Pending closure of community health center in Iowa evidences strength of healthcare as a midterms issue

Health care access has become a major issue approaching the midterm 

elections, no matter the political party. (Photo courtesy of Unsplash.com)

While Republicans tout Medicaid cuts as cost-saving and necessary to reduce fraud and waste, Democrats see the issue as an opportunity for gains in November. Rural voters have leaned reliably Republican for years but with the threat of hospital and clinic closures looming, and in the midst of an already existing crisis of access in many small communities, constituents are questioning the GOP’s strategy.

Reuters reporter Nathan Layne spoke to Shannon Gooden, a receptionist at the River Hills Community Health Center in Centerville, Iowa. The center is closing on July 31. Layne reports that even though the cuts have not been cited as the reason for the closure, it’s not a stretch to draw that conclusion. Layne quotes Gooden as evidence: “I was raised a Republican, and I’ve always voted Republican, but it’s gotten to the point now, more what are you going to do for us? … Something needs to change.”

Layne also cites a Reuters/Ipsos poll from June that showed healthcare costs at the top of all other issues that voters want Congress to address. In response, Republicans point to a $50 billion rural health fund established to help states prop up healthcare access in rural communities. The fund came in the wake of the Medicaid cuts that resulted from the One Big Beautiful Bill Act and provides $10 billion in each of the next five years to qualifying states. But Democrats and some state officials claim the fund won’t solve the problem and offers little help to rural hospitals.

The Medicaid cuts go into effect in 2027. Some states and institutions already are making cuts in preparation.

In N.C., the $50 billion federal Rural Health Transformation Program won't eliminate health care deserts

North Carolina plans to use its RHTP money on hospitals
and clinics that are open. (KFF photo)

The $50 billion Rural Health Transformation Program Congress created in 2025 to ensure the passage of President Donald Trump's One Big Beautiful Bill Act may sound like it's made to help closed rural hospitals or hospitals on the brink of shuttering, but in reality, the act strictly limits the amount of RHTP grant money struggling hospitals can use to stay afloat.

The RHTP funding restrictions haven't stopped midterm-stumping politicians in North Carolina from touting the program as a salve for rural hospitals in financial straits, report Sarah Jane Tribble and Amanda Seitz of KFF Health News. "Republican candidates in competitive midterm elections are casting the fund as a lifeline that will shore up critical rural health services across America."

In Martin County, N.C., where lawmakers face competitive midterm elections, some residents believe RHTP funds will help reopen their shuttered hospital, Tribble and Seitz report. "Martin County won’t get direct relief from Trump’s rural health fund — because its hospital isn’t open." The state plans to use its $213 million in RHTP funds on "existing health and social service organizations."

Without rural hospitals, residents in states like North Carolina, where most citizens live in rural counties, are especially vulnerable. During a medical emergency, when every second counts, rural residents must survive the travel distance to get medical care. Some don't make it. Tribble and Seitz explain, "Martin County does not have paramedics on its ambulances, and it can be 20 miles or more to the closest — and often overcrowded — emergency rooms."

Brian Floyd, the chief operating officer for ECU Health, which operates out of Greenville, N.C., told KFF, "It’s a real healthcare crisis that has already proven itself to have lost lives that perhaps didn’t have to be lost. They just want to not die because there’s nowhere to go when you have an emergency."

Babies delivered at rural hospitals can receive specialized neonatal care through a unique telehealth program

A newborn baby's care team can get live, immediate help
from a neonatologist with TeleICN. (Dartmouth photo)

A pregnancy delivery in a rural hospital far away from specialized care poses significant risks for a baby born with complex needs. In Vermont and New Hampshire, Dartmouth Health created TeleICN, a unique telehealth program that connects rural medical providers to neonatologists who can help manage a baby's health during and after delivery, reports Christopher Cheney for Healthleaders.

As more rural hospitals have cut services to save money, many have shuttered their labor and delivery units. In the case of an emergency delivery, EMS will take a pregnant patient to the nearest emergency department, where a rural care team can "connect to the TeleICN program using an iPad or making a phone call," Cheney explains.

