Story by Marley Parish of Spotlight PA State College<\/p>\n
This story was produced by the State College regional bureau of Spotlight PA<\/a>, an independent, nonpartisan newsroom dedicated to investigative and public-service journalism for Pennsylvania. Sign up for Talk of the Town, a newsletter of local stories that dig deep, events, and more from north-central PA, at spotlightpa.org\/newsletters\/talkofthetown<\/a>.<\/p>\n BELLEFONTE \u2014 The outlook for rural hospitals in Pennsylvania remains grim as the state prepares to make the best of decreased federal investments and faces budgetary challenges that officials say make it impossible to absorb the cuts.<\/p>\n Policy experts say the $50 billion, five-year Rural Health Transformation Program<\/a> won\u2019t offset deep Medicaid cuts approved in a sweeping federal budget package that slashed spending by roughly $1 trillion over the next decade and tightened eligibility requirements.<\/p>\n Pennsylvania officials estimate the state will lose about $20 billion in federal Medicaid funding over 10 years starting in 2028.<\/p>\n Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation, said the federal program was offered almost as a \u201cconsolation prize\u201d to ease fear that more hospitals would close because of the Medicaid cuts.<\/p>\n While $50 billion is a lot of money, hospitals and health systems will feel the funding reductions \u201cwhen they begin to address the needs of the uninsured,\u201d Lisa Davis, director of the Pennsylvania Office of Rural Health, told Spotlight PA.<\/p>\n Shapiro\u2019s $53.3 billion budget proposal, presented to the divided legislature in early February, mostly keeps hospital funding intact and adds $1 billion in Medicaid spending, primarily to cover services and keep up with rising costs. He also called for a higher minimum wage \u2014 from $7.25 to $15 an hour \u2014 hoping that could reduce the number of people who are insured through Medicaid.<\/p>\n But some health experts say it\u2019s still not enough to solve the problems, making it hard for hospitals to stay open.<\/p>\n A recent analysis<\/a> commissioned by the Hospital and Healthsystem Association of Pennsylvania, which has long warned about the pressures facing providers, estimates that a dozen more facilities could close over the next five years without more help from policymakers.<\/p>\n HAP, which represents 235 hospitals statewide, supports efforts to boost insurance coverage. However, President and CEO Nicole Stallings said hospitals need more. Rural communities often have older residents and treat people more reliant on government-funded insurance, which reimburses at lower rates than private plans and hasn\u2019t kept up with inflation.<\/p>\n For rural hospitals operating on tight margins, that dynamic has meant cutting services or closing altogether, leaving patients with longer commutes and waits for care.<\/p>\n \u201cThe governor\u2019s budget, for the most part, maintains funding for hospitals. But at a time when less than half of Pennsylvania\u2019s hospitals have margins necessary for long-term stability, the status quo is not enough,\u201d she told Spotlight PA. \u201cAccess to care that our communities depend on is at risk.\u201d<\/p>\n Ahead of Shapiro\u2019s budget speech, HAP sent him an open letter<\/a> asking that Medicaid reimbursement to hospitals \u201creflect the actual cost of providing care.\u201d At the same time, the group acknowledged the state\u2019s competing budgetary demands, so HAP proposed a mix of relief strategies, such as raising the base payment rates for some providers, creating new supplemental payments for things like emergency care and surgery, and boosting support for distressed hospitals.<\/p>\n And while the state Department of Human Services, which administers the Medicaid program, agrees the federal money won\u2019t offset cuts, an agency spokesperson said the new transformation dollars could expand rural health care access through wellness hubs, mobile medical units, workforce training and stipends, and other projects outlined in its funding request.<\/p>\n The U.S. Centers for Medicare and Medicaid Services administers the $10 billion-per-year program, giving approved states $100 million annually, with the potential for more based on rural population, the number of health facilities, and other factors. Direct payments to providers are capped at 15% of total funds, so most dollars go toward workforce development, infrastructure upgrades, and new ways of delivering care. Any unspent money goes back to the federal program \u2014 giving states the chance to apply for more.<\/p>\n Pennsylvania\u2019s application<\/a> detailed plans for so-called Rural Care Collaboratives \u2014 which would include elected leaders, business officials, health providers, patients, and schools \u2014 to identify needs and prioritize investments to meet specific goals for care.