By: Program and Policy Committee 

AzRHA recognizes the threats to Medicaid coverage across Arizona

Cuts to Medicaid would mean fewer Arizonans with health care coverage, resulting in more individuals delaying care until they are sicker and requiring more costly interventions.  It would also increase uncompensated care burdents for hospitals and clinics, many of which already operate with limited resources.  Nationwide, adults under 65 and children in small towns and rural areas are more likely to be enrolled in Medicaid than their urban counterparts.

Medicaid in Arizona: Essential Coverage, Powerful Federal Support

Arizona’s Medicaid program, the Arizona Health Care Cost Containment System (AHCCCS), plays a vital role in covering low-income residents—supported heavily by federal funding through the Federal Medical Assistance Percentage (FMAP). FMAP is calculated using a state’s per capita income over three years; the lower a state's income compared to the national average, the higher the FMAP. By law, the federal government pays at least 50% of Medicaid costs.

For Fiscal Year 2025, Arizona’s FMAP is 64.34%, meaning for every $1 the state spends, the federal government contributes $1.80. Some Medicaid enrollees, specifically those eligible through Arizona’s 2014 Medicaid expansion to 138% of the federal poverty level (FPL), are covered at an even higher federal match rate of 90%.

Arizona’s Medicaid Expansion Supports 500,000—but Faces a Funding Trigger Risk

Arizona’s Medicaid expansion, launched by voters through Proposition 204 in 2000 and extended by the legislature in 2014, currently covers over 500,000 low-income adults and children. Funded through provider taxes returned to health care facilities, the program expanded eligibility up to 138% of the federal poverty level—$35,632 for a family of three in 2024. However, this coverage is at risk: a state law trigger would end the expansion if the federal funding match (FMAP) falls below 80%, also eliminating the hospital assessment that funds the program.

AzRHA’s Commitment to Rural Health Access

AzRHA remains committed to advocating for policies that protect and strengthen Medicaid coverage across Arizona. In partnership with other healthcare stakeholders, we continue to support efforts that preserve this critical funding stream and ensure equitable access to care for rural residents.

Medicaid Cuts Could Leave Half a Million Arizonans Without Coverage

If proposed Medicaid cuts move forward this fall, more than 500,000 Arizonans could lose their AHCCCS coverage—jeopardizing access to care for some of the state’s most vulnerable residents. The effects would be far-reaching: health insurers could lose hundreds of thousands of enrollees, while hospitals and physicians would face a steep rise in uncompensated care. Rural and critical access hospitals could be forced to shut their doors, and emergency rooms would likely become overwhelmed as uninsured patients turn to them for care they can no longer afford elsewhere. These cuts don’t just threaten coverage—they risk destabilizing Arizona’s entire rural health care infrastructure.

Lawmakers are currently considering proposals which would reduce the amount contributed by the Federal government. Arizona residents covered under Prop 204 and the ACA Expansion are at the greatest risk. 

Today, the U.S. Department of Health and Human Services (HHS) announced a dramatic restructuring in accordance with President Trump's Executive Order, "Implementing the President's 'Department of Government Efficiency' Workforce Optimization Initiative."

The restructuring will address this and serve multiple goals without impacting critical services. First, it will save taxpayers $1.8 billion per year through a reduction in workforce of about 10,000 full-time employees who are part of this most recent transformation. When combined with HHS' other efforts, including early retirement and Fork in the Road, the restructuring results in a total downsizing from 82,000 to 62,000 full-time employees.

Secondly, it will streamline the functions of the Department. Currently, the 28 divisions of the HHS contain many redundant units. The restructuring plan will consolidate them into 15 new divisions, including a new Administration for a Healthy America, or AHA, and will centralize core functions such as Human Resources, Information Technology, Procurement, External Affairs, and Policy. Regional offices will be reduced from 10 to 5.

Third, the overhaul will implement the new HHS priority of ending America's epidemic of chronic illness by focusing on safe, wholesome food, clean water, and the elimination of environmental toxins. These priorities will be reflected in the reorganization of HHS.

Finally, the restructuring will improve Americans' experience with HHS by making the agency more responsive and efficient, while ensuring that Medicare, Medicaid, and other essential health services remain intact.

"We aren't just reducing bureaucratic sprawl. We are realigning the organization with its core mission and our new priorities in reversing the chronic disease epidemic," HHS Secretary Robert F. Kennedy, Jr. said. "This Department will do more – a lot more – at a lower cost to the taxpayer."