Tapping into TeleICN is similar to using FaceTime. The program allows a neonatologist to "talk with the local teams, look at the baby via video, and work with the mom and their family members to make decisions about the next steps in care for babies," Cheney reports. TeleICN can "connect local care teams to a neonatologist virtually on a 24/7 basis, and it serves 16 rural hospitals in New Hampshire and Vermont."

Katelyn Darling, a director at Dartmouth Health, shared the varying levels of care TeleICN often provides, saying, "Sometimes, they know a mom in labor is on the way to their hospital, and they want us to help them prep the care room. Sometimes, they want us in the background to support them. Sometimes, they want us on the frontline making decisions about care."

Because the TeleICN has been so successful, Dartmouth expanded its virtual obstetrics care with its new TeleMFM program. Cheney explains, "The focus is on high-risk obstetrics care and fetal-maternal medicine services, with the goal of reducing the need for patients to travel long distances. … Patients can go to a clinic associated with a rural hospital and get connected to a TeleMFM provider."

Jessica Clem, TeleICN's medical director, told Healthleaders, "What we are trying to do is provide equitable care in New Hampshire and Vermont, particularly for rural communities."

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.”

After 30 years, this rural hospital reopened its maternity unit

Dana Iglesias, medical director of the UNC Health Chatham Maternity Care Center, left, and Beverly Carpenter, the unit's manager, stand inside a labor and delivery room. (Photo by R. Crumpler, NC Health News)

UNC Health Chatham in North Carolina closed its obstetrical unit in 1991 after years of staffing shortages and poor financial performance. For 30 years, moms and families had to drive farther for care and delivery, while UNC hospital leadership continued to work on how to make maternity care fit in a rural hospital setting. 

After decades of consideration, UNC hospital leadership and medical providers decided to alter their obstetrical unit's staffing structure to make it more versatile and affordable. UNC Health Chatham reopened its mother-baby unit in 2020. Rachel Crumpler of NC Health News reports, "Births at the unit have increased each year since it opened, reflecting demand for local maternity care."

The unit is created to be sustainable and flexible. Crumpler writes, "It serves low-risk mothers and newborns and is staffed by family physicians trained in obstetrics and surgery, along with midwives — a lower-cost model than one centered on OB-GYNs, who cost more to employ and are harder to recruit to rural areas." 

Because family medicine doctors are trained across multiple medical specialties, their versatility helps them meet the two-patients-at-once demands of obstetrical care. Additionally, their salaries are lower than OB-GYNs, "meaning delivery volumes don’t need to be as high for the unit to be financially viable," Crumpler explains.

The unit's unique staffing structure and service model may offer a blueprint for other rural hospitals. Jesus Ruiz, a family physician at the Chatham Maternity Care, told NC Health News, "Chatham is a template, but it’s not a copy-and-paste template. . . .This shows a way that rural maternity care can be built and sustained.”

UNC Health Chatham leaders are working to spread the success of their model. Crumper adds, "Eric Wolak, the chief operating officer at UNC Health Chatham, said he’s fielded calls from other community hospitals — within and outside the UNC Health system — asking about the family medicine-driven model and Chatham’s implementation."

Opinion: The Rural Health Transformation Program challenges states to build and overhaul systems

R.J. Marse

When the Centers for Medicare & Medicaid Services announced $50 billion in funding for the Rural Health Transformation Program, many Americans may have assumed the money would help struggling rural hospitals shore up their finances and stay open. 

But RHTP program dollars aren't meant to prop up declining systems by helping them maintain the status quo of rural health care, writes R.J. Marse, General Counsel at Sprinter Health, in his opinion for Healthcare IT Today. "At $50 billion over five years. . . the amount is significant, but more noteworthy is the program’s intent."

The program aims to change how rural health care is approached and practiced by incentivizing innovation, technology and successful outcomes across a system.

RHTP challenges rural health systems to go beyond traditional health care infrastructure by designing and launching treatment that includes "telehealth and remote monitoring. . . technology-enabled solutions that allow providers to practice at the top of their license," Marse writes. "It even allows states to invest in early-stage healthcare companies, a signal that the ultimate goal is innovation."

