ļ»æEpisode 68. Ready. Set. No. Interview with Tricia Brooks, Hannah Green and Leonardo Cuello
Michelle Rathman: Hello, one and all and welcome back to a brand new episode of The Rural Impact. I'm Michelle Rathman, and you are joining us for another conversation that works hard to connect the dots between policy and rural everything. I am recording, here we go. I'm recording on this Monday, October 6th, and it is really important for me to put that as a footnote because by the time you hear this, I am 1000% certain that there has been new developments where today's topic is concerned.
And although I wish I could click my heels three times to reverse course on the subject of health policy. I am a realist after all, and I always, and I vow to always provide straight up facts. And I don't foresee good news in the forecast on this front. And I'll say I hoped to be proven wrong. I really mean it.
I hope that someone out there can prove me wrong. But alas, here we are. Again recording on 10/6. We are now in week two of a US federal government shutdown. And the impact of this is certainly being felt across the country, and every agency of government, including putting, and this is the number I read this morning, 750,000 employees on unpaid leave.
Other impacts to rural, well, I did my homework over the weekend, and here's what I found. First and foremost, let's talk about essential services. Government shutdowns affect essential services such as Social Security, Medicare and Medicaid benefits. Now these will continue to operate, but you can bet you are going to experience delays in processing.
How can we not, the fact that agencies overseeing these programs have already seen massive layoffs and operations disrupted through DOGE. And that was the Elon Musk, task at the first part of this year. And of course, we've got the kind of rapid-fire policy decisions coming out of RFK Jr's, HHS. So, we can expect further the disruptions, and again, it will come in the form of delays and disruptions in payments for reimbursement to health providers, not to individuals, but to health providers who can least afford still to the cost in rural areas. If you haven't heard already, there are some financial challenges for our rural hospitals and clinics across this country.
Okay. Additionally, we know that government shutdown is impacting USDA and HUD operations. These agencies also impacted by furloughs and we also know that, for example, the USDA rural development plans, they've already had 83% staff furlough.
So that's gonna affect things like rental assistance payments and other rural development activities. It's also going to impact responding to disasters as well. Again, this also has impact on market volatility. You know, things that we may not think about every single day, but a shutdown, especially prolonged, can create uncertainty for farmers and traders affecting commodity prices and market trends, which can be particularly challenging for rural economies already under pressure from tariffs.
And I wanna share that we will be dedicating an entire episode on how these policies are impacting America's small and family-owned farms. So please do subscribe and stay tuned for that. Bottom line the rural impact of federal government shutdowns can lead to, again, reduced access to services, increased cost for farmers, and potential disruptions in essential services that millions of people rely on.
That's the bad news. So, before I introduce you to today's guests, I also wanna put an invitation out there to you, a really serious invitation. If your organization, your rural business, your rural community, your county, is already feeling the impact of the federal government shutdown, or frankly, if you're experiencing challenges as a result of policies that have been coming at us for the last 10 months.
Well, we wanna hear from you, and you can do that by sending us an email at [email protected], again, that's [email protected]. Tell us who you are, where you're from, and in a few sentences, talk to us about how the policies are impacting you and your work and your quality of life. With that we do wanna hear your good news too. We wanna understand how are you managing policy shifts, ways you've pivoted, some positive information about the spaces where policy is providing to be a challenge, but you have managed to overcome. Share your good news with us. We could sure use that right about now.
Okay, so let's get into today's episode. Again, not a light subject, but as always, we are here to present you information that enlightens and with that, provide you with facts that you can then take to the bank as they say, and you can share it with your circle of friends and network of other influencers.
So, joining me at the table today, are individuals who are very well versed on the impact of HR 1 or the Big Beautiful Bill as it was introduced and signed into law. And that includes, on the subject of adding all sorts of restrictions and requirements for states to implement the new, and I'll add quite onerous work requirements for Medicaid participation.
