Federal funding for infrastructure improvements in colonias, predominately rural, Hispanic communities near the U.S.-Mexico border, including 150 in New Mexico, is getting a second look from the U.S. Government Accountability Office.
Jill Naamane, financial markets and community investment director for the GAO, said there are grant and loan programs targeting colonias to improve water and wastewater systems and housing but the U.S. Department of Agriculture does not have accurate data on the extent of program benefits.
She pointed out colonias have high poverty rates.
"Many of them started as settlements that were associated with military forts or missionary activities, so they kind of grew up outside of cities without being connected to the same infrastructure," Naamane explained.
The GAO analyzed program documentation and funding data from 2020 to 2023, conducted local interviews and made physical observations during 24 site visits in the four U.S.-Mexico border states. They recommended Congress consider revising the population requirement for colonias to continue receiving block-grant funding given population growth in the Southwest.
Naamane acknowledged many colonias face challenges in obtaining and using federal assistance because local governments do not have the staff to apply for federal funds. Without some administrative revisions, she projects nearly 60% of colonias will likely become ineligible in the future for certain targeted financial assistance.
"They're typically areas that have poor water and sewage infrastructure, substandard housing and a number of other economic and environmental challenges," Naamane outlined. "There's a continuing need for assistance in these communities."
In southern New Mexico, the designated colonia of Anthony, home to about 10,000 people, is refurbishing and expanding its wastewater treatment plant with grants and loans from the USDA. The new plant started treating wastewater this month, with the entire project scheduled for completion in November.
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By Liz Carey for The Daily Yonder.
Broadcast version by Mark Richardson for Minnesota News Connection for the Public News Service/Daily Yonder Collaboration
When rural patients incur medical bills they can’t pay, the impact of the debt reaches far beyond their own personal pocketbooks, a new study has found.
Medical debt also impacts the hospitals that can’t collect on the debt and the communities they serve, according to a research brief from the Rural Health Research Center at the University of Minnesota. Although medical debt is something all communities have, it hits rural communities harder, Carrie Henning-Smith, co-director for the center, said.
Researchers interviewed rural hospital administrators in seven states – Arkansas, California, Illinois, Texas, Vermont, Washington and West Virginia – to look at the implications of medical debt on rural communities at large.
“We know how widespread medical debt is,” Henning-Smith said in an interview with the Daily Yonder. “We weren’t particularly surprised by anything we heard, but I think one thing that stands out to me is that this is not just an issue of healthcare facilities passing on big bills to patients and then patients shouldering that burden.”
“This is really an issue that impacts individual patients, whole communities, and healthcare facilities, and I think smaller rural facilities that have a more tenuous bottom line are some of the most impacted,” she said.
Research indicates that about 44% of all U.S. adults are affected by medical debt, and that $88 billion in outstanding medical bills is currently in collections across the country. Researchers found the debts impact a rural hospital’s ability to continue paying their employees. With fragile bottom lines, rural hospitals are less likely to absorb the debt, respondents said.
A respondent from a Midwestern state said to the researchers, “One of the statistics that I think is really relevant is that we are about a $150 million organization… and 65% of those dollars go back in the form of compensation and benefits to our employees. So when we have medical debt that becomes excessive and we’re struggling to collect on the work that we do, it impacts our ability to employ [providers] and to serve our patients.”
With less revenue coming in, most respondents said, they are less likely to invest in equipment upgrades and their facilities, as well as less likely to hire more staff. Additionally, respondents said it’s harder to collect on that debt.
“It’s a non-recourse issue. We can’t go back and take back what we’ve done,” a Southern state administrator told researchers. “You can’t repossess anything medical like you can with a car or a home or anything like that when there’s financial troubles. We end up really just getting unpaid, mostly.”
Researchers found that much of the blame for the debt issue is not solely because of patients who are underinsured. In many cases, insurance companies and other payers – including Medicare, Medicaid and Medicare Advantage – are not covering the cost of care that the hospitals provide.
“They need to have their cost recouped for the care that they provide,” Henning-Smith said, “and when they have patients who are uninsured or underinsured or when they are dealing with insurance companies and payers that are not providing a sufficient amount to pay for the cost of the care, then the facility suffers and the patients and community suffer too.”
“It’s clear that our payer system is broken and that we have people whose care is not compensated at all or not at the rate that it needs to be to keep these facilities financially thriving,” she said.
Even if a patient is insured, some hospital administrators surveyed pointed out that underinsurance can create problems for patients and hospitals as well. High deductibles and plans with limited coverage options shift the responsibility for payment from the insurance company to the patient.
