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Department of Health and Human Services
The National Advisory Committee on Rural Health and Human Services
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April 7, 2011, Thank you and Highlights of February 2011 Meeting

April 7, 2011

The Honorable Kathleen Sebelius, Secretary
U.S. Department of Health and Human Services
200 Independence Ave, SW
Washington, D.C. 20201

Dear Secretary Sebelius,

The Committee would like to thank you for attending our winter meeting, on February 24 in Washington, D.C. After 13 years without an address from the sitting Secretary, we were honored to have you join us. We also appreciate Dr. Mary Wakefield’s continuing role and support of the Committee’s activities.

As we discussed at the meeting, we are sending you a series of white papers on key aspects of the Affordable Care Act and their implications for rural America. Enclosed are white papers with policy recommendations on Health Insurance Exchanges and the Community-Based Care Transitions Program. In the coming weeks we will send you an additional white paper on the Maternal, Infant, and Child Home Visitation Program. It is our hope that the issues raised in these papers and the recommendations will help assist the Department as it implements these provisions.

We appreciate your remarks and your willingness to address some of the issues raised during our discussion.  As we discussed there is an ongoing challenge in making sure rural populations are adequately included in broad HHS investments focused on public health as well as many of the pilots and demonstrations on health system redesign that will emerge from the Affordable Care Act.  One challenge stems from working with small numbers in a statistically valid way.  We appreciate your willingness to ask Dr. Wakefield to work with her colleagues from the Centers for Medicare and Medicaid Services and the Agency for Research and Quality.  We look forward to hearing about potential strategies to deal with these issues.

The Committee was also encouraged by your interest in addressing “disparities issues,” as this has been a longstanding challenge in rural communities.  We will review the one-year summary document on public health investments from the Centers for Disease Control under the ACA.  We also share your concern about how to better manage the population that is dually eligible for both Medicare and Medicaid.  This has been an ongoing challenge for rural areas where the dually-eligible population makes up 12.4 percent of the population compared to 10.5% in urban areas. The Committee will focus on disparities when it conducts a field meeting in Hattiesburg, Mississippi in September. 

During our meeting, we also heard a presentation on Section 5507 of the ACA which supported a collaboration between HHS and the Labor Department to train welfare recipients in high-growth health care fields.  The Committee believes such cross-Departmental efforts are worth repeating but we were concerned that almost all of the funds went to urban communities.  This was an opportunity lost for rural communities.  If HHS and Labor were able to support a similar initiative in the future it will be important to ensure broader rural participation.  In addition, there is a need to ensure better coordination between HHS activities related to Temporary Assistance to Needy Families and the Workforce Investment Act programs at the Department of Labor.  

As you continue with the implementation of the Affordable Care Act, we will continue as a Committee to advocate on behalf of rural America. As leaders in our communities we take seriously your charge to be messengers about the positive benefits of what is on the horizon and how it can improve rural health care delivery.

Thank you again for the opportunity to share highlights from our recent meeting and to raise specific concerns. We would welcome having you or your designee join us for our next Committee meeting in Traverse City, Michigan on June 15-17, 2011.

Please let us know if we can assist you in any way.


The Honorable Ronnie Musgrove