So, in analysis after analysis that I have read, state systems are quite frankly unprepared for federal demands to implement a Medicaid work reporting requirement system. And this is true for the USDA administered SNAP program, but we're not gonna talk about that today.
Today my slate of guests have done the research. Boy have they done the research, and they are here to talk to us about what all this means, that is the impact of states not being prepared for these reporting requirements and how this will, not could, but will impact rural counties, communities, health providers, patients, and so on and so on. So, to unpack it all, we've pulled out all the phone of friends stops and invited to the Rural Impact, a powerhouse team from Georgetown McCourt School of Public Policy Center for Children and Families.
That includes Tricia Brooks, Research Professor, Leo Cuello, Research Professor and also State Health Policy Analyst, Hannah Green, to discuss their outstanding new research, which answers the question, are states ready to implement HR 1 Medicaid work reporting requirements? Do you know the answer? Do you think you know the answer?
Well, in just a moment, you're gonna find out because I now invite you to tune out that background noise, and there's plenty of it. Get yourself comfortable and listen to my conversation. A very candid conversation with Tricia Brooks, Leo Cuello, and Hannah Green. I am so ready. I know you are too. So, let's go.
Michelle Rathman: Well, I promised you joining me from Georgetown McCourt School of Public Policy Center for Children and Families. I wanna welcome Tricia Brooks, Research Professor. Welcome to the Rural Impact, Tricia.
Tricia Brooks: Thanks, Michelle. It's great to be here.
Michelle Rathman: Also, you know Leo, we've never met before, but Leo Cuello, Research Professor, great to have you here.
Leonardo Cuello: Thanks so much for having me.
Michelle Rathman: And finally, you know Hannah, say, save the best for last Hannah Green State Health Policy Analyst. A warm welcome to you to the Rural Impact as well.
Hannah Green: Thanks for having me, Michelle.
Michelle Rathman: Well, I gotta say under other circumstances, I mean, I always look forward to having these conversations.
I've had the privilege; we've had the privilege of having your colleague Joan Alker on before in the past. But Tricia, you all have, as I explained in our opener, you've got another great research paper out. And so, let's just start there. The report came out on September 4th, and it asks this very important and relevant question. Are state's ready to implement HR1? That's the One Big Beautiful Bill that was signed into law back in July, the Medicaid work reporting requirements. So, before we dive in, are state's ready? Are some ready? Talk to us a little bit about kind of the, you know, why this report came to be and what it spells out for us.
Tricia Brooks: I'm happy to do so. And first of all, I would say I call it the 'Big Bad Bill, ' and of course, no state is ready today. Congress gave states less than 18 months to implement what is a major policy change, and it's going to need high performing technology systems so that we can avoid either a disruption or a loss of coverage due to paperwork and red tape.
That's what we do. We wind people up in red tape and exhaust them to where they just give up on whatever point, they're trying to, or whatever benefit they're trying to access. And, states are having to move very quickly through this uncharted territory because the Centers for Medicare and Medicaid, which administers the pro Medicaid program is not expected to issue new regulations before June of 2026. So, can states be ready no later than January 1st, '27? Well, that's what we're trying to determine using Medicaid performance indicators. And these indicators assess how well states are managing their administrative workload.
States are required to report these data to CMS, which in turn publishes the data. And then we capture the data for posting in what we're calling our HR 1 State Readiness Tracker. Now our research shows that some states are in a better position than others, but is there enough time to build and test the systems? Is there time enough for states to plan and launch multifaceted communications campaigns to prepare enrollees for what's ahead? And critical question, are there enough resources and funding to do this right? All of those questions, the answers remain to be seen, but there are many reasons for us to be concerned.
Michelle Rathman: You know, Tricia, before we go on, I mean, I wanna remind our listeners, we are now recording this on today's date is October 2nd, which is one day after the federal government shut down. And we know that as of today, reports are, you know, thousands and thousands of furloughed employees, including from HHS, which oversees CMS.
And so I'm just thinking about, you know, even with the requirements and those who are ready, I mean the chaos, the tangled web that we are weaving, it really does concern me quite a bit.