An administrator from the Midwest told the researchers, “Even the people who have the ability to pay, when you have more things like a high deductible health plan, no matter what your income is, it’s not easy for very many people if you have a $5,000 deductible. When that bill comes, that’s a difficult thing.”
Alan Morgan, CEO of the National Rural Health Association, said when rural hospitals don’t get paid, the impact is far reaching. Hospitals are typically among the largest employers in rural communities, and if a hospital fails because it can’t pay its bills, the whole community suffers.
“We’re in the midst of a hospital closure crisis and declining points of access to care in rural communities and it is because of bad debt, period,” Morgan said in an interview with the Daily Yonder. “When a hospital has to find ways to write off bad debt… for a lot of these rural hospitals, they’re operating on the margin and carrying large amounts of debt and uncompensated care that sometimes drives them to closure.”
When hospitals close due to financial problems, the economic hit on the community is multi-faceted, he said. The lost jobs not only reduce tax revenue coming into the community, but also impact the amount of consumer dollars being spent in the community. It means less income for businesses indirectly linked to the hospital, like flower shops, he said. And once the hospital closes, getting new families and businesses to move there becomes more difficult.
Fixing the issue will mean reforming how rural hospitals are reimbursed, Henning-Smith said.
“The message needs to continue to be about payment reform and understanding that medical debt is a widespread issue that’s not going away, but it’s not an individual issue and it’s not a matter of personal and individual responsibility,” she said. “It’s a community and a collective and a societal issue that if we don’t address, it’s not going to only impact the health and access to care of individuals, but it’s also going to impact availability of care in rural communities and places that need that care the most.”
Liz Carey wrote this article for The Daily Yonder.
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Researchers at the University of Oregon say a new online parenting skills program has helped improve mental health for rural Oregon families.
After using the app, called Family Check-Up, for three months, parents reported a decrease in depression symptoms and increased confidence in their parenting.
Kate Hails, research associate for the Prevention Science Institute at the University of Oregon, said the program uses techniques like focusing on parents' strengths and children's positive behaviors.
"Family Check-Up really views the parent as the expert on their own parenting in their own family and focuses on their own personal goals," Hails explained.
Hails pointed out the app is for families with young children and is based on an in-person program. She added it is designed to help rural families who face challenges with transportation, scheduling or stigma, preventing them from getting mental health support.
About a third of the parents in the study had significant levels of depression when they enrolled, and about a third were at risk for opioid misuse. Hails stressed the program starts with parents' own wellness.
"We know from research that parents really need to be able to regulate their emotions in challenging moments with toddlers because that will happen regardless of how effective of a parent you are," Hails emphasized.
Parents access the program through their smartphones. It has science-backed lessons and opportunities to meet online with trained parenting coaches. Hails explained parents can work through the program at their own pace and meet with counselors on their own time, allowing them to multitask if needed.
"That kind of squeezing it into life is not really possible when we think of traditional mental health or even like kind of telehealth zoom sessions," Hails observed.
The next step, Hails added, is to gauge the effectiveness of the program over a longer time period with trained providers who are not involved in the research.
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Rural West Virginia counties are already facing shortages of home health care services and nursing home workers. Now, they are facing accusations of alleged misconduct by contract workers in state nursing homes.
A new lawsuit cited a "systems failure" from top to bottom, where officials have allowed front line workers to act in ways that harm patients.
Michael Folio, legal director for the nonprofit Disability Rights of West Virginia, the group behind the lawsuit, outlined its goals.
"What we've identified is even the regulatory bodies in West Virginia that are charged with overseeing these facilities are so understaffed, so underfunded, that we oftentimes are reporting incidents to them, even though it's their job to actually uncover these incidents and take appropriate action," Folio explained.
The lawsuit alleged state officials knew about abuse, harassment, and retaliation of fellow employees and patients. According to the health care advocacy group KFF, there were more than 9,400 people living in certified nursing home facilities in West Virginia in 2024.
Folio pointed to documented incidents of abuse and neglect over the past year in state long-term care facilities. One case is now under criminal investigation, where hot water temperatures were said to reach between 134 and 140 degrees.
"What did they do? They ignored it for five months," Folio contended. "They placed an elderly gentleman who had dementia and he was nonverbal in this water and left him there."
According to the National Rural Healthcare Association, rural health facilities still have severe staffing shortages with fewer clinicians per capita, and sicker and older patients on average compared to urban areas.
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