who gets it, KFF reports.

Jed Hansen, executive director of the Nebraska Rural Health Association, told KFF, "Rural Health Transformation will not save a single hospital in our state. I don’t think it will save a hospital nationally.”

Study: More Americans ages 18-54 are dying from severe first heart attacks

Even some 35-year-olds are at risk for severe heart
attacks. (Photo by E. Akurt, Unsplash)

Death by heart attack used to be a worry for only older Americans, but a new study revealed an alarming increase in heart attack deaths among younger Americans. The results are particularly worrisome for younger rural Americans who tend to have less access to preventative medical treatment, are more likely to smoke cigarettes and often face longer drives to reach emergency care. 

"The proportion of adults ages 18 to 54 who died in a hospital of a severe first heart attack rose 57% between 2011 and 2022, according to the study published in the Journal of the American Heart Association," reports Betsy McKay of The Wall Street Journal. The study data showed that more than 75% of severe heart attack deaths were men, and 71% were between the ages of 45 and 54 years.

The increase in heart attacks deaths is yet another indicator younger Americans aren't as healthy as previous generations. McKay writes, "Poorer health among younger adults is one reason heart disease remains the leading cause of death in the U.S."

Americans who died after a heart attack often had other underlying chronic health issues or smoked. "About 60% had high blood pressure, while more than half also had high cholesterol and smoked. About a quarter had diabetes."

Younger adults need to be warned that the risk of heart attacks can begin "as early as age 35," McKay adds. "Younger people could use a risk calculator on the AHA’s website." Experts recommend using the 30-year estimate rather than a 10-year one for greater accuracy.

A startling look at the lack of dialysis treatment options for rural Americans experiencing kidney failure

For the roughly 240,000 rural Americans suffering from kidney failure, or End-Stage Renal Disease (ESRD), getting to a dialysis center that can deliver consistent, quality care is a struggle. The lack of reliable dialysis for rural ESRD patients has been exacerbated by too few providers within a drivable distance, with some rural residents facing travel across several counties to access dialysis.

The most common dialysis clinics near rural ESRD patients are often owned by DaVita, a "for-profit company with a documented history of kickbacks to doctors and involuntary patient discharges," reports Sarah Melotte of The Daily Yonder. Involuntary discharges are supposed to be extremely rare and regulated by the Centers for Medicare and Medicaid Services.

About 22.8 rural Americans – just over half of the total rural population – live in a county where either DaVita is the only clinic, or there is no clinic at all. (Map by Sarah Melotte, Daily Yonder, from CMS data)

In fact, for 6.1 million rural Americans, DaVita is the only Medicare-certified dialysis clinic in their county, according to Melotte's analysis of CMS data. Melotte reports. "Another 16.5 million rural Americans live in a county with no facility at all."

Overall, DaVita and its German competitor, Fresenius, "tend to have worse health outcomes compared to independent, non-profit clinics," Melotte writes. "Duke University’s research found that, after dialysis clinics were acquired by large, for-profit, companies, the likelihood of each patient being hospitalized each month increased by 4.5%."

Using a CMS dialysis facilities dataset, in 300 counties, 190 of which are non-metropolitan, or rural, "DaVita runs the only clinics in the county," according to Melotte's anaysis. "In rural counties, about 31% of clinics are owned by DaVita."

In some rural regions, the lack of dialysis centers is even more dire. "About 59% of rural counties don’t have a single Medicare-certified dialysis clinic," Melotte writes. "In places like rural Central Nebraska or Western Kansas, patients might be several counties away from the nearest clinic."

Report: Pesticides may be driving Midwestern cancer crisis

Map by Ben Felder, IM, sources from Cancer: National Cancer Institute and the CDC, Pesticides: Pesticide National Synthesis Project, from the U.S. Geological Survey

As cancer diagnosis rates among Midwesterners continue to be higher than the national average, a "growing body of research indicates that pesticides are partly to blame," reports Ben Felder of Investigate Midwest. Pesticide use helped U.S. agriculture become an international commodity powerhouse, but that success may be coming at the expense of Midwestern communities.