Marse explains, "Funding is conditioned on outcomes, so while the aim is to reach more rural patients in more rural communities, interventions will need to do so in ways that measurably improve health and lower long-term costs."

RHTP structural demands push rural health care systems to combine modern medical treatment models with the inherent challenges of working with a rural population. Marse writes, "RHTP demands confronting the fact that many rural patients will not engage with care unless it comes to them – or, at least, closer to them. . . . Rural care transformation must, by necessity, be hybrid. It should deliver care virtually when appropriate, and physically when and where it’s needed."

"Rural health doesn’t need another bailout. It needs fundamentally different operating models that can endure when federal dollars dissipate," Marse explains. "Five years from now, RHTP will be judged not by how much money was spent, but by what was built." 

Rural hospitals will be hurt the most from Minnesota Medicaid cuts

Government action, such as cuts to Medicaid in Minnesota, has an “outsized impact” on rural residents, Sarah Melotte reports for the Daily Yonder.

The Trump administration recently announced its intent to withhold $259 million from Minnesota’s Medicaid reimbursements due to fraud concerns. CMS Administrator Mehmet Oz said Medicaid funds in Minnesota were going to "bogus" centers for autistic children and a behavioral health organization that had bills showing doctors working 24 hours a day for more than 450 days.

Percentage of hospital revenue coming from low-income health insurance programs. (Map by Sarah Melotte, Daily Yonder, data from the Center for Healthcare Quality and Payment Reform, Click to enlarge)

Rural hospitals are disproportionately affected by these cuts. Melotte explains that rural hospitals are more likely to operate with negative profit margins than urban hospitals, and 39 of Minnesota’s 98 rural hospitals have negative operating margins. This means the rate of uncompensated care will increase even more in these rural hospitals.

Some of these hospitals are able to stay open using non-operating revenue, such as taxes or philanthropy, but this isn’t the case for all of them, reports Melotte. More than 100 rural hospitals throughout the U.S. have had to close in the last decade, causing rural residents to have to travel farther to access the care that they need.

One nonprofit in Minnesota that houses people with disabilities reported to Minnesota Public Radio that “any cuts to Medicaid funding will directly result in reduced services.”

Medicaid now accounts for around 19% of discharges in rural hospitals nationwide, Melotte writes. “In communities where hospitals operate on thin margins, even small cuts in federal spending can destabilize entire systems of care.”

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.”

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."

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."

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.

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. 

A rural hospital in California closes after federal officials strip 'critical access' designation it has held since 2000

Glenn Medical Center in Willows, California 
(Glenn Medical Center photo)

After more than 70 years of serving its rural community in Willows, California, Glenn Medical Center closed its doors following the loss of its "critical access" designation, which had allowed the hospital to receive higher federal reimbursements that helped it remain open.

To qualify as a "critical access" hospital, a medical center needs to be at least 35 miles from the next closest hospital. Glenn Medical Center was 32 miles from "the nearest neighboring hospital under a route mapped by federal officials," reports Jessica Garrison of the L.A. Times. "Though that distance hasn’t changed, the federal government has now decided to enforce its rules." The hospital was awarded its critical access status in 2000.

The loss of Glenn Medical Center leaves the surrounding farming community without emergency care, "eliminates 150 jobs and puts rural residents at risk of preventable deaths," Garrison writes.

Rural hospitals across the state are already at risk of closure. Peggy Wheeler, vice president of policy of the California Hospital Association, told Garrison, "It’s like the beginning of a tidal wave. I’m concerned we will lose several rural hospitals, and then the whole system may be at risk.”

Before Glenn Medical Center's designation was stripped, Glenn County officials and hospital administrators worked for months to persuade federal officials to grant an exception.

Now that the hospital is closed, many community members fear what will happen to older residents in need of immediate care, injured farm workers or victims of car accidents along nearby Interstate 5. Glenn County Supervisor Monica Rossman told Garrison, "People are going to die."

