Rural Health
Resources by Topic: Health reform
The New Rural Emergency Hospital Designation Program: Will It Improve Access to Care for Rural Americans?
Discusses rural hospital closures and the potential impact of the Rural Emergency Hospital (REH) designation. Provides U.S. maps showing Medicaid Expansion states and rural hospital closures as well as data specific to REHs in Texas.
Author(s): Suzanne B. Daly, Wei You, Elizabeth I. Merwin
Citation: Journal of Rural Health, 41(4)
Date: 10/2025
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Discusses rural hospital closures and the potential impact of the Rural Emergency Hospital (REH) designation. Provides U.S. maps showing Medicaid Expansion states and rural hospital closures as well as data specific to REHs in Texas.
Author(s): Suzanne B. Daly, Wei You, Elizabeth I. Merwin
Citation: Journal of Rural Health, 41(4)
Date: 10/2025
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Usual Source of Care Among Adults Aged 18-64 Years Post-ACA, 2010-2017
Examines self-reported usual source of care (USC) after Affordable Care Act implementation among various income groups and geographical areas. Utilizes 2010–2017 Medical Expenditure Panel Survey data to analyze USC with breakdowns according to low, middle, and high income as well as rural versus urban location.
Author(s): Sara Shahbazi, John D. Goodson
Citation: Annals of Family Medicine, 23(5), 457-459
Date: 09/2025
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Examines self-reported usual source of care (USC) after Affordable Care Act implementation among various income groups and geographical areas. Utilizes 2010–2017 Medical Expenditure Panel Survey data to analyze USC with breakdowns according to low, middle, and high income as well as rural versus urban location.
Author(s): Sara Shahbazi, John D. Goodson
Citation: Annals of Family Medicine, 23(5), 457-459
Date: 09/2025
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Evaluation of the Primary Care First Model: Third Annual Report
Provides an overview of the Primary Care First (PCF) model, which aims to enhance primary care and move primary care practitioners toward value-based payment. Describes the PCF model implementation experiences for Cohort 1 and Cohort 2 practices through 2023. Explores the characteristics of practices and payers that continued to participate in the PCF model compared to those who left. Examines the role that the PCF Model's incentives and supports played in the strategies and practices adopted to improve care delivery and how the trajectory of these strategies and activities practices have transformed over time. Estimates the impact of the PCF Model on Medicare fee-for-service (FFS) expenditures and service use, including acute hospitalizations. Estimates the impacts of the model on a set of seven leading indicators to provide an early assessment of whether care delivery changes are resulting in meaningful early outcome changes.
Additional links: Executive Summary, Findings at a Glance
Date: 05/2025
Sponsoring organizations: Centers for Medicare and Medicaid Services, Mathematica
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Provides an overview of the Primary Care First (PCF) model, which aims to enhance primary care and move primary care practitioners toward value-based payment. Describes the PCF model implementation experiences for Cohort 1 and Cohort 2 practices through 2023. Explores the characteristics of practices and payers that continued to participate in the PCF model compared to those who left. Examines the role that the PCF Model's incentives and supports played in the strategies and practices adopted to improve care delivery and how the trajectory of these strategies and activities practices have transformed over time. Estimates the impact of the PCF Model on Medicare fee-for-service (FFS) expenditures and service use, including acute hospitalizations. Estimates the impacts of the model on a set of seven leading indicators to provide an early assessment of whether care delivery changes are resulting in meaningful early outcome changes.
Additional links: Executive Summary, Findings at a Glance
Date: 05/2025
Sponsoring organizations: Centers for Medicare and Medicaid Services, Mathematica
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Policy Considerations: The Future of Group VIII (expansion) Medicaid Coverage in Ohio
Provides information on the impact of Medicaid Expansion legislation in Ohio. Includes county-level data on percentage of population enrolled in Medicaid Group VIII as of January 2025 as well as enrollee county type by metropolitan, suburban, Appalachian, or rural. Discusses access issues and potential policy considerations.
Date: 03/2025
Sponsoring organization: Health Policy Institute of Ohio
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Provides information on the impact of Medicaid Expansion legislation in Ohio. Includes county-level data on percentage of population enrolled in Medicaid Group VIII as of January 2025 as well as enrollee county type by metropolitan, suburban, Appalachian, or rural. Discusses access issues and potential policy considerations.
Date: 03/2025
Sponsoring organization: Health Policy Institute of Ohio
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Rural Hospital Experiences in the Colorado Hospital Transformation Program
Provides an overview of the Colorado Hospital Transformation Program (CO HTP), a 5-year program that ties Medicaid supplemental payments to hospitals' ability to meet performance targets through September 2026. Describes the experiences of three Critical Access Hospitals (CAHs) and explores how CO HTP impacts rural hospitals. Covers planning and community engagement, quality of care, and healthcare costs.
Date: 03/2025
Sponsoring organization: Rural Health Value
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Provides an overview of the Colorado Hospital Transformation Program (CO HTP), a 5-year program that ties Medicaid supplemental payments to hospitals' ability to meet performance targets through September 2026. Describes the experiences of three Critical Access Hospitals (CAHs) and explores how CO HTP impacts rural hospitals. Covers planning and community engagement, quality of care, and healthcare costs.
