Rural Health
Resources by Topic: Health insurance
Medicare Wage Index Trends in Rural and Urban Hospitals Before and During the Low Wage Index Policy, 2018–2022
Provides an overview of the wage index and its role in hospital reimbursement and financial stability. Describes the pattern of wage index values for rural and urban prospective payment system (PPS) hospitals from 2018 to 2022. Explores the impact of the low-wage index policy (LWIP), which was implemented in fiscal year 2020, and the potential implications of its discontinuation in fiscal year 2025.
Author(s): Saleema Karim, George Pink, Kristie Thompson, Mark Holmes
Date: 04/2026
Sponsoring organization: North Carolina Rural Health Research Program
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Provides an overview of the wage index and its role in hospital reimbursement and financial stability. Describes the pattern of wage index values for rural and urban prospective payment system (PPS) hospitals from 2018 to 2022. Explores the impact of the low-wage index policy (LWIP), which was implemented in fiscal year 2020, and the potential implications of its discontinuation in fiscal year 2025.
Author(s): Saleema Karim, George Pink, Kristie Thompson, Mark Holmes
Date: 04/2026
Sponsoring organization: North Carolina Rural Health Research Program
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Payer Mix Shifts and Profitability at Critical Access Hospitals, 2011 to 2023
Analyzes 1,384 Critical Access Hospitals between 2011 and 2023 to determine the impact of changes in commercial, Medicare, Medicaid, and uncompensated care on their finances. Discusses reimbursement policy based on study findings.
Author(s): Yusheng Jia, Yue Li, Xueya Cai, Samuel J. Enumah
Citation: Health Affairs Scholar, 4(4)
Date: 04/2026
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Analyzes 1,384 Critical Access Hospitals between 2011 and 2023 to determine the impact of changes in commercial, Medicare, Medicaid, and uncompensated care on their finances. Discusses reimbursement policy based on study findings.
Author(s): Yusheng Jia, Yue Li, Xueya Cai, Samuel J. Enumah
Citation: Health Affairs Scholar, 4(4)
Date: 04/2026
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Geographic Variation in Average Salary Expense Among Rural Hospitals Nationwide, 2018–2022
Examines the change in hospital wages between 2018–2019 and 2021–2022, with a focus on the geographic variation in these changes among Critical Access Hospitals (CAHs) and rural Prospective Payment System (PPS) hospitals. Describes the variation in average salary expense per full-time equivalent (FTE) employee for rural hospitals from 2018 to 2022. Appendices include the median salary expense per FTE of rural hospitals each year by U.S. Census region, state Medicaid expansion status, Core-Based Statistical Area (CBSA), Frontier and Remote Area (FAR) code, and by state.
Date: 04/2026
Sponsoring organization: North Carolina Rural Health Research Program
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Examines the change in hospital wages between 2018–2019 and 2021–2022, with a focus on the geographic variation in these changes among Critical Access Hospitals (CAHs) and rural Prospective Payment System (PPS) hospitals. Describes the variation in average salary expense per full-time equivalent (FTE) employee for rural hospitals from 2018 to 2022. Appendices include the median salary expense per FTE of rural hospitals each year by U.S. Census region, state Medicaid expansion status, Core-Based Statistical Area (CBSA), Frontier and Remote Area (FAR) code, and by state.
Date: 04/2026
Sponsoring organization: North Carolina Rural Health Research Program
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Average Salary Expense in Rural and Urban Hospitals Before and During the Low Wage Index Policy, 2018–2022
Examines and compares wage patterns of Critical Access Hospitals (CAHs), Rural Prospective Payment System (PPS) hospitals, and Urban PPS hospitals as related to the Low Wage Index Policy (LWIP) in effect from 2020-2022. Utilizes hospital data from the Centers for Medicare & Medicaid Services (CMS) Healthcare Cost Report Information System (HCRIS) between 2018 and 2022 and analyzes median salaries. Discusses the impact of Medicare payments and LWIP on hospitals.
Author(s): Saleema Karim, George Pink, Kristie Thompson, Mark Holmes
Date: 04/2026
Sponsoring organization: North Carolina Rural Health Research Program
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Examines and compares wage patterns of Critical Access Hospitals (CAHs), Rural Prospective Payment System (PPS) hospitals, and Urban PPS hospitals as related to the Low Wage Index Policy (LWIP) in effect from 2020-2022. Utilizes hospital data from the Centers for Medicare & Medicaid Services (CMS) Healthcare Cost Report Information System (HCRIS) between 2018 and 2022 and analyzes median salaries. Discusses the impact of Medicare payments and LWIP on hospitals.
Author(s): Saleema Karim, George Pink, Kristie Thompson, Mark Holmes
Date: 04/2026
Sponsoring organization: North Carolina Rural Health Research Program
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Medicaid Home Care Chartbook
Provides an overview of home care services within the Medicaid program, including participant eligibility, types of services delivered, inclusion in managed care arrangements, and provider distribution. Includes data on the percentage of home care recipients and location of providers in 2023 by Rural-Urban Commuting Area (RUCA) Code.