Report: Rural primary care physician shortages will persist for at least another 12 years

Graph by Celli Horstman and Arnav Shah, State of Rural Primary Care in the United States, Commonwealth Fund

Rural residents will continue to grapple with a shortage of primary care doctors for at least another 12 years, according to a report issued last week by the nonprofit Commonwealth Fund.

Using federal health workforce data, researchers concluded that "rural areas will continue to have only about two-thirds of the primary care physicians they need," reports Nada Hassanein for the Wisconsin Examiner. Report authors noted that the persistent shortage of primary care doctors leaves million of rural residents "with fewer options for routine and preventive care."

The report's release came just days after the window closed for hospitals to apply for a share of the $50 billion federal Rural Health Transformation Program administered by the Centers for Medicare & Medicaid Services. Hassanein writes, "Some states want to use the federal money to expand their rural residency programs, as physicians who complete their residencies in rural areas are more likely to practice in one."

Nearly all of the more than 40 million rural Americans live in areas with primary care physician shortages, according to the report. "Forty-five percent of rural counties had five or fewer primary care doctors in 2023," Hassanein adds. "Roughly 200 rural counties lacked one altogether."

The report found that doctor shortages in rural areas vary by region. Hassanein writes, "States in the South had 3,411 patients per physician, whereas states in the Northeast had 1,979 residents per physician."

Although rural areas will continue to lack enough primary care physicians, some of the gap will be filled by rural nurse practitioners. Hassanein adds, "Nurse practitioners are the fastest-growing type of clinician in the U.S., regardless of geography, the report authors wrote."

Quick hits: Dairy farming with a robot; CSA debate; Farmers' Almanac ends; rural hospital success; goodbye penny

A robotic milker takes the place of a hired hand as dairy
farmers face labor shortages. (Farm Progress photo)

Marlane Williams always dreamed of owning her own farm and milking her own dairy cows. Now she has both, along with a robot that helps out while she's at a day job that provides income stability. "Williams has held several jobs while trying to be a dairy farmer," reports Chris Six of Farm Progress. "She's owned a dairy farm in southwest Missouri since 2002 and says balancing both is tricky, but she feels blessed to have achieved her dream." Instead of trying to hire part-time labor, Williams purchased a Lely Astronaut milking robot to make sure her growing herd is milked twice a day.  

The debate over whether the Community Supported Agriculture model is dead or alive continues, with a fresh perspective from Ruth Katcher, who runs a thriving CSA for city folk in Brooklyn, New York. "I’ve been mulling over Lauren David’s thought-provoking article on whether we’ve outgrown the CSA model," Katcher writes for Offrange. "I have to admit she made some excellent points, especially about the appeal of models that offer more choice to consumers than traditional CSAs. . . . But the traditional CSA model has features I would hate to give up . . ." Read Lauren's essay here, and Katcher's full counter here.

Pecan trees don't have to be planted every year. 
(Photo by Elizabeth Hewitt, Reasons To Be Cheerful)

In a drastic turn from traditional row-crop agriculture, some Midwestern farmers are planting nut trees that are reviving soil depleted by corn and soybean plantings. "In 2017, Josh Payne planted 20 acres of chestnut saplings, growing commodity crops in wide rows between the trees," reports Elizabeth Hewitt for Reasons To Be Cheerful. "Payne is among a growing number of farmers looking to supplement or even replace common crops planted annually — like corn and soy — with various types of nut trees. . . which can provide a type of multi-generational resilience because they can generate income for decades."

U.S. Mint photos

The U.S. Treasury Department laid the U.S. penny to rest on Nov. 12 in Philadelphia after producing it for 232 years. Victor Mather of The New York Times reports, "Top Treasury officials were on hand for its final journey. No last words were recorded. The cost to mint the penny had risen to more than 3 cents, a financial absurdity that doomed the coin. The American penny was preceded in death by its smaller sibling, the half cent (1793-1857), and its cousin, the Canadian penny (1858-2012)."