Tricia Brooks: No doubt about it, and they have their hands full. The administration has their hands full with trying to implement this very far reaching unprecedented bill. Largest cut to Medicaid in history, nearly $1 trillion over 10 years. We're gonna feel most of those impacts in the next two to three years.
Michelle Rathman: Yeah, and I do wanna talk about what some of those impacts are because we say that, you know, kind of high-level terms, but there, there's there are actual implications, hard evidence of what that could mean. Hannah, one of those I wanna turn to you on this, in the report you all spell out in very clear terms and something that we've been hearing a lot about is that HR1 strips coverage from many lawfully, I wanna repeat that, lawfully residing immigrants, and it ties to the hands of states to raise revenue to cover the state's share of Medicaid, and specifically targets the Medicaid adult expansion enacted by the Affordable Care Act or ACA as we know it. Some call it Obamacare. Further, it was true with Medicaid unwinding that the impact on families will vary enormously so depending on where they live.
The status of the state's eligibility and enrollment processes and how well states manage the implementation. I mean, that's a mouthful. So, at the end of the day, can you give our listeners a sense of the variances from state to state? Maybe a few examples of how the pendulum will swing depending on location.
I am in Illinois, for example, Washington State is gonna get hit hard and I don't think most people understand why that is. So, could you break that down for us?
Hannah Green: Sure. So before I dive into that, I do just wanna say, and I know this is something my colleague Leo can touch on more. There's been a lot of media surrounding, coverage for the immigrant population, the lawfully residing immigrant population, but the bulk of the cuts that we're seeing actually come from these work reporting requirements and some of these financing provisions.
We are anticipating seeing something very similar to unwinding, where every state is going to implement this differently. I'm shocked Tricia hasn't said it yet, but the famous phrase is, if you've seen one Medicaid program, you've seen one Medicaid program. So, every state is going to tackle this slightly differently and some will be more successful than others.
One of the biggest things we'll see is expansion states, or states that have elected to have the Affordable Care Acts Medicaid expansion for the adult population. They will, they have the burden of the provisions on them, so they have to deal with the work reporting requirements, cost sharing, different provisions like that, that only apply to the expansion population.
But I do wanna be clear that non-expansion states, the handful that are left, are not off the hook. There are a lot of provisions that are going to apply to all states at every level of eligibility, enrollment, and renewal. So you said you're in Illinois, which is very interesting because in our report, so kind of diving into our report, Tricia touched on the metrics a little bit, but what we looked at is eight different metrics of performance that we are that sort of point to how a state is handling the administrative burden, and we wanted to get a baseline measure. So, from January through March of 2025, how were states doing on these eight different performance metrics?
What we found is just looking to make sure I get this right, but it is Missouri, Illinois, and Montana are actually at the very top of the list of states that are performing poorly on the most metrics. So, if a state is performing poorly, we give them a red flag. Those three states have seven out of eight red flags possible.
Other poor performing states are North Dakota, New Mexico, Utah, and Wisconsin. I know we'll talk about the metrics in a little bit, so I don't need to get to get too into it. But one last point I wanna make is some states, and there was actually a great article that just came out this morning about Colorado, but in my state of Virginia, this is how it works too.
Eligibility, enrollment and renewal is delegated to the counties. So, these counties are already dealing with, I mean, you know, a lack of staffing, not enough workers in general at baseline to deal with the caseload that they already have. Then implementing all of this on top of that is going to be really difficult for those states.
Michelle Rathman: Oh my gosh. Now you're making my head spin. Because I have talked to many county leaders who, honestly, I mean, this is not their expertise, not remotely prepared to bear the brunt that is coming their way. And yes, I do wanna talk about those performance indicators. Tricia, you wanna give a stab at that?
And then Leo, I'm gonna come to you with a question after that. What are those Medicaid performance indicators that you're looking at? Because again, most people don't know they're not paying attention. They don't need to.
