On behalf of the Arizona Rural Health Association (AzRHA) and the National Rural Health Association (NRHA), we are writing to emphasize the critical importance of federal funding-including grants, Medicare, and Medicaid-to rural hospitals, federally qualified health centers (FQHCS) and Rural Health Clinics (RHC)s., where much of the population faces economic hardship and resides in medically underserved areas. Federal funding plays a vital role in ensuring access to quality healthcare for these communities. 

What’s At Stake for Medicaid?

In short, the House resolution passed last night proposes $880 billion in funding cuts from programs under the Energy & Commerce Committee’s jurisdiction. While Medicaid isn’t the only program in this category, it is by far the largest. If the Senate agrees with the House’s plan, we can assume the bulk of the $880 billion in cuts would come from Medicaid. What this looks like exactly has yet to be determined. There have been several Medicaid changes floated by House Republicans, though not yet put into draft legislation. Proposals include mandatory work requirements, scaling back the financial incentive for the Medicaid expansion in 40 states and imposing per capita caps on individual Medicaid enrollees.

What’s Next?

Senate and House leadership must now reconcile their different budget resolutions before crafting legislation that specifically proposes Medicaid cuts. After that, the Senate Finance Committee and the House Energy & Commerce Committee must draft the actual policy changes to Medicaid necessary to generate truly huge savings.

This could take weeks, or months. Every day along the way is an opportunity to reach out to your elected officials to demand they oppose significant cuts to Medicaid.

How Can I Take Action?

If you have five minutes free:

Customize and send a letter to your elected officials and share this link to colleagues, family, and friends: https://thenationalcouncil.quorum.us/campaign/107658/

If you have 15 minutes free: Pick up the phone and dial your elected officials or send an email. Use the below resources:

	Phone number	Share your Thoughts
Senator Mark Kelly DC office	(202) 224-2235	Share Your Thoughts
Senator Ruben Gallego DC office	(202) 224-4521	Contact
Rep David Schweikert District 1 DC office	(202) 225-2190	Contact
Rep Eli Crane District 2 DC office	(202) 225-3361	Contact
Rep Yassamin Ansari District 3 DC office	(202) 225-4065	Contact
Rep Gregory Stanton District 4 DC office	(202) 225-9888	Contact
Rep Andy Biggs District 5 DC office	(202) 225-2635	Contact
Rep Juan Ciscomani District 6 DC office	(202) 225-2542	Contact
Rep Raύl Grijalva District 7 DC office	(202) 225-2435	Contact
Rep Abraham Hamadeh District 8 DC office	(202) 225-4576	Contact
Rep Paul Gosar District 9 DC office	(202) 225-2315	Contact

Share messaging on your social media:

If you have 1 hour free: In-person or virtual meetings with staff from your elected officials’ offices are invaluable. Contact the National Council to help coordinate next steps.

https://thenationalcouncil.quorum.us/campaign/107658/

The Medicaid program is a lifeline for the rural hospitals, providers, and patients. Medicaid cuts will close rural hospitals. Since 2010, nearly 190 rural hospitals have shuttered their doors or stopped inpatient care.¹ Public payers, including Medicare and Medicaid, comprise a larger share of hospital services in rural areas, making rural hospitals more vulnerable to cuts in these programs. Medicaid funding is critical for sustaining rural healthcare systems, including hospitals, clinics, community health centers, and long-term care facilities. Right now, almost half of all rural hospitals across the country are operating with negative margins, meaning that any reductions to Medicaid funding would force many facilities to reduce or eliminate essential services, delay much-needed equipment upgrades, or close their doors entirely. Data shows that Medicaid expansion is strongly associated with improved rural hospital financial viability and substantially lower likelihoods of closure in rural markets.² When a rural hospital closes, not only does the community lose access to vital health care, but a major employer and community lynchpin ends, affecting the economic health of the larger community.

Any cuts to the Medicaid program will disproportionately affect rural communities. Rural Americans rely on Medicaid coverage with about 20% of non-elderly adults and 40% of children living in rural areas enrolled in Medicaid and CHIP.³ In almost all states rural areas have higher rates of Medicaid enrollment than metropolitan areas.⁴ Cuts to Medicaid would shift health care costs onto rural families, many of whom already struggle with financial instability. Medicaid cuts would force families to face higher out-of-pocket expenses, leading many to delay or forgo necessary treatments. This burden would worsen health outcomes, especially for those managing chronic conditions like diabetes, heart disease, and cancer. When a hospital or clinic closes in a rural area residents must travel further to receive basic or emergency care. Right now, rural residents already travel on average two times further to access healthcare compared to their urban counterparts.⁵ Cutting the Medicaid program will cause greater access challenges for rural Americas.

