HJAR Jan/Feb 2025

HEALTHCARE JOURNAL OF ARKANSAS I  JAN / FEB 2025 15 Editor Are there state or federal funding programs currently helping sustain rural healthcare in Arkansas? What additional support is needed? Boagni Yes, but the resources are still limited. Right now, federal initiatives like the Rural Hospital Stabilization Program, funded by HRSA through the National Rural Health Resource Center, offer technical assistance to help rural hospitals enhance or expand the services that keep them afloat. Another major program, the Delta Region Community Health Systems Development Program, also funded by HRSA, takes a similar approach by strengthening the overall healthcare infrastructure in Delta communities, improving everything from clinical protocols to facility management. On top of that, the Small Rural Hospi- tal Improvement Program (SHIP) supports states in helping their smallest rural hospi- tals navigate value-based payment mod- els and quality-improvement initiatives. Through each state office of rural health, SHIP funds can cover hardware, soft- ware, training, and even help hospitals join accountable care organizations or shared savings programs. The USDA also offers grants and low-interest loans for critical healthcare infrastructure, such as facility upgrades or new equipment. What’s missing? For starters, we need more flexible and sustained funding streams. A lot of these programs provide short-term assistance or strictly targeted grants, which can expire right when hos- pitals are starting to see real progress. We also need a more comprehensive approach to workforce development, including new pipelines for training and retaining rural health professionals. Finally, telehealth and broadband expansion funds, while improv- ing, still fall short in many parts of the state. If these programs were expanded, rural healthcare providers could better serve patients locally and keep their doors open. Editor According to The New England Journal of Medicine , the implementation of Medicaid work requirements in Arkansas resulted in over 18,000 individuals losing coverage, with many unaware of the requirements or unable to navigate the reporting process. This led to delayed care and increased financial hardship. How do you think these requirements affected access to care for rural residents? What lessons can be learned to ensure policies don’t inadvertently harm vulnerable populations? Boagni Honestly, it was devastating for many rural Arkansans and placed an even heavier burden on local clinics and hospitals already operating on thinmargins. By losing coverage, people lost access to primary care providers, leading to worsening chronic conditions and a greater reliance on emergency care. The bottom line is that policies must account for real-life challenges like varying work schedules, limited internet access, and basic health literacy. One proven way to do this is by tapping into community health workers (CHWs). Since they already know and trust the people in their hometowns, CHWs can help residents navigate the paperwork, stay informed about deadlines, and make sure no one slips through the cracks. Editor Rural hospitals in Arkansas, already operating on thin margins, faced increased financial strain due to Medicaid work requirements, as the rise in uninsured patients led to a projected 4.9%–5.1% decline in operating margins, according to The Commonwealth Fund. What was the impact of these requirements on rural hospitals’ ability to provide care? What policy changes could better support these critical institutions while maintaining program accountability? Boagni Rural hospitals in Arkansas were already balancing on a razor’s edge, so a 4.9%–5.1% drop in operating margins was nothing short of crippling. Suddenly, these facilities had fewer resources to cover everyday costs like payroll and supplies, even as uninsured patients needed more care. The result? Many hospitals had to cut back on services or delay investments in critical upgrades, further widening the healthcare gap for rural residents. A more thoughtful policy approach could ease the strain without compromising accountability. That might include tiered reporting requirements — so lower-volume, rural hospitals face fewer administrative hurdles — or extra financial support for organizations that serve a high percentage of uninsured patients. We also need programs to train and retain CHWs who can help uninsured individuals understand new coverage rules or sign up for assistance. Ultimately, strengthening the financial stability of rural hospitals is about ensuring that Arkansans — no matter where they live — can count on accessible and quality care. Editor Northwest Arkansas has been making significant strides in healthcare transformation through the work of the Northwest Arkansas Council’s Health Care Transformation Division and the Heartland Whole Health Institute. Is your organization involved with their efforts? Do you think their model — emphasizing workforce development, graduate medical “When healthcare teams, community partners, and local farmers all collaborate, we can start knocking down the social and logistical barriers that keep people from accessing healthier food options in rural Arkansas.”