Tricia Brooks: Right in, in addition to state's reporting enrollment data, there are a number of performance indicators. However, CMS only publishes a handful of those on a regular basis. So, we have a 12 areas of performance indicators over 80 measures and submeasures, and we're getting reporting on enrollment and eight others.
So, this is not a complete picture, but it's the best that we have to deal with. So, it starts with the average call wait times. So, call wait times are the average amount of time that an enrollee is left on hold. Now when you think about this, if I'm working at Walmart and I have a 15-minute break. Guess what? I can't stay on hold for 57 minutes, which is what the average was in Missouri, during the unwinding.
So, long wait times means the state really lacks the staffing that it needs to be able to support enrollees and applicants who need assistance. And there are ways that states can improve these measures and we can talk a little bit about that in a minute.
Well, let's tick through these average call wait times, then call abandonment rate. That means at my 15-minute mark in Missouri, I gotta hang up 'cause I gotta get back to work. Guess what, I am working as most Medicaid enrollees are, and if they're not working, they're caregiving to a child or to an elderly parent, or they're disabled themselves. So, call abandonment rates. If there's a lot of them, or if the phone lines are flooded, the system fails and drops all these calls. That's two.
Application processing times. There's a standard in Medicaid for applications to be processed no later than 45 days, and states report these times in buckets.
So, we're looking at states that have more than the, have more applications pending for 30 days or more. That means the state just can't stay on top of the workload. Then we've got the overall renewal rate of the people I have enrolled, how many are able to stay enrolled? And we believe in eligibility. If they're not eligible, then that's fine, but the reality is that most people lose coverage for red tape paperwork, things get lost, manual processing makes errors. So, if you're not relying on technology, you're going to have problems staying on.
Michelle Rathman: Yeah, Tricia, I wanna put up a point in here at this, at this point in time, because of the work that I am so familiar with. And I think it's really important for us to talk about a reality here is that during a period of time where someone's coverage has lapsed or if there's paperwork issues or whatnot, that there's no indication that they won't need healthcare to, to use the system, if you will. And so, what I think is important for us to understand here is the domino effect is that they will still present somewhere for care if they do, typically in an emergency room setting, the most expensive level of care.
And then that, another domino that falls is that institution then ends up not being able to be reimbursed for the care that they are providing, another casualty in all of this. So, I just think that's important for us to state as well.
Tricia Brooks: N no doubt there is that trickle out impact in a number of ways. One of the most important indicators that we have is something called ex parte renewals. This is using third party data to confirm eligibility. It's a way to automate the renewal process so that I can, as a state, go look at the state quarterly wage data and say, oh, Tricia's you know, earning $3,000 a month. Yeah, she's definitely working in order to earn $3,000 a month. So, during the unwinding that was when the Medicaid continuous enrollment provision was in place during COVID. Once that ended, then all the states had to renew all these people, the states that had higher ex parte, automated renewal rates had better results because if you can automatically renew people, it's cost efficient, it's accurate, and it saves both state workers and individuals time in trying to gather up the paperwork and process that paperwork. So that's an important measure.
And I can give you an example here in the state of Texas during unwinding, their ex parte rate was less than 5%, and yet we had a handful of states that had over 70% ex parte rates. So, you can see the disparity from state to state.
And then, the other measure is the pending renewals, and that is when a state hasn't been able to get to a renewal and process it before the end of the month. Then guess what? That renewal is going to be pending. So, when we look at things like you got a long call time rate, you've got a high abandonment rate, you've got application processing that's taking way too long. You're not renewing a lot of people. You have low ex parte, and you have high pending renewals. Well, guess what? You're not in very good shape as a Medicaid eligibility enterprise.
Michelle Rathman: I read in the first quarter of 2025, the share of pending renewals ranged from a high of 71.4% in Nebraska. And Nebraska's in a world of hurt right now to a low of 0% in Minnesota. Nevada, and Rhode Island, the pending renewal rate was greater than 12.9% in states in the bottom quartile, the national medium was 4.8%.