Further, any cuts to one part of the healthcare system will shift costs elsewhere, which makes sweeping Medicaid cuts a serious concern for rural providers. Rural populations are older, tend to rely more on public coverage, and are more likely to be low-income, unemployed, and under- or uninsured.⁶ This means that on average, over 70% of rural hospital revenue comes from public payers – Medicare, Medicaid, and the Marketplace.⁷ Loss of coverage under any of these payers means an increase in uncompensated care that rural providers cannot sustain. NRHA further urges Congress against any cuts to the Medicare program, which aids in keeping rural providers afloat. Maintaining public payers, like Medicaid, supports strong rural health infrastructure that is critical to the future of rural areas. Thank you for your work on behalf of rural Americans.

¹ Rural Hospital Closures, N.C. Rural Health Research Center, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill https://www.shepscenter.unc.edu/programs-projects/rural-health/ruralhospital-closures/. ² Zachary Levinson, Jamie Godwin, Scott Hulver, Rura Hospitals Face Renewed Financial Challenges, Especially in States That Have Not Expanded Medicaid, KFF, Feb. 23, 2023, https://www.kff.org/health-costs/issue-brief/rural-hospitals-facerenewed-financial-challenges-especially-in-states-that-have-not-expanded-medicaid/. ³ Joan Alker, Aubrianna Osorio, & Edwin Park, Medicaid’s Role in Small Towns and Rural Areas, GEORGETOWN CENTER FOR CHILDREN AND FAMILIES, Jan. 15, 2025, https://ccf.georgetown.edu/2025/01/15/medicaids-role-in-small-towns-and-ruralareas/. ⁴ Id. ⁵ Marvellous Akinlotan, et al., Rural-Urban Variations in Travel Burdens for Care: Findings from the 2017 National Household Travel Survey, SOUTHWEST RURAL HEALTH RESEARCH CENTER, July 2021, at ⁵, https://srhrc.tamu.edu/publications/travel-burdens-07.2021.pdf. ⁶ Vann Newkirk & Anthony Damico, The Affordable Care Act and Insurance Coverage in Rural Areas, KFF, May 29, 2014, https://www.kff.org/uninsured/issue-brief/the-affordable-care-act-and-insurance-coverage-in-rural-. ⁷ Zachary Levinson, et al., Key Facts About Hospitals: Rural Hospitals, KFF, Feb. 19, 2025, https://www.kff.org/key-factsabout-hospitals/?entry=rural-hospitals-rural-discharges-by-payer.

As we come to the close of another year, I would like to take a moment to wish everyone a joyous and peaceful holiday season. This is a time to reflect on all that we have faced and overcome together, and to celebrate the many accomplishments that have strengthened rural health in Arizona.

Your dedication and resilience in addressing the unique challenges of rural communities continue to inspire. It is through this collective effort that we ensure better health outcomes and create lasting impacts for those we serve.

I hope you take the holiday season to reflect, recharge, and find gratitude in the progress we’ve made together. May this time bring you renewed inspiration and a strengthened spirit of community as we look ahead to 2025 with hope and determination.

Thank you for all that you do. Wishing you health, happiness, and success in the year to come.

Respectfully,

Holly Figueroa
President
Arizona Rural Health Association

The Arizona Rural Health Association encourages all members and attendees to exercise your rights at citizens and vote for your preferred candidates for office.  Below includes important information as we approach election day in November.

Important Election Dates

• General Election Day: November 5^th (6 a.m. to 7 p.m.)
• Voter Registration Deadline: October 7^th
• Early Voting Begins: October 9^th
• Last Day to Request Ballot by Mail: October 25^th
• Mail Back Early Ballot: October 29^th
• Last Day to Vote Early in Person: November 1^st at 7 p.m.

Registering to Vote:

If you are eligible and want to vote in the November election, you must register to vote before the applicable registration deadlines, which vary by state and territory. Learn more about registering to vote in your home state at vote.gov, where you will find a guide to voting and information for college students.

In the state of Arizona, Oct. 7^th, is the last day to register to vote. You can complete your Arizona voter registration online, by mail (postmarked Oct. 7), or in person. Eligible voters who will turn 18 on or before Nov. 5 can register to vote by the Oct. 7 deadline. Review the requirements for registering and voting in Arizona

Early Voting Options

https://azsos.gov/elections/about-elections/elections-procedures/early-voting-procedures

County Election Officials Contact Information

https://azsos.gov/elections/about-elections/county-election-officials-contact-information

What ID should I bring to the poles? https://azsos.gov/elections/voters/voting-elections (click on Election Day Voting)

BY SERENA O'SULLIVAN

KTAR.com

Sens. Kyrsten Sinema and Mark Kelly have recently secured over $25 million in federal funds for Arizona.

The money is supporting small businesses, community health centers, workforce training programs, fire prevention and more, according to an announcement from last week.

“I’m proud to deliver strong investments for Arizona — supporting projects and priorities that will grow our economy, protect the health and prosperity of our families and loved ones, secure our border and keep families safe,” Sinema said in a statement.

Both senators secured a variety of investments to support leaders at county, city and local levels. The money will enhance the safety, health, security and economic strength of Arizona’s communities, the senators said.