Because more than half of U.S. cropland is in the Midwest, Midwesterners who don't live in a major metro area are likely to live near a farm that uses pesticides. Felder explains, "Sprayed from airplanes, drones, tractors and handheld devices, these chemicals can drift through the air or run off into nearby rivers and streams."

"Most of the 500 counties with the highest pesticide use per square mile are located in the Midwest," Felder reports. "Sixty percent of those counties also had cancer rates higher than the national average of 460 cases per 100,000 people, according to an analysis of data from both the U.S. Geological Survey and the National Cancer Institute."

Lisa Lawler from Hardin County, Iowa, believes that pesticides are the primary driver of cancer diagnoses in her community, including her mother's and her own. Felder writes, "The county is home to around 800 farms, has a pesticide use rate more than four times the national average and a cancer rate among the highest in the state."

Lawler had extensive testing completed to see if her cancer was hereditary. She told Felder, "The genetic test they ran for me was one that covered 81 genes that are typically related to breast cancer. . . .They told me my cancer is likely not genetic, but likely environmental, based on these 81 genes."

Pesticide manufacturers have continued to reject claims that pesticides have any part in regional cancer diagnosis trends. "But scientific research linking pesticides with certain types of cancers has been growing," Felder writes. A 2024 study published in Frontiers in Cancer Control and Society linked "pesticides to prostate, lung, pancreas and colon cancers. Pesticides have also been associated with lymphoma and Parkinson’s disease."

Wyoming officials aim to keep the state's Rural Health Transformation Program award going in 'perpetuity'

Wyoming is the most sparsely populated state in
the U.S. (Photo by Karsten Koehn, Unsplash)

As Wyoming's rural hospitals struggle to make ends meet and hire enough medical providers, state officials have hatched a plan using money from its Rural Health Transformation Program funds to buffer losses, create more robust provider training and incentives, while using investments to help the money stretch for decades, reports Arial Zionts of KFF Health News.

If Wyoming's plan receives federal approval to invest a substantial portion of its $205 million award, the state's "Rural Health Transformation Perpetuity fund could provide $28.5 million for the state to spend every year," Zionts explains. "Wyoming would spend the money on scholarships for health students and incentive payments to help keep small hospitals and rural ambulance services afloat."

The federal RHTP program requires states to spend their awards by established deadlines, or the money will be shelled out to other states. The question is, will the Centers for Medicare & Medicaid Services, which manages RHTP, see placing the money in an investment account as "spending it."

Stefan Johansson, the director of Wyoming’s health department, thinks it will. "He said that CMS called in December to specifically ask questions about the fund and that he believes the agency has formally approved it," Zionts reports. "But 'the devil’s always in the details,' he said, as the state works with CMS during the budget review period."

CMA has already told some states that RHTP grants "cannot be used to 'generate income.'" Zionts adds. "Wyoming officials wrote in the state’s application that the perpetuity fund won’t be making or keeping any profit. . . .Other states proposed funds in their applications, but Wyoming’s appears unique, according to a KFF Health News review of state applications."

This robot helps rural seniors stay healthier and allows them to live independently longer

ElliQ is designed to be a companion and helper.
(Intuition Robotics photo)

In more remote parts of the country, residents can go for days without seeing another human. But as people age, going without human connection can be lonely and potentially dangerous. For some rural seniors living in isolation in Washington state, participating in a pilot program that pairs them with a robot companion offers a potential solution, reports Eli Saslow of The New York Times.

Jan Worrell, 85, is participating in the pilot so she can continue living alone in her home, which sits on an isolated strip of the Long Island Peninsula. Firefighters came to Worrell's home and installed her new robot partner: "ElliQ."

One of ElliQ's initial greetings to Worrell sounded like a new friend's introduction. Saslow writes, "'Oh, I’m so thrilled to meet you,' ElliQ said. 'I was worried they’d deliver me to the wrong house! I’m excited to start our journey together.'"

"A few thousand ElliQs have been shipped to seniors across the United States since 2023. . . . by nonprofits and state health departments as an experiment in combating loneliness," Saslow reports. "ElliQ is designed for the most human act of all: to become a roommate, a friend, a partner."