These aren't good numbers.
Tricia Brooks: No, they're not. And we should explain the procedural dis-enrollment. What that means is that the state did not have enough information to determine whether I was eligible or not. They're missing information, and this gets back to manual processing, red tape, losing paperwork, et cetera, that, uh, we see where all the problems happen and procedural.
Michelle Rathman: Our focus, obviously being rural, those barriers are different. You know, because we are talking about connectivity issues, we're talking about fewer people. I mean, I was just in a county, a rural county, and I won't say the state, I always try and protect those, where there only had three admin, three county commissioners, and one administrator.
So you're talking about, you know, in Massachusetts, you might have 25 people in the payroll in the county, versus a rural county in Colorado, which might have three. And so that definitely is determination. All right. You know, Leo, I gotta turn to you now because, um, I read that you love all things Medicaid process and procedure and all that good stuff.
I mean, we've got a lot of bad news here today, but I would like to kind of focus on maybe where you're seeing some state level strategies that could help reduce the negative impacts of these work requirements as a result of HR1, because HR1, Medicaid work requirements, just one piece of a long line of bad news where this is concerned.
So, what are some strategies that states can do to, instead of, I should say, kind of bracing for the impact of what they can't do? How can they build their bench to, to make sure that the residents and their states don't get locked up in this red tape to the point of having no coverage whatsoever.
Leonardo Cuello: Right. So, as my colleagues described, right, this is a big burden for states. They're gonna have a lot of work to do here. And, and it's so many things. Let's talk about two important things that are really important for rural America. First, HR1 reduces the state funding for Medicaid and specifically funding that tends to go to rural hospitals, right?
At the same time, it's increasing the number of uninsured people that are gonna be walking into those hospitals, right? So, if you're that hospital, your budget is getting cut, and you have more people you have to take care of for free, right? So that is a recipe for even more rural hospitals going bankrupt.
And we've already seen that be a really big problem over the last 20 years. And I always like to remind people, right that impacts everyone in rural communities, 'cause those hospitals are often major employers. The biggest employer in the county.
But also even if you have a great private work insurance, right? You can't go to the hospital if there is no hospital, right? So, states are gonna have to find ways to get more money to rural providers, and they're gonna have to look at their state financing systems and figure out how to do that, but that's a big problem.
Second, this work requirement is gonna play really badly in rural areas because people are more likely to be in Medicaid expansion, they have may have more challenges finding employment. They may have past or current opioid-related issues that interfere with employment. They may have chronic conditions more likely to have those that impair employment. So how this requirement gets implemented is gonna impact their ability to have insurance.
And the important thing for listeners to understand is that we are all supportive of work. But the most important thing to understand is that the biggest losers under work requirements are workers. Because when workers have to file paperwork proving that they are working, many are unable to, right? Most Medicaid enrollees are in working households, so this doesn't lead to people starting to work. It leads to workers losing their health insurance. How can states reduce the harm? They can look at policies that will be more likely to get success. So, first of all. Don't take the flexibility to do this work requirement every single month. States can choose to only do it at renewal, and that's what they should do.
Michelle Rathman: Okay.
Leonardo Cuello: Second, right, as Tricia has been talking about these, these data systems, right? The more that states can access their own information, access third party data, and use that to determine people eligible so that people don't have to do the paperwork, the better we're going to do.
And then states have to think a lot about when people have to submit something, what is the process and can it be multimodal? So a lot of ways for somebody to satisfy the process. And can we maximize the use of self attestation, right? Because there is an exemption for somebody who has a self substance use disorder. But how does somebody go about proving that?
Right? So you need to allow people to raise their hands, self-identify, and that should be the end of the story and then I will say the last thing for state workforce is states really need to invest money in their workforce to actually get the work done and then their consumer assistance processes, 'cause people are going to need a lot of help.
We have seen that in the states that have done work requirements before, people are lost in this system. They don't even know what's happening.