The specific contents of the restructuring plan that have been announced so far are as follows:

• Creation of the Administration for a Healthy America (AHA), which will combine multiple agencies - the Office of the Assistant Secretary for Health (OASH), Health Resources and Services Administration (HRSA), Substance Abuse and Mental Health Services Administration (SAMHSA), Agency for Toxic Substances and Disease Registry (ATSDR), and National Institute for Occupational Safety and Health (NIOSH) - into a new, unified entity. This centralization will improve coordination of health resources for low-income Americans and will focus on areas including, Primary Care, Maternal and Child Health, Mental Health, Environmental Health, HIV/AIDS, and Workforce development. Transferring SAMHSA to AHA will increase operational efficiency and assure programs are carried out because it will break down artificial divisions between similar programs.
• Strengthening the Centers for Disease Control and Prevention (CDC): the Administration for Strategic Preparedness and Response (ASPR), responsible for national disaster and public health emergency response, will transfer to the CDC, reinforcing its core mission to protect Americans from health threats.
• New Assistant Secretary for Enforcement: HHS will create a new Assistant Secretary for Enforcement to oversee the Departmental Appeals Board (DAB), Office of Medicare Hearings and Appeals (OMHA), and Office for Civil Rights (OCR) to combat waste, fraud, and abuse in federal health programs.
• Research and Evaluation for Health Policy: HHS will merge the Assistant Secretary for Planning and Evaluation (ASPE) with the Agency for Healthcare Research and Quality (AHRQ) to create the Office of Strategy to enhance research that informs the Secretary's policies and improves the effectiveness of federal health programs.
• Reorganization of the Administration for Community Living (ACL): Critical programs that support older adults and people with disabilities will be integrated into other HHS agencies, including the Administration for Children and Families (ACF), ASPE, and the Centers for Medicare and Medicaid Services (CMS). This reorganization will not impact Medicare and Medicaid services.

"Over time, bureaucracies like HHS become wasteful and inefficient even when most of their staff are dedicated and competent civil servants," Secretary Kennedy said. "This overhaul will be a win-win for taxpayers and for those that HHS serves. That's the entire American public, because our goal is to Make America Healthy Again."

By Elizabeth Kizer, DrPH

In an exciting development for rural healthcare, the Arizona Rural Health Association (AzRHA), in collaboration with the Arizona State Office of Rural Health (AzSORH), has been awarded a grant to enhance obstetric (OB) care in communities with non birthing Critical Access Hospitals (CAHs). This initiative, which began under the Arizona Rural Hospital Flexibility program (AzFlex), will bring OB simulation training to seven CAHs and communities lacking birthing centers over the coming year, enhancing maternal care and emergency preparedness.

Rural community hospitals are vital in maternity care, delivering 15% of babies in the U.S. However, by 2020, less than half of these hospitals could offer obstetric services, leaving many rural women in Arizona traveling over 100 miles to reach the closest birthing hospital. The Arizona reproductive healthcare Maternal Vulnerability Index is 94/100, indicating an extremely high level of vulnerability for Arizona women. Of all U.S. states, Arizona ranks one of highest in maternal mortality with a rate of 31.4 per 100,000 live births as compared to 23.5 in the US

AzFLEX and the Nurse Midwife program at the University of Arizona developed a novel OB simulation training to address these gaps. The initial training was successfully offered in January 2025 at the White Mountain Regional Medical Center, located 50 miles from the closest birthing center at Summit Healthcare in Show Low. However, expanding the program to other regions across the state was not feasible due to limited resources. 

When funding became available through the National Rural Health Association, the Arizona Rural Health Association (AzRHA) took the lead in expanding OB Simulation training. Partnering with the AzSORH, AzFLEX,  the University of Arizona’s Nurse Midwife program, and Arizona State University’s (ASU) College of Health Solutions,  AzRHA developed a proposal that would expand training to equip non-birthing CAHs and first responders with the skills needed to support emergency OB care in rural communities.The training will be provided to seven CAHs without OB services, including two located in OB deserts, and three serving tribal communities.  The priority hospitals for this initiative include:

1. Copper Queen Community Hospital & Douglas Emergency Department 

2. San Carlos Apache Healthcare Center

3. Hopi Health Care Center

4. Huhukam Memorial Hospital / Gila River Healthcare

5. La Paz Regional Hospital (OB desert) & Parker Indian Healthcare Center (OB desert)

6. Northern Cochise Community Hospital

7. Benson Community Hospital

A graduate student from ASU’s College of Health Solutions, specializing in healthcare systems and quality improvement within the Master of Science in Healthcare Administration and Policy program, will lead the program evaluation and share the findings. The evaluation will focus on measuring changes in participant knowledge, assessing program impact, and conducting interviews with medical personnel to gain insights and establish best practices.  