Recently, CMS released the Medicare Prescription Payment Plan (M3P) Part Two Draft Guidance. The Medicare Prescription Payment Plan is a new program required under the Inflation Reduction Act under which Part D sponsors must provide enrollees the option to pay out-of-pocket prescription drug costs in the form of monthly payments over the course of the plan year, instead of all at once at the pharmacy, beginning in 2025.  A 30-day comment period for the draft part two guidance opened today and concludes on March 16, 2024.

Press Release: https://www.cms.gov/newsroom/press-releases/cms-issues-additional-guidance-program-allow-people-medicare-pay-out-pocket-prescription-drug-costs

Fact Sheet: https://www.cms.gov/files/document/fact-sheet-medicare-prescription-payment-plan-draft-two-guidance.pdf

M3P Draft Part 2 Guidance: https://www.cms.gov/files/document/medicare-prescription-payment-plan-draft-part-two-guidance.pdf

By MADELINE ARMSTRONG | January 17, 2024 
Today's News-Herald

House Representative Selina Bliss has proposed a bill that establishes a Health Care Workforce Advisory Council as well as an Arizona Health Care Workforce Investment Fund that would address the healthcare workforce shortage in Arizona.

“As of January 2022, Arizona ranked among the top 5 states with the most severe healthcare staffing shortages,” reads a press release from the Arizona State Board of Nursing.

Among those most affected by the healthcare workforce shortage are Arizona’s rural communities including Mohave County.

According to a report released from the Arizona Department of Health Services on medically underserved areas in Arizona, Mohave County is home to a number of underserved areas including Lake Havasu City, Bullhead City, Kingman, Golden Valley, Colorado City and the Hualapai Tribe.

Phil Fitzgerald, CEO for Havasu RegionalMedical Center in Lake Havasu City and Valley View Regional Medical Center in Bullhead City, said that staffing shortages are a challenge that his hospitals have faced for years.

“Every range of departments is experiencing some type of shortage,” Fitzgerald said. “We’re not able to open as many beds as we have before. We can’t bring in as many patients as we would like to - people who are trying to access our facility for care, so we do have to send some of those patients outside of their own support area.”

Fitzgerald said that there are a number of reasons why Mohave County is facing a healthcare workforce shortage including the cost of living in the area.

“The area that we’re in; it’s hard. The cost of living has something

Click here to view the full article

Consider submitting a presentation proposal or research poster to contribute to NRHA's Health Equity Conference, one of the only meetings in the nation to focus on health equity issues in rural America, May 6-7, 2024, in New Orleans, La.

Presentations are due by next Thursday, Dec. 7 for this one-of-a-kind event, while posters are due by Feb. 8.

Coordinated by NRHA's Health Equity Council, this conference is designed for those who are dedicated to bringing quality health care and health care services to underserved and often under-represented populations. These include LGBTQIA+, veteran, and homeless rural residents as well as multiracial and multicultural members of rural communities.

Click here to submit an abstract

  

Holly Figueroa Recognized as Arizona’s
“Community Star” on National Rural Health Day 

Arizona Center for Rural Health – Holly Figueroa, BCBSAZ Health Choice & Arizona Rural Health Association, has been named Arizona’s 2023 “Community Star” by the National Organization of State Offices of Rural Health (NOSORH). 

On the third Thursday of November, NOSORH leads National Rural Health Day (NRHD), an annual celebration that shines a light on those who serve the vital health needs of the nearly 61 million people living in rural America. Holly Figueroa will be featured prominently on the official NRHD website, PowerOfRural.org, on November 16, 2023, alongside other Community Stars from across the nation. This platform will showcase each Star’s remarkable dedication and contributions to rural healthcare.

Arizona Center for Rural Health is proud to join NOSORH in honoring Holly Figueroa as Arizona's Community Star. Ms. Figueroa has shown steadfast commitment to improving health systems in her community and throughout Arizona. We are honored to work with her and congratulate her on this well-earned recognition.               

In 2015, the Community Star Recognition Program was established in conjunction with NRHD to tell the stories of the people and organizations who make a difference in rural communities. Since then, over 300 inspiring rural stars have been honored nationwide on NRHD.

Additional information about National Rural Health Day can be found at PowerOfRural.org. To learn more about Arizona Center for Rural Health visit crh.arizona.edu.

Ann Garn
Arizona Center for Rural Health
agarn@arizona.edu

Release Date: November 1, 2023

Elizabeth Hall-Lipsey, JD, MPH, past president of AzRHA and faculty of the College of Pharmacy at the University of Arizona, recently completed her fellowship with the National Rural Health Association (NRHA). NRHA's Rural Health Fellows program is a yearlong, intensive training program that develops leaders who can articulate a clear and compelling vision for rural America.

The Arizona Rural Health Association (AzRHA) has announced a call for nominations for its 2024 board of directors.  If you are interested in nominating a colleague or self-nominating, you may click here to complete the board application form.