Michelle Rathman: No, and I'll tell to all three of you, the hospitals that I am working with right now, they are working to find room in their budgets to hire somebody to physically be in their clinics to answer those calls and the money that's required to put someone on the payroll and offer them benefits, just to be a navigator where states are failing to do that.
So Leo, I would add to that is just really good educational material that employers, you know, can get in on this. I mean, I would like to hear your, any of your feedback on that, because I think at this point, you know you all are providing the data and the information, the resources, but we have to make sure that employers and county leaders and so forth also have information that they can push out to, to those who will be impacted by this.
Because if we don't, I mean we're gonna make the problem much worse than, than I think it needs to be. Absent the education.
Tricia Brooks: So, we did a research project with the Urban Institute on just lessons learned from the unwinding. And I also, am the lead author on a KFF, 50 state eligibility and enrollment survey every year. And over and over states told us that engaging community-based partners was an important part of what was successful during the unwinding.
And so it's health providers, it's community-based organizations, it's schools, it's adult training programs. You know, the list goes on where faith-based organizations, you need to have people who are trusted messengers in the community that can share the message. And the more that states provide materials to them, provide talking points, the better this will be.
The other thing that states can do, and we have an outreach scan on our website looking at what states do to help people understand what they have to do to get enrolled and stay enrolled. And we know that states have tutorials and other self-help tools that can make a difference. But no matter what, we cannot make this all about technology because as you stated before, there are a lot of people who have limitations in terms of using technology.
So, we've gotta find a way to serve all of the populations here and not put people without internet access or computer skills at a disadvantage.
Michelle Rathman: Because we're also talking about, you know I wanted to see if any of you all could touch on another paper that you did, which is the rate of uninsured children in the United States and you know, here we are. This is gonna be another whole segment of our population where they at least can afford.
And I don't have the number, I know Joan shared it with us a few episodes back about how many children in rural America are, they are Medicaid, that's how their coverage goes. And so, I wonder if any of you could speak to, you know, some of these new requirements. I mean, children aren't required to work, but their parents are, and navigating the disenrollment for them is gonna be just another whole, I don't know, even know what I'm running out of adjectives to describe my frustration.
Tricia Brooks: Well, I can appreciate that. I have some choice words that I often use. But okay. I wasn't gonna repeat them, but I think people know what I mean by that.
So what we saw coming off of the unwinding is that the uninsured rate for children increased, between 2022, which was sort of the height of enrollment in, during COVID, it rose to 6%, and that is the highest rate of uninsured children in a decade, in a full decade. And we saw statistically significant increases in uninsured rates in 19 states. We're going already in the wrong direction.
Now, when the ACA was implemented, everybody said, this isn't about kids. And it wasn't, there really wasn't anything in the ACA specific to children, but if you looked at the states that had low uninsured rates, prior to the implementation of the ACA, you will find that their uninsured rates actually went lower even because when parents get coverage, their kids get coverage, and the reverse is going to be true with work reporting requirements. When parents lose out, somehow we're gonna find out that kids slipped through the cracks as well.
Michelle Rathman: Yeah, I don't think you have to be, you have a crystal ball to identify what some of those challenges are. The other thing I wanna ask all of you, I mean I was mentioning to Trisha before we started recording today is that I've been on several calls, several conversations around the Rural Health Transformation Fund.
There's a lot of misinformation about what it is, and so I wonder if each of you or one of you could just kind of touch on, you know, in context of this conversation, how it will or will not change course for those who will soon be entangled in these complex work requirements. Because $50 billion split between 50 states, half out front. I mean, I won't go in to explain it. We've done enough of that.
But I would imagine that these requirements are, you know, it's a wash. I mean, I don't see how hospitals are going to, or fare 'cause not a hospital fund, how providers are going to fare with just yet another roadblock of these Medicaid work requirements.
And knowing that fund doesn't touch doesn't even begin to touch the financial woes that they're about to experience.
Leonardo Cuello: Yeah. To call it a wash would be very generous. Right, right.