This collaborative effort underscores AzRHA’s and the SORH's commitment to elevating the standard of care in rural healthcare settings and ensuring all communities have access to quality obstetric services. As the program unfolds, it promises to foster safer birthing experiences and enhance health outcomes in Arizona's rural populations.

If you want to learn more or have questions about this program, please contact AzRHA Board member Elizabeth Kizer (azrhassociation@gmail.com).

The Arizona Rural Health Association is deeply saddened to learn of the passing of Congressman Raul Grijalva, who represented Arizona’s 7^th District with dedication and passion.  We extend our heartfelt condolences to his family and loved ones during this difficult time.

Congressman Grijalva was a steadfast advocate for rural and tribal communities across Arizona. His leadership in tackling critical issues, from safeguarding the Grand Canyon to expanding healthcare access through the Affordable Care Act, has left a profound and lasting impact.  Most memorably, we had the privilege of meeting with him during the National Rural Health Association Policy Institute Capitol Hill visits to discuss rural health concerns in Arizona.

His commitment to equity, access, and the well-being of our communities will not be forgotten. We honor his legacy and the work he championed, knowing that his impact will continue to inspire future efforts in rural health and beyond.

Holly Figueroa,
President
Arizona Rural Health Association

On behalf of the Arizona Rural Health Association (AzRHA) and the National Rural Health Association (NRHA), we are writing to emphasize the critical importance of federal funding-including grants, Medicare, and Medicaid-to rural hospitals, federally qualified health centers (FQHCS) and Rural Health Clinics (RHC)s., where much of the population faces economic hardship and resides in medically underserved areas. Federal funding plays a vital role in ensuring access to quality healthcare for these communities. 

What’s At Stake for Medicaid?

In short, the House resolution passed last night proposes $880 billion in funding cuts from programs under the Energy & Commerce Committee’s jurisdiction. While Medicaid isn’t the only program in this category, it is by far the largest. If the Senate agrees with the House’s plan, we can assume the bulk of the $880 billion in cuts would come from Medicaid. What this looks like exactly has yet to be determined. There have been several Medicaid changes floated by House Republicans, though not yet put into draft legislation. Proposals include mandatory work requirements, scaling back the financial incentive for the Medicaid expansion in 40 states and imposing per capita caps on individual Medicaid enrollees.

What’s Next?

Senate and House leadership must now reconcile their different budget resolutions before crafting legislation that specifically proposes Medicaid cuts. After that, the Senate Finance Committee and the House Energy & Commerce Committee must draft the actual policy changes to Medicaid necessary to generate truly huge savings.

This could take weeks, or months. Every day along the way is an opportunity to reach out to your elected officials to demand they oppose significant cuts to Medicaid.

How Can I Take Action?

If you have five minutes free:

Customize and send a letter to your elected officials and share this link to colleagues, family, and friends: https://thenationalcouncil.quorum.us/campaign/107658/

If you have 15 minutes free: Pick up the phone and dial your elected officials or send an email. Use the below resources:

	Phone number	Share your Thoughts
Senator Mark Kelly DC office	(202) 224-2235	Share Your Thoughts
Senator Ruben Gallego DC office	(202) 224-4521	Contact
Rep David Schweikert District 1 DC office	(202) 225-2190	Contact
Rep Eli Crane District 2 DC office	(202) 225-3361	Contact
Rep Yassamin Ansari District 3 DC office	(202) 225-4065	Contact
Rep Gregory Stanton District 4 DC office	(202) 225-9888	Contact
Rep Andy Biggs District 5 DC office	(202) 225-2635	Contact
Rep Juan Ciscomani District 6 DC office	(202) 225-2542	Contact
Rep Raύl Grijalva District 7 DC office	(202) 225-2435	Contact
Rep Abraham Hamadeh District 8 DC office	(202) 225-4576	Contact
Rep Paul Gosar District 9 DC office	(202) 225-2315	Contact

Share messaging on your social media:

If you have 1 hour free: In-person or virtual meetings with staff from your elected officials’ offices are invaluable. Contact the National Council to help coordinate next steps.

