An Alabama group is sounding the alarm about the need for Medicaid expansion, in part to keep rural hospitals in business.

Many hospitals in Alabama are becoming what's known as Emergency Rural Hospitals, reducing their services to emergency-only operations and eliminating inpatient care.

Debbie Smith, Cover Alabama campaign director for the group Alabama Arise, said it is largely due to financing, noting Medicaid reimbursement rates are too low to cover the cost of care.

She is particularly concerned without inpatient services, maternity care may be limited, sending women to other areas, even for routine care.

"A lot of women just can't afford to do that," Smith pointed out. "They don't have the transportation, or a lot of people would have to take off the full day of work just to go see the doctor. So, it's really concerning, and I think that's a real deterrent for people to even go see the OB/GYN and get their regular checkups, which can lead to a lot of issues down the line."

She emphasized the service cutbacks could also limit critical mental health and specialty care access across the state. Grove Hill Memorial Hospital in Clarke County is one of the latest to announce its move to Emergency Rural Hospital status. Hospitals in Bullock, Chambers and Monroe counties have done the same.

The Emergency Rural Hospital designation was created by Congress under the 2021 Consolidated Appropriations Act. It provides hospitals with higher reimbursement rates and financial assistance to help keep them afloat.

Smith believes one way to improve health outcomes is through Medicaid expansion.

"We have seen from other states that there's a much less likely chance of our rural hospitals closing in expansion states; it's proven," Smith asserted. "Medicaid expansion can really help with helping out on those costs and helping with uncompensated care costs."

Smith added Gov. Kay Ivey could use her executive authority to expand Medicaid. Alabama is one of only 10 states to have not done so, leaving nearly 300,000 people in the "coverage gap," who work but make too much money to qualify for Medicaid and not enough to afford traditional health insurance.

Seven cases of H5N1 avian flu have been reported in Michigan since Dec. 16. The first case was discovered at a poultry facility in Ottawa County.

Avian flu circulates in wild birds and can infect poultry, causing illnesses classified as highly or low pathogenic. Michigan's first cases in 2022 introduced a highly pathogenic strain.

Dr. Kimberly Dodd, dean of the College of Veterinary Medicine at Michigan State University and an infectious disease expert, explained why the initial outbreak was unique.

"Generally, once it comes to wintertime the number of cases drop off and sometimes that's all we see at the outbreak, and it's resolved," Dodd noted. "In this case, the outbreak continued over the winter and spread across the entire country."

The recent outbreak has affected more than 340,000 birds. Early findings showed the virus also infecting wild mammals, especially young carnivores and scavengers, later spreading to marine mammals near infected waterfowl.

As of now, avian flu has been detected in 30 dairy cattle herds across Michigan. The initial case, reported in March 2024, marked the first instance of avian flu in dairy cattle in the U.S. Since then, the virus has spread to additional herds around the state. Dodd pointed out dozens of domestic and wild cats were also infected after the virus spread to dairy cattle.

"We think this is primarily due to the fact that these barn cats may have access to raw milk on the farm," Dodd emphasized. "We know that raw milk contains high levels of virus."

The Centers for Disease Control and Prevention has reported 67 confirmed human cases of avian flu in the United States, with one death reported in Louisiana. However, the CDC views the situation as a low health risk to the public.


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The Medicaid and CHIP programs are vital to rural Missouri, according to a report that says reliance on this safety-net health coverage is much higher in small towns than in cities - especially for children.

The Georgetown University report says proposed federal cuts threaten rural communities, where nearly 41% of children rely on Medicaid, compared to 38% in metro areas.

Dr. Shanon Luke, a pediatrician at a Federally Qualified Health Center in rural Missouri, said her clinic is essential to a community where the nearest hospital is 45 minutes away.

"The clinic being open is incredibly important to these kids receiving healthcare," said Luke. "Having Medicaid allows them to come in for their well-child checks, and for us to do some monitoring and treating of things before they get to scary points."

The report says to stay afloat, many rural hospitals have already been forced to close less profitable units. In 2022, 52% eliminated their maternity wards, compared to 36% of urban hospitals.

The report also reveals disparities, with about 40% of American Indian and Alaska Native people more likely to live in non-metro areas without access to adequate healthcare.

Joan Alker is the executive director and co-founder of the Center for Children and Families at Georgetown University. She said Medicaid helps recipients through much-needed preventive care.

"People wind up sicker and then, they're in the emergency room," said Alker, "and children can't get their asthma inhalers and they miss school."

Statistics show Medicaid helps prevent medical debt, covers most nursing home residents, and funds a significant portion of births and maternal care - issues Dr. Luke said her patients are familiar with, firsthand.

"For our families, both financially and medically, as well as mentally," said Luke, "it's really important to know that they have that coverage."

Just over 24% of Missouri's population lives in rural areas.

This month is National Blood Donor Month, and blood donor groups are making sure people know the importance of giving blood.

Blood can't be manufactured, so people need to donate blood at their local blood bank. Nearly 400 people a day donate blood to the American Red Cross in the DMV metro area.

Bethany Bray Patterson, communications director of the National Capital and Greater Chesapeake Region of the American Red Cross, said donor blood is used in a variety of medical situations.

"Donated blood," said Patterson, "goes to people who are heading into surgery, fighting cancer, newborn babies in the NICU and people who are living with sickle cell disease and other chronic illnesses."

Patterson added that someone in the U.S. needs a life-saving blood transfusion every two seconds.

However, only 3% of eligible donors donate each year. According to America's Blood Centers, if just 1% more of Americans donated, blood shortages would be alleviated.

Patterson said the blood supply in the country is stable, but organizations like the Red Cross are also on the look out for universal donors.

"There is an increased need right now for type O blood donation, and platelet donations," said Patterson. "Type O blood is always in demand. It's often going out to hospitals faster than it's coming in through blood donation, because it is the universal blood type. It's used the most by hospitals."

You can find blood donation locations and schedule an appointment at RedCrossblood.org.




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