Initially, Worrell didn't want help or company at home. "That’s what she told her relatives whenever they gently suggested that maybe it was time to move into a care center, or closer to family," Saslow adds. "But despite her strength and stubborn independence, her doctors had warned that living alone sometimes came at a cost." Loneliness can be deadlier than many chronic diseases.

Now, ElliQ keeps Worrell company by providing conversation, medication reminders, playing music and asking questions. Saslow writes, "It has been designed to read a room, calculate moods and then decide when to speak and what to say."

South Dakota lawmakers grapple with Rural Health Transformation funding and sustainability

Monument Health in Rapid City, S.D., will receive RHTP funding.
(Photo by Seth Tupper, South Dakota Searchlight)

Legislative and practical worries about staffing and sustainability have some South Dakota lawmakers worried that the $189.5 million the state received from the Rural Health Transformation Program won't be enough to strengthen its rural hospitals in the long term, reports Makenzie Huber of South Dakota Searchlight.

Sen. Taffy Howard, R-Rapid City, has "questions and frustrations about the funding," Huber writes. Because of the way RHTP is structured, if South Dakota lawmakers don't spend the money, "another state will spend it instead."

South Dakota's RHTP application targeted 10 initiatives, including "creating a 'data atlas' for providers and facilities to share local and state agency data, improving the rural health care workforce, improving chronic disease management, establishing regional maternal and infant health care hubs, and regionalizing behavioral health care," Huber explains. 

To support its initiatives, the state's plan includes numerous incentives designed to attract and keep needed medical staffing, such as "sign-on bonuses, relocation assistance, and rural service stipends," Huber writes. Medical professionals who accept incentives must work in their assigned rural community for at least five years.

In reviewing all the initiatives, several lawmakers "asked questions about workforce needs and how those would be addressed outside of the incentives mentioned," Huber reports. "Howard told officials that she’s skeptical about the proposal and its sustainability." Howard pointed out that infant care hubs and mental health treatment may need more than "one-time funding to operate in financially strapped rural communities."

While state lawmakers are hopeful RHTP funding can sustainably improve rural health care, many remain concerned about what the loss of federal Medicaid dollars will mean for many rural patients and hospitals. 

Rep. Erik Muckey, D-Sioux Falls, told Huber, "This still doesn’t answer the question about how to sustain quality health care going forward because of massive cuts to Medicaid.” 

States work to prepare for Rural Health Transformation Program funding, which varies 'wildly' by state

In late December, rural hospitals in all 50 states learned how much funding they would receive from the federal Rural Health Transformation Program.

Now, the race is on for hospitals to "submit revised budgets, begin spending, and show the money is going to good use," reports Sarah Jane Tribble, Arielle Zionts and Maia Rosenfeld of KFF Health News. "Federal officials will begin reviewing state progress in late summer and announce 2027 funding levels by the end of October."

The overall RHTP includes $50 billion in federal funds, with $25 billion allocated in different amounts based on a "complicated formula" and the robustness of state applications. For instance, Texas received the largest award at $281 million, while New Jersey received the smallest allotment at $147 million. The initial $25 billion is divided equally among the states.

After state allocations were announced, researchers "began to parse the awards to better understand why some states received more than others, including whether the awards reflected any partisanship or political favoritism," KFF News reports. Although at least one researcher found that higher dollar awards went to Republican states, overall the awards vary "wildly. . . with almost a hundredfold difference between the top and bottom."

State applications consistently included the Trump administration's fitness and nutrition goals, with half promising to "mandate the presidential fitness test," Tribble explains. "Many states also proposed food waivers under the Supplemental Nutrition Assistance Program, known as SNAP, which would limit low-nutrition items such as soda."

Before any RHTP money is spent, states must set up program infrastructure to manage funds and collaborate with rural hospitals. KFF News reports, "Many state legislatures must pass laws to distribute the funding to their state offices. Meanwhile, state officials are hiring staff, organizing advisory committees, and preparing to dole out money."