https://thenationalcouncil.quorum.us/campaign/107658/

The Medicaid program is a lifeline for the rural hospitals, providers, and patients. Medicaid cuts will close rural hospitals. Since 2010, nearly 190 rural hospitals have shuttered their doors or stopped inpatient care.¹ Public payers, including Medicare and Medicaid, comprise a larger share of hospital services in rural areas, making rural hospitals more vulnerable to cuts in these programs. Medicaid funding is critical for sustaining rural healthcare systems, including hospitals, clinics, community health centers, and long-term care facilities. Right now, almost half of all rural hospitals across the country are operating with negative margins, meaning that any reductions to Medicaid funding would force many facilities to reduce or eliminate essential services, delay much-needed equipment upgrades, or close their doors entirely. Data shows that Medicaid expansion is strongly associated with improved rural hospital financial viability and substantially lower likelihoods of closure in rural markets.² When a rural hospital closes, not only does the community lose access to vital health care, but a major employer and community lynchpin ends, affecting the economic health of the larger community.

Any cuts to the Medicaid program will disproportionately affect rural communities. Rural Americans rely on Medicaid coverage with about 20% of non-elderly adults and 40% of children living in rural areas enrolled in Medicaid and CHIP.³ In almost all states rural areas have higher rates of Medicaid enrollment than metropolitan areas.⁴ Cuts to Medicaid would shift health care costs onto rural families, many of whom already struggle with financial instability. Medicaid cuts would force families to face higher out-of-pocket expenses, leading many to delay or forgo necessary treatments. This burden would worsen health outcomes, especially for those managing chronic conditions like diabetes, heart disease, and cancer. When a hospital or clinic closes in a rural area residents must travel further to receive basic or emergency care. Right now, rural residents already travel on average two times further to access healthcare compared to their urban counterparts.⁵ Cutting the Medicaid program will cause greater access challenges for rural Americas.

Further, any cuts to one part of the healthcare system will shift costs elsewhere, which makes sweeping Medicaid cuts a serious concern for rural providers. Rural populations are older, tend to rely more on public coverage, and are more likely to be low-income, unemployed, and under- or uninsured.⁶ This means that on average, over 70% of rural hospital revenue comes from public payers – Medicare, Medicaid, and the Marketplace.⁷ Loss of coverage under any of these payers means an increase in uncompensated care that rural providers cannot sustain. NRHA further urges Congress against any cuts to the Medicare program, which aids in keeping rural providers afloat. Maintaining public payers, like Medicaid, supports strong rural health infrastructure that is critical to the future of rural areas. Thank you for your work on behalf of rural Americans.

¹ Rural Hospital Closures, N.C. Rural Health Research Center, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill https://www.shepscenter.unc.edu/programs-projects/rural-health/ruralhospital-closures/. ² Zachary Levinson, Jamie Godwin, Scott Hulver, Rura Hospitals Face Renewed Financial Challenges, Especially in States That Have Not Expanded Medicaid, KFF, Feb. 23, 2023, https://www.kff.org/health-costs/issue-brief/rural-hospitals-facerenewed-financial-challenges-especially-in-states-that-have-not-expanded-medicaid/. ³ Joan Alker, Aubrianna Osorio, & Edwin Park, Medicaid’s Role in Small Towns and Rural Areas, GEORGETOWN CENTER FOR CHILDREN AND FAMILIES, Jan. 15, 2025, https://ccf.georgetown.edu/2025/01/15/medicaids-role-in-small-towns-and-ruralareas/. ⁴ Id. ⁵ Marvellous Akinlotan, et al., Rural-Urban Variations in Travel Burdens for Care: Findings from the 2017 National Household Travel Survey, SOUTHWEST RURAL HEALTH RESEARCH CENTER, July 2021, at ⁵, https://srhrc.tamu.edu/publications/travel-burdens-07.2021.pdf. ⁶ Vann Newkirk & Anthony Damico, The Affordable Care Act and Insurance Coverage in Rural Areas, KFF, May 29, 2014, https://www.kff.org/uninsured/issue-brief/the-affordable-care-act-and-insurance-coverage-in-rural-. ⁷ Zachary Levinson, et al., Key Facts About Hospitals: Rural Hospitals, KFF, Feb. 19, 2025, https://www.kff.org/key-factsabout-hospitals/?entry=rural-hospitals-rural-discharges-by-payer.

As we come to the close of another year, I would like to take a moment to wish everyone a joyous and peaceful holiday season. This is a time to reflect on all that we have faced and overcome together, and to celebrate the many accomplishments that have strengthened rural health in Arizona.

Your dedication and resilience in addressing the unique challenges of rural communities continue to inspire. It is through this collective effort that we ensure better health outcomes and create lasting impacts for those we serve.

I hope you take the holiday season to reflect, recharge, and find gratitude in the progress we’ve made together. May this time bring you renewed inspiration and a strengthened spirit of community as we look ahead to 2025 with hope and determination.

