Rural Health
Resources by Topic: Policy
Medicare Payment for Rural or Geographically Isolated Hospitals, 2026
Displays data on Medicare payment adjustments for Sole Community Hospitals, Medicare-Dependent Hospitals, Low-Volume Hospitals, and Critical Access Hospitals. Includes information on the number of qualifying hospitals by state and eligibility criteria.
Date: 04/2026
Sponsoring organization: Congressional Research Service
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Displays data on Medicare payment adjustments for Sole Community Hospitals, Medicare-Dependent Hospitals, Low-Volume Hospitals, and Critical Access Hospitals. Includes information on the number of qualifying hospitals by state and eligibility criteria.
Date: 04/2026
Sponsoring organization: Congressional Research Service
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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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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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Health Care Access and Quality for New York Veterans Provided by the U.S. Department of Veterans Affairs and Community Care
Features information on healthcare access and quality for New York veterans: Volume I focusing on veteran's healthcare policy changes and Volume II focusing on methods and supporting data. Discusses the U.S. Department of Veterans Affairs (VA) Community Care Program, geographic access to care for veterans, quality of care, and policy implications for VA Community Care.
Additional links: Volume II
Author(s): Claire E. O'Hanlon, Catria Gadwah-Meaden, Nsheng Dong, et al.
Date: 04/2026
Sponsoring organization: RAND Corporation
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Features information on healthcare access and quality for New York veterans: Volume I focusing on veteran's healthcare policy changes and Volume II focusing on methods and supporting data. Discusses the U.S. Department of Veterans Affairs (VA) Community Care Program, geographic access to care for veterans, quality of care, and policy implications for VA Community Care.
Additional links: Volume II
Author(s): Claire E. O'Hanlon, Catria Gadwah-Meaden, Nsheng Dong, et al.
Date: 04/2026
Sponsoring organization: RAND Corporation
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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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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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Early Evaluation of the Rural Emergency Hospital Program
Results of a study conducted January 2023 to December 2025, to assess differences between hospitals that converted to Rural Emergency Hospital (REH) status and eligible rural hospitals that did not. Includes statistics on the financial performance of the hospitals before and after conversion, and hospital features and services provided, with breakdowns by REH or non-REH status.
Author(s): Mitchell Mead, Nina M. Clark, Janice C. Probst, et al.
Citation: JAMA Network Open, 9(4), e269217
Date: 04/2026
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Results of a study conducted January 2023 to December 2025, to assess differences between hospitals that converted to Rural Emergency Hospital (REH) status and eligible rural hospitals that did not. Includes statistics on the financial performance of the hospitals before and after conversion, and hospital features and services provided, with breakdowns by REH or non-REH status.
Author(s): Mitchell Mead, Nina M. Clark, Janice C. Probst, et al.
Citation: JAMA Network Open, 9(4), e269217
Date: 04/2026
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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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April 2026 MedPAC Meeting Transcript
Transcript from the Medicare Payment Advisory Commission's (MedPAC) April 2026 meeting. Covers Medicare payment incentives, regional benchmarks and benchmark-plan availability in the Part D prescription drug plan (PDP) market, preferred networks and pharmacy access in Medicare Part D, the estimated association between Medicare Advantage enrollment and hospitals' and post-acute care providers' finances, information sources that beneficiaries use to make Medicare enrollment decisions, and institutional special-needs plans. Includes a mandated report on the assessment of the Medicare ground ambulance data collection system. Includes rural references and considerations throughout.
Additional links: Advising the Congress on Medicare Issues Preferred Networks and Pharmacy Access in Part D, Mandated Report: Assessment of the Medicare Ground Ambulance Data Collection System
Date: 04/2026
Sponsoring organization: Medicare Payment Advisory Commission
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Transcript from the Medicare Payment Advisory Commission's (MedPAC) April 2026 meeting. Covers Medicare payment incentives, regional benchmarks and benchmark-plan availability in the Part D prescription drug plan (PDP) market, preferred networks and pharmacy access in Medicare Part D, the estimated association between Medicare Advantage enrollment and hospitals' and post-acute care providers' finances, information sources that beneficiaries use to make Medicare enrollment decisions, and institutional special-needs plans. Includes a mandated report on the assessment of the Medicare ground ambulance data collection system. Includes rural references and considerations throughout.
Additional links: Advising the Congress on Medicare Issues Preferred Networks and Pharmacy Access in Part D, Mandated Report: Assessment of the Medicare Ground Ambulance Data Collection System
Date: 04/2026
Sponsoring organization: Medicare Payment Advisory Commission
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