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.

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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.

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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.

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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.

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November 18, 2024

Rural Health Research – Understanding the Impact of Medical Debt in Rural Communities: Perspectives from Rural Hospital Administrators

This policy brief presents findings from key informant interviews with nine administrators representing rural hospitals in seven states (Arkansas, California, Illinois, Texas, Vermont, Washington, and West Virginia).

Using content analysis of interview data, researchers share findings around hospital and community-level implications of medical debt, and policies that may help or hinder this issue.

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