Health Equity blog

The 2025 Rural Health State of the State report issued by the Chartis Center for Rural Health exposes the dire circumstances facing sustained access to care in rural areas of the United States. “Care deserts” continue to proliferate at a time when the population health status of the more than 46 million residents living in these rural areas is already on a downward spiral. The Chartis report also opines that nearly half of all rural hospitals in the United States are operating in the red, and 432 rural hospitals are vulnerable to permanently closing their doors. In the past year alone, 18 rural hospitals have already either ceased operations or discontinued inpatient services.

President Trump has issued an unprecedented number of executive orders so early in his presidency, many of which have health equity implications, such as those impacting transgender care. While a president may issue executive orders to direct federal agencies to take steps within the scope of the president’s constitutional authority or as delegated by Congress, executive orders may not exceed that authority or otherwise override federal laws and statutes. Many of President Trump’s administrative actions are being challenged in court as exceeding that authority. Just Security, an online platform affiliated with NYU School of Law, has established a webpage that tracks litigation in response to executive orders, memoranda, proclamations, and other actions taken by the Trump Administration. With the rapidly evolving legal challenges to President Trump’s actions, Just Security’s well-organized website provides a handy tool to stay abreast of the latest developments.

Included in a number of Executive Orders (EOs) signed on his first day in office, President Trump directed the U.S. to withdraw from the World Health Organization (WHO) claiming mishandling of the organization’s response to the COVID-19 pandemic, failure to undertake needed reforms and inequitable financial burden placed upon the U.S. compared to other participating nations. On the same day, President Trump issued an Executive Order that only recognizes the biological sexes of male and female, prohibiting any Federal laws or regulations designed to accommodate gender identity that deviates from such assignments of sex at birth. Further, it prohibits the use of “gender” rather than “sex” in any Federal policies or documents.

Before leaving office, members of the Department of Health and Human Services (HHS) under the Biden Administration released its Strategic Plan for the Use of Artificial Intelligence in Health, Human Services, and Public Health. While recognizing the evolving space, the plan includes actions HHS should consider as AI adoption in health care continues to grow.  While not its focus, the plan recognizes there are inherent risks in AI in health care, such as algorithmic biases that may unintentionally hinder equity. Additionally, responsible AI should ensure equitable access and beneficence, which means ongoing appropriate human oversight and involvement are imperative. In particular, historically underserved populations, such as rural communities and people with disabilities, need to be the focus of AI equitable access to ensure a more diverse and inclusive research and delivery healthcare landscape.

On January 14, HHS’s Office of Civil Rights (OCR) issued guidance on the implementation of  HHS’s updated final rule, which went into effect July 2024, governing the application of Section 504 of the Rehabilitation Act of 1973 to child welfare agencies that receive Federal financial assistance from HHS. These regulatory provisions clarify Section 504’s applicability in the child welfare context and do not cover all disability rights laws applicable to child welfare agencies. Among the issues addressed are requirements that ensure individuals with disabilities are not discriminated against in any programs and activities, including parent-child visitation, reunification services, and child placement, among others.

On January 6, the Centers for Medicare and Medicaid Services (CMS) announced 15 states – including California – have been chosen to participate in its Transforming Maternal Health (TMaH) Model. TMaH is the latest CMS model structured specifically to improve maternal health care for individuals enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). Unique to the TMaH program will be a whole-person approach to pregnancy, childbirth, and postpartum care that tackles the physical, mental health, and social needs encountered during and immediately following pregnancy. This model seeks to reduce persistent disparities in both access and treatment.

In mid-January, the DEA issued three new telemedicine rules (available here, here, and here) to make permanent some of the temporary telemedicine flexibilities created during the COVID-19 public health emergency while also instilling new patient protections. Such patient protections include establishing a Prescription Drug Monitoring Program (PDMP) to aid the healthcare industry in protecting against abuse and the diversion of controlled substances into the ever-looming threat of the illegal drug market.

Nearly two years since releasing its Framework for Advancing Health Care in Rural, Tribal, and Geographically Isolated (RTGI) Communities, the Centers for Medicare & Medicaid Services (CMS) issued its FY2024 Year in Review, which describes progress made to address the unique needs of RTGI Communities, including increased investments for organizations critical to helping RTGI community members find and enroll in affordable health coverage through the Marketplace. In addition, CMS has streamlined the prior authorization process for Medicare Advantage, Medicaid, and CHIP, which are all vital to meeting these RTGI community needs. CMS also began implementing a policy that enables certain Indian Health Service (IHS) and Tribal facilities to convert to Rural Emergency Hospitals, as well as released tailored resources for American Indians and Alaska Natives to help make health care coverage more accessible.

On October 16, the Centers for Medicare & Medicaid Services (CMS) approved 1115 demonstrations for Arizona, California, New Mexico, and Oregon expanding their Medicaid and CHIP covered services to include traditional health care practices provided by Indian Health Services facilities, Tribal facilities, and urban Indian organizations. Recognizing the importance of traditional health care practices to American Indian and Alaska Native (AI/AN) populations, CMS hopes this policy effort will improve access to culturally appropriate and quality health care in Tribal communities. AI/AN populations experience significantly worse health disparities compared to the general population, including higher rates of diabetes, obesity, cancer, substance use disorder (SUD) and other mental illnesses. Studies have shown that traditional health care practices, including traditional healers and natural helpers, can improve the health outcomes for individuals facing these challenges. In particular, recognizing the fact that Native American populations are disproportionately affected by the opioid epidemic, Medi-Cal has announced that it will place a particular emphasis on traditional health care practices that have proven successful in treating SUD.

The Centers for Medicare & Medicaid Services (CMS) issued its final MPFS rule for CY2025 (to appear in Federal Register on Dec. 9). The new fee schedule is indicative of a broader federal government strategy to create a more equitable health care system that results in better accessibility, quality, and affordability for all Medicare beneficiaries, including those individuals most marginalized historically. For instance, with regard to opioid treatment programs (OTPs), while state law still applies, CMS is allowing telecommunication flexibilities that will promote access to care for populations that often face barriers to entering and participating in treatment and allow OTPs and their patients to mutually agree on the best modality for receiving care. The 2025 MPFS also finalizes a continued policy to delay the in-person visit requirement for mental health services furnished via communication technology by rural health clinics (RHCs) and federally qualified health centers (FQHCs) to beneficiaries in their homes until 2026, which is a critical win for patients in rural and other underserved communities who vitally need access to such services.