Internal medicine residents at Billings Clinic 
in Montana. (Photo by Colton Adams via the Yonder) 

A community hospital in Billings, Montana, is bucking trends with its successful medical residency programs, which train new doctors who often decide to stay in the state and practice. "As rural areas across the country face worsening provider shortages and reductions in health care services, Billings Clinic is celebrating the success of two new residency programs training," reports Madeline de Figueiredo for The Daily Yonder. "Since launching its internal medicine residency program in 2014, Billings Clinic has graduated 75 physicians, with half now practicing in rural communities. The program’s outcomes stand out amid national trends, where only 11% of physicians work in rural areas."

After more than two centuries of publication, the Farmers' Almanac from Maine announced that 2026 is its last print run. "The 208-year-old, Maine-based publication that farmers, gardeners and others have relied on for planting guidance and weather predictions will publish for the final time," report Patrick Whittle and Kathy McCormack of The Associated Press. "The Farmers’ Almanac, not to be confused with its older, longtime competitor, The Old Farmer’s Almanac in neighboring New Hampshire. . . . The almanac cited the growing financial challenges of producing and distributing the book in today’s 'chaotic media environment.'" The first Farmers' Almanac was published in 1818.

Rural hospitals tap into high schools to meet ongoing staffing challenges

Ballad Health is one of several rural-serving 
hospitals training high school students.

Ballad Health is a rural hospital system in Tennessee that, like many rural hospitals, spends millions of dollars a year paying traveling nurses to cover staffing shortages. To address its recruitment woes, Ballad is working with area high schools to train its next generation of medical care workers, reports Te-Ping Chen of The Wall Street Journal. 

Ballad's high school training academy includes students from "five northeast Tennessee school districts," Chen writes, "The first batch of 200 students will graduate in 2029, with their licensed practical nurse credentials and be eligible to work right away at Ballad, earning $23 an hour." 

Building and implementing a medical training academy for high school students is time-intensive and expensive, so Ballad Health partnered with Bloomberg Philanthropies, which "last year announced it was pumping $250 million into 10 programs in states including Tennessee, Texas and North Carolina to create a high school-to-healthcare pipeline," Chen explains. 

Ballad isn't alone in its staffing struggles, and as the baby boomer generation ages, demand for medical care staffing is expected to grow. Chen reports, "Human resources advisory firm Mercer projects a deficit of 100,000 healthcare workers by 2028."

Since 2006, Baystate Health system, which serves rural populations in western Massachusetts, has invested in a "high-school career program for jobs such as respiratory therapist and sterile processing technician," Chen adds. "Many participants have gone on to pursue additional training, and more than 900 have ended up working for Baystate in the past decade."

Rural hospitals in Arkansas find different ways to stay open and still serve their communities

Rural hospitals, represented by green dots, stretch across mid- to southern Arkansas counties. 

Rural hospitals in Arkansas continue to explore the best ways to serve their communities despite severe financial struggles. Some medical centers have found success by ending inpatient care in exchange for more Medicare dollars, while others keep their doors open by opting for other designations to continue providing vital care, such as inpatient stays, reports Tess Vrbin of The Arkansas Advocate. According to a 2023 University of Arkansas review, roughly 41% of Arkansas residents live in rural areas.

Two years ago, DeWitt Hospital and Nursing Home was in financial straits and CEO Brian Miller chose to convert it into a "rural emergency hospital, which draws more federal funds to rural hospitals if they reduce or eliminate inpatient services and focus on emergency and outpatient treatment," Vrbin writes.

Beyond higher Medicare payments, the switch helped DeWitt lower costs while adding income from outpatient services, such as cardiology and wound care. The hospital is one of five Arkansas hospitals to sign up for the emergency rural designation.

But converting to an emergency triage-type care model doesn't work for every rural community. The Southwest Arkansas Regional Medical Center in Hope will not apply for rural emergency status because inpatient stays are needed for residents in surrounding counties. Its chief administrative officer, Shelby Brown, told Vrbin, "We want to be able to, if we need to admit someone, to put them in our hospital so they can stay home locally."

