The Rural Policy Research Institute - RUPRI

06/01/2026

New RUPRI Center brief: MEDICARE ADVANTAGE ENROLLMENT UPDATE 2025
This policy brief is part of the RUPRI Center's ongoing annual series analyzing Medicare Advantage (MA) enrollment trends. It examines both total and rural/urban (nonmetropolitan/metropolitan) enrollment patterns, as well as shifts in the types of MA plans selected by beneficiaries. The brief also explores how past policy changes may have influenced these enrollment dynamics.
Key Findings:
• MA enrollment in 2025 grew 1.5 percent from 2024, marking the smallest annual increase in a decade. However, growth remained higher in nonmetropolitan counties (2.5 percent) than metropolitan counties (1.4 percent).
• Despite past projections, nonmetropolitan MA pe*******on did not exceed 50 percent in 2025. Instead, it reached 49.2 percent, compared to 56.8 percent in metropolitan counties.
• Much of the growth in nonmetropolitan MA enrollment remains in local preferred provider organization plans.

Click for full brief -
https://rupri.public-health.uiowa.edu/publications/policybriefs/2026/2025%20MA%20Enrollment%20Update.pdf

05/21/2026

New policy brief from the RUPRI Center for Rural Health Policy Analysis -
Changes in Staffing, Resident Health, Closure, and Financial Performance of Rural Nursing Homes from 2017 to 2022

by Gulrukh Mehboob, MS; Hari Sharma, PhD; Fred Ullrich, BA; Keith Mueller, PhD

In this study, we will compare the changes in resident health status as well as average nursing home staffing levels for registered nurses, licensed practical nurses, and certified nurse aides from 2017 to 2022. We will also evaluate nursing home closure and financial performance for rural and urban nursing homes from 2017 to 2022.

Click here to read full brief:https://rupri.public-health.uiowa.edu/publications/policybriefs/2026/Nursing_Home_Staffing_and_Performance.pdf

05/02/2026

Magazine article published in the April 2026 issue of Good Day!
RUPRI work highlighted work from the Rural Wealth Framework and the Future of Rural Health Summit. www.rupri.org

📬 Now arriving in mailboxes across the country!
The April 2026 issue of Good Day! magazine focuses on the question "How do we define 'Rural America?'" With more than a dozen definitions, it's not as easy as you think.
This issue also includes information about Grange programs, introduces a new "Health & Wellness" section, and welcomes spring with recipes featuring fresh, seasonal produce and herbs... and more!

Not a subscriber yet? Visit https://www.nationalgrange.org/goodday to subscribe today, or visit the Grange Store to order a copy.

04/20/2026

The Rural Policy Research Center has released a new brief, Trends Among Medicare Special Needs Plan Enrollment in Metropolitan and Nonmetropolitan Areas -https://rupri.public-health.uiowa.edu/publications/policybriefs/2026/SNP_Enrollment_Trends.pdf
This brief examines recent trends in Medicare Advantage Special Needs Plan (SNP) enrollment by type and geographic variation across metropolitan and nonmetropolitan areas.

03/19/2026

The RUPRI Health Panel releases a new brief -

The Importance of Long-Term Services and Supports to a High-Performance Rural Health System: Demographic, Policy and Economic Challenges

Prepared by the RUPRI Health Panel: Alva O. Ferdinand, DrPh, JD; Mark Holmes, PhD; Alana D. Knudson, PhD; Jennifer P. Lundblad, PhD, MBA; A. Clinton MacKinney, MD, MS; Timothy D. McBride, PhD; and Keith J. Mueller, PhD (Chair)

The long-term services and supports (LTSS) system is an important element of a high performing rural health system. The purpose of this Policy Brief is to assess the potential for transforming the LTSS system while it faces considerable challenges driven by demographic, economic and policy forces. The policy forces include the potential impact of planned expenditure reductions to Medicaid over the 2026-2034 period, with intended as well as unintended effects. Clickhttps://rupri.org/wp-content/uploads/LTSS-Brief-by-Health-Panel_FINAL.pdf to read full brief.

12/02/2025

Congratulations!! Dr. Whitney Zahnd, assistant professor of health management and policy and deputy director of the RUPRI Center for Rural Health Policy Analysis, was named the 2025 recipient of the Iowa Rural Health Association (IRHA)’s Jerry Karbeling Award. This annual award honors exceptional rural health leaders who demonstrate outstanding advocacy, innovation, and commitment to improving health and well-being across Iowa’s rural communities. Named in memory of Jerry Karbeling, a visionary leader and tireless advocate for rural health, this award recognizes individuals who exemplify the spirit of collaboration, service, and leadership that strengthen Iowa’s rural health system and advance IRHA’s mission. She received the award on November 20th ( National Rural Health Day) as part of IRHA’s annual conference.

11/19/2025

Mueller live in studio - IPR News, River to River. November 2025
What federal cuts to Medicaid mean for Iowans' healthcare
A discussion on how federal cuts to Medicaid will impact Iowans and rural healthcare.

River to River is a conversation about the news with an Iowa perspective. Together we dig into the story behind the headlines - we talk with newsmakers and a diverse range of experts to find out how the news affects you. We take on challenging topics, explore issues from all sides, and foster conver...

11/14/2025

Keith Mueller was recently cited in the Daily Iowan, "Iowa’s rural hospitals brace for impacts from Medicaid changes".

Grace Nelson, a third-year University of Iowa student from Sioux City, Iowa, was diagnosed with spinal muscular atrophy at 18 months old and has been a powered wheelchair user since she was 3. Nelson uses a personal care attendant for 14 to 18 hours a day, seven days a week — a program paid for...

10/07/2025

The October 2025 episode of RHIhub's podcast features an interview with Dan Shane, Associate Professor with the RUPRI Center for Rural Health Policy Analysis. We examine opportunities for applying technological advances in rural health and human services, potential challenges, and future avenues of....

10/01/2025

New policy brief - Health Insurance Coverage in Rural and Urban Areas in the U.S., 2023

This brief outlines the health insurance status of people in the United States, by residence (rural and urban) in 2023, with additional breakdowns by age groups.
Full brief -https://rupri.public-health.uiowa.edu/publications/policybriefs/2025/Health_Insurance_Coverage.pdf