Date: 04/2026
Sponsoring organizations: Health Management Associates, National Alliance for Care at Home, Research Institute for Home Care
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Provides an overview of home care services within the Medicaid program, including participant eligibility, types of services delivered, inclusion in managed care arrangements, and provider distribution. Includes data on the percentage of home care recipients and location of providers in 2023 by Rural-Urban Commuting Area (RUCA) Code.
Date: 04/2026
Sponsoring organizations: Health Management Associates, National Alliance for Care at Home, Research Institute for Home Care
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Value-based Payment Strategies Used by Medicaid Managed Care Organizations
Presents findings from a review of 36 state Medicaid program websites that detail value-based payment (VBP) strategies deployed by state-contracted Managed Care Organizations (MCO). Describes how Medicaid MCOs approach VBP strategies and implications for rural healthcare providers and organizations.
Additional links: Appendix: State Medicaid Programs with VBP Elements
Date: 04/2026
Sponsoring organization: Rural Health Value
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Presents findings from a review of 36 state Medicaid program websites that detail value-based payment (VBP) strategies deployed by state-contracted Managed Care Organizations (MCO). Describes how Medicaid MCOs approach VBP strategies and implications for rural healthcare providers and organizations.
Additional links: Appendix: State Medicaid Programs with VBP Elements
Date: 04/2026
Sponsoring organization: Rural Health Value
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Comparing the Care and Distance Traveled by Rural and Urban Children and Adolescents with Medicaid Insurance and Opioid Use Disorder
Presents a study on the geographic factors that affect access to treatment for youth and adolescents, aged 0-17, with an opioid use disorder (OUD) and enrolled in Medicaid in 2019. Discusses the effects of rurality, travel burden, and residing in a county without a clinician with a DEA waiver, among other measures.
Author(s): Janessa M. Graves, Lisa A. Garberson, Sara C. Woolcock, C. Holly A. Andrilla
Date: 04/2026
Sponsoring organization: WWAMI Rural Health Research Center
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Presents a study on the geographic factors that affect access to treatment for youth and adolescents, aged 0-17, with an opioid use disorder (OUD) and enrolled in Medicaid in 2019. Discusses the effects of rurality, travel burden, and residing in a county without a clinician with a DEA waiver, among other measures.
Author(s): Janessa M. Graves, Lisa A. Garberson, Sara C. Woolcock, C. Holly A. Andrilla
Date: 04/2026
Sponsoring organization: WWAMI Rural Health Research Center
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Rural-Urban Variation in Opioid Use Disorder Treatment Access among Commercially Insured Children and Adolescents
Details a study on the geographic factors that affect access to treatment for youth and adolescents, aged 0-17, with an opioid use disorder (OUD) and covered by commercial insurance in 2019. Discusses the effects of rurality, provider type, travel burden, and residing in a county without a clinician with a DEA waiver, among other measures.
Author(s): C. Holly A. Andrilla, Lisa A. Garberson, Sara C. Woolcock, Janessa M. Graves
Date: 04/2026
Sponsoring organization: WWAMI Rural Health Research Center
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Details a study on the geographic factors that affect access to treatment for youth and adolescents, aged 0-17, with an opioid use disorder (OUD) and covered by commercial insurance in 2019. Discusses the effects of rurality, provider type, travel burden, and residing in a county without a clinician with a DEA waiver, among other measures.
Author(s): C. Holly A. Andrilla, Lisa A. Garberson, Sara C. Woolcock, Janessa M. Graves
Date: 04/2026
Sponsoring organization: WWAMI Rural Health Research Center
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April 2026 MACPAC Meeting Transcript
Transcript from the Medicaid and CHIP Payment and Access Commission's (MACPAC) April 2026 meeting. Covers community engagement requirements in Medicaid, state and federal tools for ensuring accountability of Medicaid managed care plans, the role of the state Medicaid agency in the Program of All-Inclusive Care for the Elderly (PACE), pharmacy benefit managers and Medicaid, and more. Includes rural references throughout.
Date: 04/2026
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Transcript from the Medicaid and CHIP Payment and Access Commission's (MACPAC) April 2026 meeting. Covers community engagement requirements in Medicaid, state and federal tools for ensuring accountability of Medicaid managed care plans, the role of the state Medicaid agency in the Program of All-Inclusive Care for the Elderly (PACE), pharmacy benefit managers and Medicaid, and more. Includes rural references throughout.
Date: 04/2026
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Trends Among Medicare Special Needs Plan Enrollment in Metropolitan and Nonmetropolitan Areas
Examines enrollment trends from 2016-2025 in Medicare Advantage plans that provide benefits and services to people with specific conditions or healthcare needs, or who also have Medicaid. Features statistics with breakdowns by year and by metropolitan or nonmetropolitan location.
Author(s): Edmer Lazaro, Fred Ullrich, Keith Mueller
Date: 04/2026
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Examines enrollment trends from 2016-2025 in Medicare Advantage plans that provide benefits and services to people with specific conditions or healthcare needs, or who also have Medicaid. Features statistics with breakdowns by year and by metropolitan or nonmetropolitan location.
Author(s): Edmer Lazaro, Fred Ullrich, Keith Mueller
Date: 04/2026
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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