Review of Rural U.S. Economic and Health Care Trends

Date: September 19, 2022

Review of Rural U.S. Economic and Health Care Trends

This report reviews recent literature and publicly available data to explore important issues at the nexus of health care and local economic vibrancy. The report also explores the economic implications associated with COVID-19, however full impacts will not be known for several years.

Key Takeaways

  • There have been 140 rural hospital closures between January 2010 and July 2022. While some facilities have converted to other health care purposes, the majority have completely shut down.
  • There are additional losses to a community associated with a rural hospital closure including both the loss of hospital spending as well as a reduction in employee spending (due to a loss of employment). Other industries including restaurants, professional services, and other healthcare services are negatively impacted when a rural hospital closes or contracts in size.
  • Rural ambulance services are facing significant challenges including reimbursement, workforce, and funding for operations. The closure of rural hospitals further exacerbates these issues.
  • There continues to be a shortage of health professionals in many rural areas. For some professions, there is an excess supply of providers in urban areas and a shortage in rural places.
  • Those states that opted to expand Medicaid have lower uninsured rates (in both rural and urban areas). Insurance premiums through health insurance markets continue to climb as number of insurance companies decline.

Contact Information:

Alison F. Davis, PhD
Center for Economic Analysis of Rural Health
Phone: 859.257.7260

Additional Resources of Interest:

Grants 101 Workshop

Date: September 19, 2022

Grants 101 Workshop

The Health Resources and Services Administration (HRSA) Office of Intergovernmental and External Affairs (IEA) Region 7 will host a Grants 101 Workshop in St. Louis, Missouri! Attendees will learn about the federal grant application process, where to find funding opportunities, strategies for putting together a successful application from a grantee’s perspective, engaging with foundations, and resources to support their grant writing efforts. Space for this free grants workshop is limited.

Date:  Thursday, September 29, 2022

Time:  9:00 AM – 4:00 PM CT | Registration begins at 8:30 AM.

Location: Betty Jean Kerr People’s Health Center, 5701 Delmar Blvd., St. Louis MO 63112

Who Should Attend This Workshop?
Community and faith-based organizations, hospitals, health centers, universities, community colleges, and public health departments interested in learning how to register for federal funding opportunities, where to find those opportunities, and how to create a competitive grant proposal and submit a successful grant application.

 Register here.

For more information, contact Myesha Kennedy at

18th Annual Health Ethics Conference

Date: September 15, 2022

18th Annual Health Ethics Conference. Burnout, incivility, and moral injury: Optimizing ethical response in times of crisis

Date: October 6, 2022

Location: Hampton Inn Events Center, Columbia, MO 65201

Through the exploration of patient and provider stories, this conference will focus on navigating ethical challenges heightened by the global pandemic, divergent belief structures, and misinformation further polarizing communities. Join to listen to wellness advocates and a range of healthcare professionals who have first-hand experience of the challenges encountered in today’s complex healthcare environment leading to rising incivility, burnout, and moral injury. Participants will explore these challenges as well as interventions, processes and resources aimed at optimizing well-being and mitigating harm to health professionals.

The conference agenda is posted on the website.

Presented By:

Center for Health Ethics
MU Office of Clinician Well-being
MU School of Medicine
MU Sinclair School of Nursing
MU Continuing Education for Health Professions
MU Extension

Accreditation Information

Continuing Medical Education (CME)

Activity approved for AMA PRA Category 1 Credits™

Continuing Nursing Education (CNE)

University of Missouri Sinclair School of Nursing is approved as a provider of nursing continuing professional development by the Midwest Multistate Division, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

Midwest Multistate Division Provider Number MO1022-6

Other credit being pursued: Licensed Professional Counselors, Psychologists, and Social Workers with Missouri licenses.

Availability of Emergency Department, Nursing Home, and Substance Use Disorder Services in Minoritized Racial/Ethnic Group Areas

Date: September 15, 2022

Availability of Emergency Department, Nursing Home, and Substance Use Disorder Services in Minoritized Racial/Ethnic Group Areas

This series of briefs documents disparities in geographic access to health services for ZIP code tabulation areas (ZCTAs) containing a high proportion of minoritized racial/ethnic group (MRG) residents.