Study: How independent pharmacy challenges and closures impact rural pharmacists

Harris Pharmacy serves Rocky Ford, Colorado.
(University of Colorado photo)

Many studies on the closure of independent pharmacies focus on what happens to patients when a pharmacy closes. A new study by Michael J. DiStefano, PhD, at the University of Colorado, examines how those closures impact pharmacists. The study also explores how independent pharmacists navigate the current reimbursement model and what some states are doing to help them stay solvent. 

In interviews with pharmacists, DiStefano and his colleagues "heard palpable frustration, stories of mental health impacts and examples of how pharmacy closures touch entire communities," reports Matthew Hastings for the University of Colorado. 

DiStefano told Hastings, “It’s a series of ripple effects. When a pharmacy closes, not only do you see the impacts to medication access and job losses in that community; surrounding pharmacies will experience a series of stressors. All those patients impacted by the closure need to be added to your system, with new patient histories and records.” 

Study interviewees stressed that independent rural pharmacists should always have a succession plan that ideally includes a younger pharmacist who could take over the business, rather than a rural community having to recruit a new pharmacist who may not have the experience to navigate the financial demands of running a rural pharmacy. 

At Harris Pharmacy in Rocky Ford, Colorado, which serves a rural southeastern part of the state, owner Ky Davis believes running his pharmacy is all about problem-solving because there isn't another nearby pharmacy to refer patients to if his pharmacy runs out of a particular medication.

The current insurance reimbursement model for medications also means rural pharmacists can lose money caring for their patients. Davis told Hastings, "You're losing $80 to fill a prescription, and there's definitely a temptation to be like. We're not going to do that. We're not going to stock this drug."

At least in Colorado, lawmakers have eased some burdens on rural pharmacists, allowing them to approve prescriptions remotely. Davis told Hastings, "The bill passed this year has helped a lot. I’m able to leave the pharmacy open and remotely verify or have another one of our pharmacists remotely verify a prescription if I step away.” 

States receive notice of how much money they will receive from the $10 billion Rural Health Transformation Program

Texas was awarded $281 million and New Jersey 
$147 million by CMS. (Adobe Stock photo) 

The wait is finally over for rural health care officials and advocates across the U.S., who have been "hotly debating" how much of the newly formed $50 billion Rural Health Transformation Program their state will receive. The Centers for Medicare & Medicaid Services announced their awards last week.

The five-year program divides half of the $10 billion-per-year distribution equally among the states; however, the division of the remaining $25 billion was "determined by the CMS based on how well the states’ pitches met goals of strengthening rural health prevention, standing up sustainable access, developing a rural workforce and introducing innovative care delivery and technology," reports Dave Muoio of Fierce Healthcare. 

CMS paired its award listing with an abstract of each state's application. "Only a subset of states have so far opted to make their full applications available to the public," Muoio explains. The complete list of state funding awards is here.

All 50 states received awards from the second half of the funds, with Texas and Alaska garnering the largest awards, and New Jersey and Connecticut receiving the smallest funding amounts. Some factors involved in the selective division included each state's rural population and the number of residents living in frontier regions.

While rural hospitals and providers have voiced support for the program, many are cautious about how much the new funding can do to balance "the nearly $1 trillion of nationwide Medicaid cuts expected over the coming decade," Muoio adds.

Last month, CMS announced the formation of a new office to manage the Rural Transformation Program and its funds.

Mental Health First Aid for Rural Communities trains laypeople to be the first line of help

Rural residents can help one another work through
mental crisis or illness by learning MHFA.

Mental health care in rural America has always been more challenging to ask for, find and afford than in more populated parts of the country. A program that trains laypeople may offer rural residents in mentally stressful situations or suffering from untreated mental illness the best path toward getting the help they need.

The National Council for Mental Wellbeing’s Mental Health First Aid for Rural Communities works with "people not necessarily in the health professions to give them the tools they need to recognize and respond to the signs of mental health or substance use challenges," reports Liz Carey of The Daily Yonder. The training teaches participants that while they are not there to treat or diagnosis mental health problems, they are equipped with the skills and knowledge to support a family or friend until professional care is available.

A community that adds this training to its safety net toolbox is spending time incorporating a process that makes a difference. Carey writes, "Studies have consistently shown that it works — more than 90 peer-reviewed studies over the past 15 years have shown that MHFA has a lasting impact."