Instead of opting to convert to a rural emergency hospital, Southwest Arkansas Regional applied for and received approval to become "a critical access hospital, a federal designation for facilities located no fewer than 35 miles from other hospitals and maintaining no more than 25 beds," Vrbin explains. "Medicare subsidizes critical access hospitals for inpatient treatment of Medicare recipients."

For many rural hospitals in Arkansas, the choice between ending certain types of patient care or possible closure is difficult. Brown told the Advocate, "The big scheme of rural health in the state of Arkansas is in a crisis mode. . . . I would always think it’s better to have a rural emergency hospital versus no hospital.”

Rural hospitals struggling to stay open can't use the newly created $50 billion federal fund to survive

President Trump signs his bill of tax breaks and spending cuts.
(Photo by Julia Demaree Nikhinson, AP via the Yonder)

Rural hospitals struggling to stay open will be unable to manage financial shortages caused by ongoing Medicaid cuts with funds from the Rural Health Transformation Program, which sets aside $50 billion in federal dollars for rural hospitals. Liz Carey for The Daily Yonder reports, "The legislation itself specifically says RHTP funds cannot be used as an offset for Medicaid. And the administration in multiple avenues has specifically said this cannot be used to keep rural hospitals open, period.”

During summer budget negotiations, lawmakers created the RHTP program and touted it as a way to protect rural hospitals; however, the totals don't balance each other out. "Federal Medicaid spending in rural areas is expected to drop by about $15.5 billion per year over the next 10 years," Carey explains. The Rural Health Transformation Program "will provide about $10 billion per year over five years. Many industry experts say that’s not enough."

Although lawmakers may have said the fund was to keep rural hospitals open, the program isn't designed to save struggling medical centers in the short term. Instead, states that apply to the program must include a "rural transformation plan" that outlines how they will improve services, cut costs and deploy technology with RHTP funding aimed at long-term solvency.

Any state that receives RHTP funding will also be "assessed for additional funding based on its population, the number of rural health facilities it has, and the situation of the hospitals in the state to receive additional funds," Carey explains. "Additional funds would also be allocated based on 'how well state applications align with program strategic goals,'" which includes the HHS Make America Healthy Again initiative.

At its core, RHTP funds won't help financially strapped hospitals stay open, and rural residents will likely face more struggles to access providers and care. Alan Morgan, president of the National Rural Health Association, told the Yonder, "The $50 billion cannot by legislation (and is not by the administration) going to be used to help rural hospitals keep their doors open. This $50 billion is about sustaining healthcare for the future. It has nothing to do with maintaining access today.”

Clinicians in rural Idaho brace for Medicaid cuts that 'are already creating hurdles'

Pregnant women in Idaho often drive hours for
prenatal care. (Adobe Stock photo)

New rules for Medicaid have Idaho clinicians predicting more emergency visits, fewer residents with health care coverage and more maternity care deserts, reports Madeline de Figueiredo for The Daily Yonder. The systemic Medicaid changes will be the hardest on rural residents who tend to be more reliant on Medicaid.

Many Idaho medical providers see new Medicaid work requirements, income checks and possible co-payments as "changes [that] are already creating hurdles and could lead to major coverage losses and reduced access to care," according to the article. 

Coverage losses often increase emergency room visits because people delay care until their symptoms are so severe that they have no choice but to go to the emergency room. Individuals can be left with costly ED bills for care that could have been affordable if it had been sought sooner.

Idaho is already facing rural hospital closures and provider shortages, both of which impact prenatal care for expecting mothers and their babies. Figueiredo reports, "Bonner General Health, the only hospital with OB-GYNs in Bonner County, closed its obstetrics services in 2023. . . . All four OB-GYNs from Bonner County told NBC that Idaho’s strict abortion laws influenced their decision to leave."

The lack of obstetric care throughout the state means pregnant women often have to travel hours for care. Many are told to purchase insurance for emergency medical flights. Amy Klingler, a primary care physician assistant in Stanley, Idaho, told Figueiredo, “We encourage everyone, really, in our community to have that [coverage]. . . . Helicopter rides are probably anywhere from $25,000 to $50,000."