Availability of Hospital-Based Emergency Department and Trauma Services in Minoritized Racial/Ethnic Group Areas

  • The median distance to the nearest emergency department in rural ZCTAs with a top proportion of minoritized groups was 16.2 miles compared to 3.9 miles for urban ZCTAs of the same classification. Similarly, rural MRG ZCTAs were a median of 25.6 miles from trauma services versus 6.4 miles for urban MRG ZCTAs.
  • Within rural ZCTAs, the ZCTAs at the top of the distribution for minoritized populations were slightly farther from an emergency department or trauma center.

Availability of Nursing Homes in Minoritized Racial/Ethnic Group Areas

  • Top MRG ZCTAs having the greatest median distance to a nursing home were American Indian/Alaska Native (AI/AN) (13.2 miles), Hispanic (10.6 miles), and multiple MRGs (11.3 miles). Rural ZCTAs were a median of 8.2 miles from the nearest nursing home compared to 2.9 miles for urban ZCTAs.
  • Overall, only 4.6% of rural ZCTAs lacked access to a nursing home within 30 miles. However, when looking at the top MRG ZCTAs, the percentage of rural ZCTAs lacking access to a nursing home within 30 miles was 14.7% for more than one MRG population ZCTAs, 13.6% for top AI/AN ZCTAs, and 11.1% for top Hispanic ZCTAs.

Availability of Substance Use Disorder Treatment in Minoritized Racial/Ethnic Group Areas

  • The median distance to the nearest methadone treatment program across all rural ZCTAs was 27.7 miles versus 8.0 miles for urban ZCTAs.
  • Overall, rural ZCTAs were more distant from the nearest buprenorphine provider than urban ZCTAs at a median of 8.0 versus 4.2 miles respectively.
  • Access to buprenorphine providers appeared poorest for top AI/AN ZCTAs with 11.9% of rural and 10.6% of urban top AI/AN ZCTAs being more than 30 miles from the nearest buprenorphine provider.

Contact Information:

Janice C. Probst, PhD
Rural and Minority Health Research Center
Phone: 803.251.6317

Additional Resources of Interest:

Behavioral Health Equity Webinar

Date: September 15, 2022

The Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) would like to share this announcement on behalf of the Substance Abuse and Mental Health Services Administration (SAMHSA) Office of Behavioral Health Equity (OBHE).

On Thursday, September 22, 2022, from 1:30 – 3:00 PM ET, SAMHSA OBHE will host a webinar to discuss the need for behavioral health equity to ensure individuals living in underserved communities have access to recovery, treatment, and support.

During the webinar, Dr. Victoria Cargill will discuss:

  • The impact of discrimination, racism, and racial trauma on marginalized individuals living with substance use disorders;
  • Intersecting effects of the social determinants of health;
  • Effective and successful interventions that support substance use disorder treatment for underserved populations;
  • Barriers to equitable treatment, recovery, and support services; and
  • How we move forward together as a nation.

To join the webinar

  • Webinar ID: 161 401 7737
  • Passcode: 393593

About the Presenter:

Victoria Cargill, MD, MSCE IAS-USE

Assistant Commissioner, Baltimore City Health Department

Dr. Victoria Cargill is a Boston and Harvard University trained board-certified internal medicine and HIV physician, and former Assistant Commissioner of Health at the Baltimore City Health Department, overseeing the Ryan White program and Community Risk Reduction/Syringe Support Services. Prior to becoming an Assistant Commissioner, she served as a senior policy analyst and program director for 20 years at the National Institutes of Health (NIH) in both the Office of AIDS Research (OAR) and the Office of Research on Women’s Health (ORWH). At OAR, she was the Director of Minority Research and Clinical Studies, and Acting Director of HIV Therapeutics Research. At ORWH, she served as the Associate Director for Interdisciplinary Research, and grew the U3 program focused on stimulating research on understudied, underreported, and underrepresented women to over $3 million dollars. She has also served as the acting chair of the FDA Antiviral Advisory Committee, including chairing the hearings of the first two U.S.-approved HCV antivirals.

A former co-investigator at the Case Western AIDS Clinical Trials Unit and the creator of an AIDS education and prevention adolescent-focused program that reached over 100,000 teens in five Ohio cities, she has extensive public health and HIV prevention research experience. Currently the principal investigator of a HRSA-funded Ending the HIV Epidemic grant, and the author of over 150 scientific articles, research presentations, book chapters and popular press educational materials, she has been nationally recognized as one of America’s Top Doctors. Dr. Cargill continues to consider patients and communities as her best teachers.