Jamie Hagenbuch, program manager at the Mental Health First Aid at Madison County Rural Health Council in Cazenovia, New York, told Carey, "I think rural communities definitely don’t have the resources that cities and urban communities do, so having the initial skills to be able to recognize if somebody’s becoming unwell and how to approach them and know what resources do exist, as well as being able to navigate them to those resources, is critical."

Mental Health First Aid training can help "anyone in a rural community to spot the signs of someone struggling with a mental health issue and to be able to step in to help," Carey explains. "A study in 2021 of Cooperative Extension agents in Mississippi found that 62.5% of the participants in the MHFA training programs used their skills six months after training."

Individuals interested in getting training can find more information at https://mentalhealthfirstaid.org

A Medicare pilot program will use artificial intelligence for prior authorizations. Doctors and lawmakers are alarmed.

Some prior authorization requests are already decided
by artificial intelligence. (Adobe Stock photo) 

A Medicare pilot program that allows private companies to use artificial intelligence to approve or deny medical care requested by their members has some doctors and lawmakers worried. Companies included in the pilot would get paid, "based on how much money they save Medicare by denying approvals," reports Anna Claire Vollers of Stateline.

The pilot, known as the Wasteful and Inappropriate Services Reduction (WISeR) Model, will launch after Jan. 1 in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. WISeR is more likely to impact health care treatments for rural Americans in those states because rural populations often skew older and sicker than their suburban and urban counterparts.

At its core, the WISeR model effectively introduces a prior authorization process into traditional Medicare. Prior authorization is already unpopular with many patients and doctors because it requires members or medical providers to request an insurance company's approval for certain treatments or medications before proceeding.

While some Medicare Advantage and private insurance companies have already deployed AI into some of their prior authorization processes, its use has "attracted intense criticism, legislative action by state and federal lawmakers, federal investigations and class-action lawsuits," Vollers explains. "It’s been linked to bad health outcomes. Dozens of states have passed legislation in recent years to regulate the practice."

The new program has "alarmed many physicians and advocates in the affected states," Vollers reports. In practice, the prior authorization process can create obstacles to care by requiring physicians to spend hours fighting with an insurance company to justify the care they believe their patient needs. At times, medical providers may avoid treatments that would be best because an insurance company is likely to deny them, at least initially.

Last month, congressional representatives from several states "introduced a bill to repeal the WISeR model. It’s currently in committee," Vollers reports. The program is scheduled to run from 2026 to 2031.

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. 

What does it mean when cuts from the 'One Big Beautiful Bill Act' close a rural town's only health care clinic?

The OBBBA cuts billions in federal spending on rural
health care over the next 10 years. (Wikipedia photo)

After the only health care clinic in rural Churchville, Virginia, closed, residents in this 200-person community are struggling to adjust.

"Gone are the days of seniors walking down the road from their house to see the town doctor," reports Eva McKend of CNN News. "Augusta Medical Group cited the health care provisions in the One Big Beautiful Bill Act for closing the rural clinics in Churchville and two other locations."

Even when the clinic's closure means some residents have to drive an hour to Charlottesville to see doctors, community members are reluctant to say anything negative about President Trump or his signature OBBBA legislation.

Across from the town's coffee shop, and just a few feet away from the shuttered clinic, a bold banner waves with the words "Thank you, TRUMP, Save America Again."

Democrats are planning to make health care a "defining issue nationally in next year’s midterms," McKend writes. "But the environment in Churchville illustrates the challenges the party faces, particularly in rural communities."

Dale White, a Churchville resident and church administrator, says the "concerns about the clinic are overblown," McKend writes. White told her, "These are old-time rural farming folks, and they’ve been going to get medical care in Staunton and Fishersville, Waynesboro and Charlottesville since they can remember."

Many rural hospitals, clinics and providers that serve Medicaid patients were struggling to stay afloat before the OBBBA cuts. McKend reports, "The policy research organization KFF estimates that Trump’s bill will cut federal Medicaid spending in rural communities by $137 billion over the next decade."