So let's talk about what we're talking about here. This is a fund that offers $50 billion for states for rural health improvements. But the problem is that the other pieces of the law make $137 billion in cuts to rural healthcare. So, if you cut $137 billion and you give back $50 billion, rural America is still out $87 billion for their healthcare.
So, it doesn't solve the financial crisis for healthcare, and it doesn't change the fact that millions of people will lose health insurance, right. Probably disproportionately in rural areas. And in addition all the cuts in the law, those are permanent cuts. Those are gonna go on and on. Whereas this fund lasts five years and disappears, right? So we're really putting a bandaid on a long-term problem. Now that said, once you're out $137 billion, it's at least important to get back the 50 billion that you can get back, right?
So states, really need to apply for that money and that application has to be done by early eight, by early November, right? So, this whole process is a bit rushed. It's a bit of a mess. The federal government has a lot of flexibility over what states it approves for the funding. So, this has also research raised concerns for states about fairness, about whether they would sort of be pressured into doing other things in order to get this money. Um, and then once the state does get the money, the requirements are actually more lax than you would expect about making sure the money really goes to rural healthcare.
So that's gonna be another place where we're going to, people are gonna need to pay attention and really make sure that their states are using the money in ways that will benefit rural healthcare.
Michelle Rathman: Yeah, and I remind people that the other part of this is that I always you know, we're talking about data here and, and you know, research is fueled by really good data. As I wonder, you know, every penny that's a state does see how will we be able to measure what transformation has actually occurred as a result, 'cause this can't just be about to pay past due bills. I mean, this is supposed to transform, rural health.
Leo, I wanna stick with you because again, you really do work on, part of your work is, is developing educational material on advocacy, and if I, if there is any other, if there are lawmakers that we can still bend their ear and advocate for, I mean, they have a lot on their plates right now.
What do the stakeholders, and maybe let's talk about those stakeholders, right? We have providers, so we've got rural health clinics, we've got federally qualified health clinics, we've got rural hospitals. We've got rural employers who don't wanna see their work, those who are working, lose their health coverage.
I mean, they might not be employer-based, but all these stakeholders, what do we need to be saying to our policy makers? What in the world is going to stop them dead in their tracks and listen to the pleas of those who know what's coming, not in the not-too-distant future?
Leonardo Cuello: Yeah, so I think all of those stakeholders need to get engaged is the first message, right? You can't sit by idly. You need to be talking to your state legislature. You need to be talking to your state Medicaid agency. You need to be telling them, number one, we need to design systems that will work for people.
Number two, we need to invest resources in helping people navigate those systems we design, which will just by definition have shortcomings. Third, they really need to commit to collecting data and regularly reporting data on what impact these policies are having. Part of the reason that we were able to respond effectively and somewhat nimbly to unwinding as it played out to the pandemic, unwinding as it played out, was the fact that we at least had some data to tell us where are their fires and, and what, how can we diagnose why these fires are happening? Right? So, we need all of that.
And then I think the other really important role for stakeholders is to be lifting up and telling the stories of the people they know that are going through this system and experiencing how the system just fails enrollees in ways that are probably unimaginable to the average citizen and even the average legislator, until they hear it from the pediatrician, until they hear it from the American Lung Association, right? They need to hear it from the people who actually are working with the patients.
Michelle Rathman: Hannah I'm gonna ask you this last question here, because I've been thinking so much about just data collection and how, again, how it fuels research and I have come to know the work of the Congressional Health District dashboard, for example, and they're collecting data and they're putting into this.
So we can see, you could plug in your congressional district and you can see what the food insecurity is, health disparities and so forth. In your work, as a researcher, what do you foresee some of the things that you have to maybe do differently to be able to collect data that fuels your research? Do you see some roadblocks that you all have to move to make sure that this great data that you provide us keeps flowing? Any change of plans for you?
Hannah Green: I don't see any changes right now. As long as CMS continues to post these monthly metrics, we are gonna continue to compile them into these quarterly averages. Part of this report, so the report is a point in time look, at things, but it's connected to our online tracker, and we are gonna continue to push out these averages so we can track states in as real time as possible.
