{"id":183418,"date":"2025-09-26T17:37:07","date_gmt":"2025-09-26T17:37:07","guid":{"rendered":"https:\/\/www.newsbeep.com\/us\/183418\/"},"modified":"2025-09-26T17:37:07","modified_gmt":"2025-09-26T17:37:07","slug":"states-should-use-rural-transformation-fund-to-focus-on-children-and-families-center-for-children-and-families","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/us\/183418\/","title":{"rendered":"States Should Use Rural Transformation Fund to Focus on Children and Families \u2013 Center For Children and Families"},"content":{"rendered":"

At this moment, states are seeking input<\/a> and putting ideas on paper to develop priorities for their state applications for a piece of the $50 billion Rural Health Transformation Fund included in H.R. 1<\/a> (with applications due to the federal government by November 5th<\/a>). Our colleague Adam Searing reminded readers<\/a> that these funds will by no means make up for the hits to rural hospitals and state Medicaid programs given the over $900 billion in Medicaid cuts included in H.R. 1. But in some states, $100+ million a year may help mitigate some of the damage \u2013 that is, if the funds are spent thoughtfully and targeted towards those in most need. To be clear, decisions about how best to use limited funding are even more challenging now as states prepare for the onslaught of cuts Congress handed down to them with H.R.1. But could these funds continue to drive system changes that could more effectively serve rural children and families in the long term? We argue it\u2019s a gamble worth taking and have some ideas on possible proposals.<\/p>\n

First and foremost, proposals should put children and families covered by Medicaid front and center as part of any application for the Rural Health Transformation Fund. Medicaid plays an essential role for children and families in small towns and rural areas. In fact, as highlighted in a CCF report<\/a> from earlier this year, non-elderly adults and children in small towns and rural areas are more likely than those living in metro areas to rely on Medicaid and the Children\u2019s Health Insurance Program (CHIP) for their health coverage. As a result, reductions in federal funding \u2013 such as those recently passed by Congress in H.R .1 \u2013 are more likely to cause greater harm to rural areas and small towns than metro areas.<\/p>\n

For children this is especially true in Arizona, Florida, North Carolina, Virginia, South Carolina, California, Minnesota, Georgia, South Dakota, and Alaska. And nationally, in 2023, 40.6% of children living in small towns and rural areas were covered by Medicaid\/CHIP.<\/p>\n

In addition, in a follow up report<\/a> from May, CCF researchers found that Medicaid is also a vital source of health coverage for women of childbearing age across the US but is even more important to those living in small towns in rural communities.<\/p>\n

Nationally 23.3% of women of childbearing age in rural areas are covered by Medicaid as compared to 20.5% of women in metro areas. And according to the 2023 data, the top ten states with the highest share of rural women of childbearing age covered by Medicaid were: New Mexico, Louisiana, Kentucky, West Virginia, Arizona, Oregon, Montana, Maine, New York, and Arkansas \u2013 all states that have taken up the Affordable Care Act\u2019s Medicaid expansion and which as a result, are hit particularly hard the Medicaid cuts included in H.R. 1.<\/p>\n

Focus on care needs for pregnant and postpartum moms and their infants \u2013 especially mental health. With rural hospitals or their OB units at risk of accelerated closures, states could do more to consider how best to ensure pregnant women have safe places to give birth.\u00a0 In addition to helping to shore up hospital birthing care access<\/a> and support quality care through state perinatal quality collaboratives<\/a>, states are also looking to midwifery care models<\/a> to help extend the traditional care workforce through community-based supports. All but two states have extended postpartum coverage from 60 days to 12 months, with many also considering new community-based care extenders such as community-based doulas<\/a> to help meet the demand and reach more families who may have been marginalized by the traditional health system. States are still working to ensure the longer postpartum coverage period translate to ensuring new parents<\/a> get health, mental health<\/a> and substance use disorder treatment support they may need during a time of family change. The postpartum year also offers an important opportunity to support early relational health, starting with the nurturing interactions between moms and their newborns. Given the role Medicaid plays for moms and babies, especially those in rural areas, policies and programs that focus on postpartum and infant care are especially ripe for additional support.<\/p>\n

Use payment incentives to boost pediatric primary care through \u201chigh performing\u201d family-centered models that serve as a care hub for families. AAP Bright Futures screening recommendations are only as good as the capacity of the practices who can implement them.\u00a0 AAP and others have made clear that team-based approaches that serve the parent and child produces the best results. While an overall boost to primary care rates may be challenging, states could pilot or provide payment incentives to practices that meet a set of standards for a high performing pediatric primary care home, such as Healthy Steps<\/a>, DULCE or others.<\/p>\n

Shore up the EPSDT benefit, including access to mental health care for children and adolescents.\u00a0 Medicaid\u2019s Early, Periodic, Screening, Diagnostic and Treatment (EPSDT) benefit<\/a> means children covered by Medicaid are supposed to get the right care, in the right place, at the right time. However, we know the promise does not always live up to the reality in practice. In 2022, as part of the Bipartisan Safer Communities Act<\/a>, Congress took bipartisan action to promote better oversight and support to states when it comes to implementation of this benefit. This was followed up by a CMS informational bulletin on \u201cLeveraging Medicaid, CHIP, and Other Federal Programs in the Delivery of Behavioral Health Services for Children and Youth<\/a>\u201d as well as a State Health Official letter on \u201cBest Practices for Adhering to Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Requirements<\/a>.\u201d Both of these guidance documents not only reiterate that EPSDT is a \u201ccornerstone\u201d of the Medicaid program but also that a state\u2019s obligation to provide all medically necessary care under EPSDT extends to prevention, screening, assessment and treatment for mental health and substance use disorders (SUDs). States should use the Rural Health Transformation Fund application process as an opportunity to review these guidance documents and work with stakeholders to identify ways to better support implementation of the EPSDT benefit and related protections (like informing families of the benefit) and close ongoing and persistent gaps<\/a> in access to services like mental and behavioral health care for children. Proposals could include those that support the rural pediatric mental health and community-based workforce, promote efforts to integrate behavioral health and primary care, expand access to school-based Medicaid services and rural school-based health centers, and leverage telehealth (including Pediatric Mental Health Care Access Programs<\/a>) to better meet the behavioral health needs of children in rural areas.<\/p>\n

Need other ideas? The Medicaid Maternal Health Coalition, of which Georgetown CCF is a member, highlighted recommendations in its 2024 Blueprint for Improving Maternal and Infant Health Outcomes<\/a>, Nurture Connection highlighted state policy actions<\/a> to advance early relational health, along with its Guide for Transforming Care of Young Children in Community Health Centers<\/a> offer more opportunities for states.<\/p>\n

While Congress cut more than $900 billion from Medicaid (and thus the health system), Americans\u2019 health needs will not go away. Our country is still combating real crises in maternal and infant mortality, mental health, and access to care that need urgent action and a long-term vision for change. Funding explicit opportunities for prevention and early intervention for moms, children and their families during consequential stages of development\u2013 especially those living in rural areas\u2013 is a sound investment.<\/p>\n","protected":false},"excerpt":{"rendered":"At this moment, states are seeking input and putting ideas on paper to develop priorities for their state…\n","protected":false},"author":2,"featured_media":183419,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[59],"tags":[97,252,253],"class_list":["post-183418","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health-care","tag-health","tag-health-care","tag-healthcare"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/183418","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/comments?post=183418"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/posts\/183418\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media\/183419"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/media?parent=183418"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/categories?post=183418"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us\/wp-json\/wp\/v2\/tags?post=183418"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}