September 12, 2025

Research Alert: Comparing Utilization of Home Health Care Between Traditional Medicare and Medicare Advantage by Rural-Urban Status

This report describes differences in utilization of home health care between beneficiaries enrolled in Traditional Medicare (TM) and Medicare Advantage (MA), a publicly-funded, privately managed option for Medicare beneficiaries, and by rural-urban status. Researchers examined differences in use of home health overall, provision of specific services during home health, and receipt of care from high-quality home health agencies by enrollment in TM and MA, including plan type (e.g., preferred provider organization, health maintenance organization), and by rural-urban status, including intra-rural variation.

Key Findings:

• Beneficiaries enrolled in MA who are also living in rural communities may be underutilizing home health.
  • Compared to beneficiaries enrolled in MA, regardless of type of MA plan.
  • Utilization of home health was also significantly lower among beneficiaries living in rural versus urban communities, with progressively decreasing likelihood of home health utilization as rurality increased.
• Beneficiaries enrolled in MA were also significantly less likely to receive care form a high-quality home health agency compared to beneficiaries enrolled in TM, regardless of MA plan type, but there was no association between receiving care from a high-quality home health agency and rural-urban status.
• Utilization of specific services during home health varied based on enrollment in MA versus TM and rural-urban status.
  • In general, utilization of specific services was significantly lower for beneficiaries enrolled in MA compared to TM, but this pattern was not consistent for all services across all types of MA plans.
  • Beneficiaries living in rural communities generally had significantly lower utilization of physical therapy, occupational therapy, speech-language pathology, and medical social work services, but significantly higher utilization of home health aide services.

Click Here to Read Full Research Article

July 25, 2025

Rural Health Research: Interstate Occupational Licensure Arrangements to Expand Access to Behavioral Health Services

This policy brief from the WWAMI Rural Health Research Center describes state-based provisions to expand behavioral health services through interstate licensure arrangements for:

• Psychologists,
• Social workers,
• Licensed professional counselors,
• Marriage and family therapists, and
• School psychologists

Click Here to Read Brief

July 15, 2025

The Impact of High Hospital Fixed-Cost Ratios on Rural Populations

This brief from the RUPRI Center for Rural Health Policy Analysis describes the regional variation in Critical Access Hospital (CAH) and Low-Volume Hospital (LVH) status with respect to average fixed-to-total-cost ratios, finding that CAHs tend to have the highest ratios, followed by LVHs. However, the average ratio for each status differs regionally across the United States.

Click Here to Read More

July 15, 2025

Geographic and Demographic Correlates of Living in Manufactured Homes: Implications for Health

Manufactured homes (formerly known as mobile homes) can provide an affordable housing option, especially in places with few other options. However, manufactured homes are associated with poorer health outcomes and are less well equipped to protect their residents from the effects of natural disasters than more permanent housing structures.

This brief from the University of Minnesota Rural Health Research Center examines rates of living in manufactured homes by rural and urban location, as well as rates among rural residents by region and socio-demographic characteristics. It also examines differences in crowded housing, housing quality, and housing cost burden by manufactured vs. more permanent housing structures.

Click Here to Read Brief

June 17, 2025

Rural Health Research: Preventing Medical Debt Among Rural Residents: Example Programs from Hospitals in Minnesota and Montana.

Medical debt, which includes unpaid bills, loans, and other debt incurred from health care expenses, affects roughly 15% of adults in the U.S. this is despite more than 90% of U.S. adults having some form of health insurance.

Medical debt is an important social driver of health, with disproportionate impacts for populations already experiencing greater health risks. Overall, rural residents report more problems paying medical bills and are more likely to be unable to pay their medical bills altogether in comparison to urban residents.

This case series from the University of Minnesota Rural Health Research Center examines how two rural hospitals aim to reduce medical debt for their patient populations and address barriers to medical debt relief.

Click Here to Read More

May 1, 2025

Rural Health Research: Federal and State Reimbursement for Youth Behavioral Health Services

The prevalence of behavioral health conditions, including depression, suicidal ideation, and substance use continue to increase among young people in the United States (U.S.). Medicaid is an important source of health coverage for youth in the rural U.S., covering 47% of youth. Because Medicaid is jointly funded by states and the federal government and is administered by each state within federal guidelines, reimbursement policies for behavioral health care vary across states.

This brief provides a structured review of the state-level policies and federal and state funding mechanisms that may affect the supply of behavioral health services for children and youth through 24 years of age.

Among the findings:

• Medicaid reimbursement and coverage policies for behavioral health professionals vary across and within states.
• A review of individual state Medicaid manuals indicates that social workers and psychologists are eligible for Medicaid manuals indicates that social workers and psychologists are eligible for Medicaid reimbursement for behavioral health services in all 50 states and the District of Columbia. Marriage and family therapists (MFTs) are eligible for reimbursement by all but two state Medicaid programs.
• All 50 states and the District of Columbia allow reimbursement of social workers and psychologists for behavioral health services provided through school-based Medicaid programs, while approximately one-third of states omit MFTs from the list of providers eligible for reimbursement within school-based Medicaid programs.

Click Here to Read Full Brief