National Hispanic Heritage Month

Date: September 15, 2022

National Hispanic Heritage Month

This year, as the Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH) honors National Hispanic Heritage Month, the focus will be on the nation’s 60.5 million Hispanics by highlighting some common health disparities facing Hispanic populations and sharing resources to help further health equity.

Hispanic populations suffer from lower rates of health insurance coverage compared to their non-Hispanic counterparts, with nearly 30% of Hispanic adults aged 18 to 64 being uninsured. Like other minority groups, Hispanic populations are disproportionately affected by chronic health conditions, such as diabetes, cancer, and heart disease. Hispanic subpopulations also face their own distinct health disparities including higher rates of smoking among Puerto Rican and Cuban male populations, as well as higher rates of chronic liver disease and cirrhosis among Mexican populations. Additionally, among Hispanic pregnant individuals, the maternal mortality rate increased significantly from 2019 to 2020, largely due to COVID-19 related health disparities.

As Hispanic populations continue to face disparities related to COVID-19 and other health conditions, it is important to have all the information and resources needed to ensure Hispanic patients receive culturally and linguistically competent care from their health care provider and are able to take steps towards better health. Below, please find materials in Spanish, data, resources on language access, culturally and linguistically appropriate services (CLAS), and more. Throughout this month and beyond, CMS OMH encourage you to review and share these resources to continue to advance health equity for Hispanic populations.


The U.S. Department of Homeland Security issued a final rule applicable to noncitizens who receive or wish to apply for benefits provided by the HHS and States that support low-income families and adults. This rule will help ensure that noncitizens can access health-related benefits and other supplemental government services to which they are entitled by law, without triggering harmful immigration consequences. The final rule will be effective on December 23, 2022.

Health Insurance Marketplaces: Issuer Participation Trends in Non-Metropolitan Places, 2014-22

Date: September 14, 2022

Health Insurance Marketplaces: Issuer Participation Trends in Non-Metropolitan Places, 2014-22

Since the 2014 implementation of Health Insurance Marketplaces (HIMs), authorized by the Patient Protection and Affordable Care Act of 2010, considerable changes have been observed in the number of insurance companies offering plans across the 50 states and the District of Columbia. This policy brief describes the changes in HIM plan issuers over the 2014-2022 period with an emphasis on the variation across metropolitan and non-metropolitan places.

Key Findings

  • Non-metropolitan counties have had less marketplace participation than metropolitan counties since their implementation in 2014. However, issuer participation in metropolitan and non-metropolitan counties fluctuates in a similar manner over time.
  • Since 2018, metropolitan, micropolitan, and noncore counties have experienced steady growth in the number of competing issuers in the marketplaces.
  • A larger percentage of non-metropolitan counties (micropolitan: 37.9 percent; noncore: 42.3 percent) had fewer than three issuers participating in the marketplaces, compared to metropolitan counties (20.8 percent).
  • Non-metropolitan counties in states that have expanded Medicaid have had greater marketplace participation on average than their counterparts in states that have not expanded Medicaid. However, this difference appears to be closing as of 2022.

Contact Information:

Timothy D. McBride, MS, PhD
RUPRI Center for Rural Health Policy Analysis
Phone: 314.935.4356

Additional Resources of Interest:

New Enhancing Oncology Model

Date: September 13, 2022

Enhancing Oncology Model (EOM) Resources

June 27, the CMS Innovation Center (CMMI) announced the new Enhancing Oncology Model (EOM). EOM builds on insights from the Oncology Care Model (OCM) and intends to drive transformation in oncology care by enhancing the quality of care furnished to beneficiaries undergoing chemotherapy while reducing Medicare Fee for Service (FFS) spending. The model features a focus on equity, with an aim to increase participation and support for oncology practices working with traditionally underserved populations. Applications for the model are due from interested organizations by September 30, 2022. The model itself will launch in July 2023.

To support awareness and increase successful applications, the EOM team has developed resources to assist cancer care and payment stakeholders in understanding the policies and benefits of EOM. The EOM website has resources to answer questions and help PGPs and other payers prepare to submit an application.

If you would like to learn more about the model:

Note: Dates are subject to change. Please sign up for the CMS listserv to receive direct announcements about the EOM