<\/p>\n The state pitched a short-term Rapid Response Access Stabilization Program for the first two years of the federal program to target investments in hospital and emergency services capacity, technology projects, and workforce initiatives.<\/p>\n Some of the state\u2019s application focused on legislation, including a bill<\/a> that would bring Pennsylvania into a compact allowing for out-of-state physician assistants, also known as physician associates, to treat patients here.<\/p>\n Jennifer Campbell, president of the Pennsylvania Society of Physician Associates, said the agreement could expand access to care in rural areas and reduce administrative burden for health professionals, who wouldn\u2019t have to maintain licenses in separate states.<\/p>\n \u201cIt will expand the workforce in our state and then, hopefully, expand access to care for patients that need it,\u201d she told Spotlight PA.<\/p>\n The state cited the University of Pittsburgh School of Dental Medicine\u2019s regional training centers<\/a> as a possible way to address service gaps in the field. With current plans to launch in Cambria, Crawford, and McKean Counties, Pennsylvania said startup funds could support another three centers over the next two years \u2014 offering certification programs in dental assisting and hygiene.<\/p>\n Helen Hawkey, executive director of the Pennsylvania Coalition for Oral Health, said the goal is to train students in the communities that need providers most and encourage them to stay.<\/p>\n \u201cYou\u2019re not going to get a student that grew up in Pittsburgh to go practice along the New York border. That\u2019s just not going to happen,\u201d she told Spotlight PA. \u201cBut if you can grab a couple of those students from those rural areas and get them into dental school and get them trained, there\u2019s a better, much better chance they\u2019re going to go back to those areas and practice there.\u201d<\/p>\n Still, Hawkey said the cost of dental school is a major barrier, with many students facing roughly $500,000 in debt. Scholarships, she added, are \u201ca much better way\u201d to boost enrollment in Pennsylvania\u2019s dental programs, which have struggled to attract in-state applicants.<\/p>\n Even then, building a workforce pipeline takes time \u2014 far longer than the five-year federal program, she said.<\/p>\n While the money wasn\u2019t something states could afford to walk away from, Hempstead doubts it will lead to a full \u201ctransformation\u201d of rural health.<\/p>\n \u201cIt\u2019s not new to think about rural workforce and transportation,\u201d she told Spotlight PA. \u201cWill there be some big breakthrough that comes from these applications for these grants? Will we get lightning in a bottle somehow? I\u2019m not going to rule it out, but I don\u2019t think it\u2019s preordained.\u201d<\/p>\n Some problems, she added, can\u2019t be solved through innovation alone.<\/p>\n \u201cI don\u2019t think there\u2019s a startup or a tech solution, or AI, that can solve problems created by too few paying customers, really long distance, and just the complexities of delivering quality health care,\u201d Hempstead said.<\/p>\n BEFORE YOU GO\u2026 If you learned something from this article, pay it forward and contribute to Spotlight PA at spotlightpa.org\/donate<\/a>. Spotlight PA is funded by foundations and readers like you<\/a> who are committed to accountability journalism that gets results.<\/p>\n","protected":false},"excerpt":{"rendered":"Story by Marley Parish of Spotlight PA State College This story was produced by the State College regional…\n","protected":false},"author":2,"featured_media":111053,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[6],"tags":[28,30,29],"class_list":{"0":"post-111052","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-pennsylvania","8":"tag-pennsylvania","9":"tag-pennsylvania-headlines","10":"tag-pennsylvania-news"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us-pa\/wp-json\/wp\/v2\/posts\/111052","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us-pa\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us-pa\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-pa\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-pa\/wp-json\/wp\/v2\/comments?post=111052"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us-pa\/wp-json\/wp\/v2\/posts\/111052\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-pa\/wp-json\/wp\/v2\/media\/111053"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us-pa\/wp-json\/wp\/v2\/media?parent=111052"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-pa\/wp-json\/wp\/v2\/categories?post=111052"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-pa\/wp-json\/wp\/v2\/tags?post=111052"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}