Thank you for all that you do. Wishing you health, happiness, and success in the year to come.

Respectfully,

Holly Figueroa
President
Arizona Rural Health Association

The Arizona Rural Health Association encourages all members and attendees to exercise your rights at citizens and vote for your preferred candidates for office.  Below includes important information as we approach election day in November.

Important Election Dates

• General Election Day: November 5^th (6 a.m. to 7 p.m.)
• Voter Registration Deadline: October 7^th
• Early Voting Begins: October 9^th
• Last Day to Request Ballot by Mail: October 25^th
• Mail Back Early Ballot: October 29^th
• Last Day to Vote Early in Person: November 1^st at 7 p.m.

Registering to Vote:

If you are eligible and want to vote in the November election, you must register to vote before the applicable registration deadlines, which vary by state and territory. Learn more about registering to vote in your home state at vote.gov, where you will find a guide to voting and information for college students.

In the state of Arizona, Oct. 7^th, is the last day to register to vote. You can complete your Arizona voter registration online, by mail (postmarked Oct. 7), or in person. Eligible voters who will turn 18 on or before Nov. 5 can register to vote by the Oct. 7 deadline. Review the requirements for registering and voting in Arizona

Early Voting Options

https://azsos.gov/elections/about-elections/elections-procedures/early-voting-procedures

County Election Officials Contact Information

https://azsos.gov/elections/about-elections/county-election-officials-contact-information

What ID should I bring to the poles? https://azsos.gov/elections/voters/voting-elections (click on Election Day Voting)

BY SERENA O'SULLIVAN

KTAR.com

Sens. Kyrsten Sinema and Mark Kelly have recently secured over $25 million in federal funds for Arizona.

The money is supporting small businesses, community health centers, workforce training programs, fire prevention and more, according to an announcement from last week.

“I’m proud to deliver strong investments for Arizona — supporting projects and priorities that will grow our economy, protect the health and prosperity of our families and loved ones, secure our border and keep families safe,” Sinema said in a statement.

Both senators secured a variety of investments to support leaders at county, city and local levels. The money will enhance the safety, health, security and economic strength of Arizona’s communities, the senators said.

Recently, CMS released the Medicare Prescription Payment Plan (M3P) Part Two Draft Guidance. The Medicare Prescription Payment Plan is a new program required under the Inflation Reduction Act under which Part D sponsors must provide enrollees the option to pay out-of-pocket prescription drug costs in the form of monthly payments over the course of the plan year, instead of all at once at the pharmacy, beginning in 2025.  A 30-day comment period for the draft part two guidance opened today and concludes on March 16, 2024.

Press Release: https://www.cms.gov/newsroom/press-releases/cms-issues-additional-guidance-program-allow-people-medicare-pay-out-pocket-prescription-drug-costs

Fact Sheet: https://www.cms.gov/files/document/fact-sheet-medicare-prescription-payment-plan-draft-two-guidance.pdf

M3P Draft Part 2 Guidance: https://www.cms.gov/files/document/medicare-prescription-payment-plan-draft-part-two-guidance.pdf

By MADELINE ARMSTRONG | January 17, 2024 
Today's News-Herald

House Representative Selina Bliss has proposed a bill that establishes a Health Care Workforce Advisory Council as well as an Arizona Health Care Workforce Investment Fund that would address the healthcare workforce shortage in Arizona.

“As of January 2022, Arizona ranked among the top 5 states with the most severe healthcare staffing shortages,” reads a press release from the Arizona State Board of Nursing.

Among those most affected by the healthcare workforce shortage are Arizona’s rural communities including Mohave County.

According to a report released from the Arizona Department of Health Services on medically underserved areas in Arizona, Mohave County is home to a number of underserved areas including Lake Havasu City, Bullhead City, Kingman, Golden Valley, Colorado City and the Hualapai Tribe.

Phil Fitzgerald, CEO for Havasu RegionalMedical Center in Lake Havasu City and Valley View Regional Medical Center in Bullhead City, said that staffing shortages are a challenge that his hospitals have faced for years.

“Every range of departments is experiencing some type of shortage,” Fitzgerald said. “We’re not able to open as many beds as we have before. We can’t bring in as many patients as we would like to - people who are trying to access our facility for care, so we do have to send some of those patients outside of their own support area.”

Fitzgerald said that there are a number of reasons why Mohave County is facing a healthcare workforce shortage including the cost of living in the area.

“The area that we’re in; it’s hard. The cost of living has something

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