California State Rural Health Association

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California State Rural Health Association

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Improving the quality and length of life
of rural Californians through advocacy, collaboration and education.

10/21/2026

Critical access hospitals now face a new schedule for checking whether they still meet Medicare's rural location and distance rules.

A Centers for Medicare & Medicaid Services memo issued August 21 took effect September 20. A review is now triggered when a new hospital opens nearby or a facility applies for the designation, and every critical access hospital will be reviewed every ten years starting in 2033.

A hospital found out of compliance generally gets about two years to reclassify, convert to a rural emergency or acute care hospital, or leave Medicare.

If your hospital is planning a new off-campus site, get a CMS determination before you commit.

Read the CMS memo: bit.ly/4cVWwKq

10/14/2026

A pilot fund meant to keep rural labor and delivery units staffed will not move forward.

Governor Newsom vetoed AB 1882 (Ellis) on September 18, after the bill passed the Legislature without a single no vote. The Safe Delivery Fund Pilot Program would have let the Department of Health Care Access and Information pay hospitals serving geographically isolated communities up to $5 million a year to keep obstetric staff on hand through stretches with few births.

Low and unpredictable birth volume is the core problem for rural birthing units, and each closure adds miles to the drive for expectant parents. Ridgecrest Regional Hospital was among the hospitals expected to benefit.

Read the bill and its history: bit.ly/4xZFTFn

10/07/2026

Medi-Cal's new work and renewal rules start in January, and the notices explaining them have already gone out to about 4.8 million members.

The Department of Health Care Services began mailing the federally required letters to Medi-Cal's adult expansion group the week of August 31. Starting in 2027, members who are not exempt will need to show about 80 hours a month of work or other qualifying activity, and renewals move to every six months.

A new state law, AB 2161, signed September 14, adds safeguards before anyone loses coverage: a chance to fix conflicting data, 30 days to respond, and good cause when a notice never arrived.

Rural enrollees face the longest odds, with fewer in-person offices, weaker broadband, and slower mail. Front-desk staff who can explain the letter will keep more patients covered.

More from DHCS: bit.ly/4cVWtOK

10/05/2026

California's rural providers have a direct line to federal and state agencies this month.

The Centers for Medicare & Medicaid Services (CMS), the Health Resources and Services Administration (HRSA) and the California Department of Health Care Access and Information (HCAI) State Office of Rural Health are hosting three free virtual sessions, one for each facility type. Each opens with agency updates on policy, funding and resources, followed by an open listening session for your questions and feedback.

Wednesday, October 14, Critical Access Hospitals: bit.ly/4hxiSTJ
Wednesday, October 21, Federally Qualified Health Centers: bit.ly/4rEaxlP
Wednesday, October 28, Rural Health Clinics: bit.ly/4y0wsWa

All sessions run 12:00 to 1:30 p.m. Pacific. Registration is required, and if your date does not work, you are welcome at another session.

09/16/2026

Federal money for new health center sites landed in the Central Valley last month.

The U.S. Department of Health and Human Services announced $102 million in New Access Point awards in August, funding 158 health centers and 415 new sites expected to reach close to one million people. HHS made the announcement at Castle Family Health Center in Atwater, which was selected from more than 600 applicants and now joins the federally qualified health center program.

HRSA-funded centers already serve one in five rural residents nationwide, so this round matters well beyond the sites named in it.

Organizations that applied should watch for their award notice. Those that did not should start tracking the next New Access Point cycle now, because the application window is short relative to the work a competitive submission takes.

Read the announcement: bit.ly/4x2yhBu

09/09/2026

Rural clinics and emergency departments without a local prescriber now have somewhere to send patients the same day.

California launched CA Bridge Connect in August, a free and confidential call and text line billed as the first statewide service of its kind in the country. Behavioral Health Navigators assess what a caller needs, make real-time referrals to treatment sites and telehealth providers, and can arrange Medication for Addiction Treatment when it is appropriate.

It is open to patients, families, caregivers, and clinicians regardless of insurance. Reach it at 1-800-944-1807 or by text at 1-833-308-0461, Monday through Friday, 9:00 a.m. to 5:00 p.m. Pacific.

For rural California the value is the referral itself. A site that cannot start treatment locally can still hand a patient a number that connects them to someone who can.

More details here: bit.ly/4gVumBm

09/02/2026

California has more Medicaid hospital funding exposed to the new federal payment limits than any other state.

A KFF analysis published in August puts the figure at $7.4 billion a year in federal spending on state directed payments that sits above the new caps. State directed payments are how a state requires its Medi-Cal managed care plans to pay providers at set rates, and California has used them heavily to lift hospital reimbursement above the base Medi-Cal rate.

The 2025 reconciliation law replaced the old commercial rate benchmark. Medicaid expansion states like California are capped at 100 percent of Medicare, and existing payments step down 10 percentage points a year starting in January 2028. At least 37 states have hospital payments above the new limits.

Rural hospitals draw a larger share of revenue from Medi-Cal than urban systems do, so the same percentage cut lands on a thinner base. CMS has not finalized the rule, which makes this the window to model the 2028 step-down against your own payer mix.

Read the full analysis: bit.ly/4c8OVI2

08/22/2026

New episode of This Is Rural Health: Rural Aging Policy, featuring Dr. Pauline DeLange Martinez, research and community engagement manager at the UC Davis Betty Irene Moore School of Nursing's Family Caregiving Institute.

Nearly one in eleven Californians age 65 and older lives in a rural community, and California's population age 85 and older is projected to grow 158 percent between 2025 and 2040. Dr. DeLange Martinez draws on a two-year Rural Master Plan for Aging initiative across three California regions and 227 community participants, covering hidden homelessness and manufactured-home costs, the shortage of direct care workers, the pressure on family caregivers, long travel distances to care, dementia care, and transportation barriers.

She also walks through the policy responses: expanding home- and community-based services, building the rural direct care workforce, widening telehealth and community paramedicine, and writing older adults into California's Rural Health Transformation Plan.

Listen to the full episode at csrha.org/podcast.

08/19/2026

Rural sites that were told their shortage area designation was headed for withdrawal have more time.

HRSA announced on July 1 that designations flagged in its 2025 national review will stay in Proposed for Withdrawal status rather than being withdrawn. State Primary Care Offices now have until the next federal notice, due on or before July 1, 2027, to review the data and submit corrections. Roughly 100 of California's 374 primary care designations were headed for withdrawal, according to Hospital Council reporting in March. The reprieve does not cover withdrawals a state requested itself.

Health Professional Shortage Area status governs loan repayment eligibility. Confirm your site's standing before the California State Loan Repayment Program closes September 15.

Learn more here: bit.ly/4x8SOo3

08/13/2026

This is the last call before the CalRHT application deadline closes on August 14. If your organization hasn't created a Partnership Directory profile yet, please do it this week.

It only takes about 10 minutes, and being listed gives you a real shot at finding a partner before applications close.

Please have just one person per facility complete the profile so the matching stays accurate.

Create your profile: https://vist.ly/5epjy

Address

Folsom, CA
95630, 95671, 95763

Website

http://www.csrha.org/

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