One thing that I know that other folks on our team are doing is we are gonna be tracking enrollment data in as real time as possible. And in order to do that, we'll be looking for these state administrative enrollment reports. So not just relying on CMS, in case anything changes on their end.
Again, we're not anticipating that. But in case anything does change on how they post their data or the frequency with which they post their data, from an enrollment perspective, we'll still be able to pull the reports from the states that do post them online, and be able to track enrollment this way.
Michelle Rathman: Yeah, I, I appreciate that I wanted to put that out there because you never know. There are a lot of things. My mornings I wake up and said, who knew? And then, and then here we are. Trisha, you have something to say about that.
Tricia Brooks: Yeah, I was gonna say that you know, we hear, HHS Secretary Kennedy saying that they're all about radical transparency. Well, now is good time to be radically transparent with what is happening. They say that no one's gonna lose coverage. Guess what? That's not true. And there are a lot of things that they have told us that are not accurate and time will tell, but the data is critically important in order for us to figure out what's happening, who it's happening to, and what we can do to fix it.
Michelle Rathman: Yeah, absolutely. Oh my gosh, Hannah, Leo, Tricia. I mean, it, I really, really appreciate everything you've shared with us. We'll be watching, we are gonna make sure to all of our listeners that we put this report in, others that we talked about here today. On our website, you'll find us theruralimpact.com.
So, although we have to say goodbye to all of you again, thank you so much for joining us. I invite you to stay with us 'cause we'll be right back with a few closing thoughts right after this really important message. Stay tuned.
Michelle Rathman: My thanks to Hannah and Leo and Tricia. And as a reminder, you can find their entire research report on the matter of state preparedness for implementing work requirements when you head over to theruralimpact.com and just click on our resource page, and that's also where you're going to find a piece that Leo wrote last week and a 'Say Ah' column.
That was focused on, well, I'll tell you, it was a doozy of a fact checker. It debunks a full-on Pinocchio nose growing claims about Medicaid and marketplace health coverage for immigrants in this government shutdown. And I really, again, I highly recommend that you read this piece because in a most shameful way, and I don't say that lightly.
This false claim about immigrants and the fight around immigrants receiving health coverage has been parroted across every social media platform, even mainstream media in on the game to deliberately deceive the public. And I won't suggest the motive behind it, but I will say this disinformation at any time, but especially now in these very challenging times.
It's not helpful to say the least. So, it's important to have those facts and make sure that when someone tells you otherwise, that you at least are able to present them with facts and information that clears things up. It's quite empowering, I will say that.
So, a few of the things before we close out, a very friendly reminder to subscribe to The Rural Impact wherever you'd like to get your podcast fix, including on YouTube, you can watch us there and make sure that you go on our website, theruralimpact.com, to subscribe to our E-blog. You'll get information about episodes you may have missed, and you'll also receive details about what we've got in store for you next.
On our website, that's also the place where you can make a donation if you are so inclined. We're very appreciative to those of you who have done that, and you can learn more about our partnership opportunities that'll help you expand your rural reach. Again, we're easy to find at theruralimpact.com.
And real quickly, speaking of partners, I just wanna say we are proud to support the Rural Urban Bridge Initiative and their important work, including sharing information with you about details on their upcoming community work summit. And that is a summit designed to find common ground rebuilding trust with neighbors working together for our rural communities.
That is happening on October 22nd. You can get all the details, go to our resource page, and you'll be able to click over to that event and register. Lastly, I promise you, I invite you to follow me, Michelle Rathman and The Rural Impact on LinkedIn and Blue Sky and other platforms. We so appreciate it when you engage with us.
A quick thank you to Brea Corsaro and Sarah Staub for all the work that they do behind the scenes to help make this podcast possible. Until we're together again, I invite you to take really good care of yourself and to the best of your ability, those around you. We'll see you soon on a new episode of The Rural Impact.