Date: 03/2025
Sponsoring organization: Rural Health Value
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The Pennsylvania Rural Health Model (PARHM): Fourth Annual Evaluation Report
Evaluates the fourth performance year of the Pennsylvania Rural Health Model (PARHM), an initiative designed to test if global budgets can help rural hospitals improve their financial viability, provide flexibility to meet locally defined community health needs, and reduce overall healthcare spending. Provides an overview of the model and describes the implementation experience of participating hospitals and payers. Presents a descriptive quantitative assessment of financial performance, spending and utilization, access to care, and quality of care outcomes from 2016, the model's baseline, through 2022. Includes three case studies discussing three themes: experiences with global budget reconciliation, behavioral health transformation, and interactions and alignment between PARHM and other value-based care programs.
Additional links: Appendix, Findings at a Glance
Date: 12/2024
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
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Evaluates the fourth performance year of the Pennsylvania Rural Health Model (PARHM), an initiative designed to test if global budgets can help rural hospitals improve their financial viability, provide flexibility to meet locally defined community health needs, and reduce overall healthcare spending. Provides an overview of the model and describes the implementation experience of participating hospitals and payers. Presents a descriptive quantitative assessment of financial performance, spending and utilization, access to care, and quality of care outcomes from 2016, the model's baseline, through 2022. Includes three case studies discussing three themes: experiences with global budget reconciliation, behavioral health transformation, and interactions and alignment between PARHM and other value-based care programs.
Additional links: Appendix, Findings at a Glance
Date: 12/2024
Sponsoring organizations: Centers for Medicare and Medicaid Services, NORC at the University of Chicago
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Impact of the Affordable Care Act on Access to Accredited Facilities for Cancer Treatment
Examines access to cancer care at accredited hospitals in Pennsylvania due to expanded coverage under the Affordable Care Act (ACA). Analyzes patient characteristics before and after ACA implementation, with breakdowns according to sex, age, race/ethnicity, area deprivation, and urban, large town, small town, or rural location, among other characteristics. Provides commentary on ACA impacts for patients in nonurban areas.
Author(s): Lindsay M. Sabik, Youngmin Kwon, Coleman Drake, et al.
Citation: Health Services Research, 59(6)
Date: 12/2024
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Examines access to cancer care at accredited hospitals in Pennsylvania due to expanded coverage under the Affordable Care Act (ACA). Analyzes patient characteristics before and after ACA implementation, with breakdowns according to sex, age, race/ethnicity, area deprivation, and urban, large town, small town, or rural location, among other characteristics. Provides commentary on ACA impacts for patients in nonurban areas.
Author(s): Lindsay M. Sabik, Youngmin Kwon, Coleman Drake, et al.
Citation: Health Services Research, 59(6)
Date: 12/2024
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Five Things to Know About Medicare Site-Neutral Payment Reforms
Discusses site-neutral payment reforms that seek to align Medicare payments with outpatient services in different settings. Examines benefits and drawbacks of the policy and discusses how the policy would impact rural hospitals.
Author(s): Zachary Levinson, Tricia Neuman, Scott Hulver
Date: 06/2024
Sponsoring organization: KFF
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Discusses site-neutral payment reforms that seek to align Medicare payments with outpatient services in different settings. Examines benefits and drawbacks of the policy and discusses how the policy would impact rural hospitals.
Author(s): Zachary Levinson, Tricia Neuman, Scott Hulver
Date: 06/2024
Sponsoring organization: KFF
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Prepregnancy Health Care Engagement Among American Indian and Alaska Native People Before and After the Affordable Care Act
Examines the impact of the Affordable Care Act (ACA) on healthcare engagement and disparities in American Indian and Alaska Native (AI/AN) populations as compared to White populations. Utilizes 2009-2015 Pregnancy Risk Assessment Monitoring System data to examine Medicaid coverage, healthcare interaction and screening, family history discussions, prenatal vitamin use, and teeth cleaning in rural versus urban populations, before and after ACA implementation.
Author(s): Danielle R. Gartner, Katlyn Hettinger, Heather Howard-Bobiwash, Claire E. Margerison
Citation: Health Equity, 8(1)
Date: 05/2024
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Examines the impact of the Affordable Care Act (ACA) on healthcare engagement and disparities in American Indian and Alaska Native (AI/AN) populations as compared to White populations. Utilizes 2009-2015 Pregnancy Risk Assessment Monitoring System data to examine Medicaid coverage, healthcare interaction and screening, family history discussions, prenatal vitamin use, and teeth cleaning in rural versus urban populations, before and after ACA implementation.
Author(s): Danielle R. Gartner, Katlyn Hettinger, Heather Howard-Bobiwash, Claire E. Margerison
Citation: Health Equity, 8(1)
Date: 05/2024
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Nonmetropolitan Premiums, Issuer Participation, and Enrollment in Health Insurance Marketplaces in 2022
Policy brief describing differences in unsubsidized and net-of-subsidy premiums in 2022 between nonmetropolitan and metropolitan counties in Health Insurance Marketplace plan design and availability. Features statistics with breakdowns by metropolitan, micropolitan, and noncore areas.
Author(s): Abigail Barker, Ayushi Shrivastava, Eliot Jost, Timothy McBride, Keith Mueller
Date: 03/2024
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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Policy brief describing differences in unsubsidized and net-of-subsidy premiums in 2022 between nonmetropolitan and metropolitan counties in Health Insurance Marketplace plan design and availability. Features statistics with breakdowns by metropolitan, micropolitan, and noncore areas.
Author(s): Abigail Barker, Ayushi Shrivastava, Eliot Jost, Timothy McBride, Keith Mueller
Date: 03/2024
Sponsoring organization: RUPRI Center for Rural Health Policy Analysis
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