Background

 

Alabama is the thirtieth largest state and is sometimes called the Yellowhammer State, after the state bird. It is bordered by Tennessee to the north, Georgia to the east, Mississippi to the west, and Florida and the Gulf of Mexico to the south. Montgomery is the state capital and the location of the Central Office of ADPH. The largest urban areas in Alabama are the cities of Birmingham, Mobile, Montgomery, and Huntsville. Birmingham is the largest city in the state and the location of UAB Hospital which has one of the state’s level-one trauma hospitals. Mobile is the state’s port city and the third-largest metropolitan area. It considers itself the cultural center of the Gulf Coast and the birthplace of America's original Mardi Gras. Huntsville, the fourth largest city, has experienced exponential growth in the last 10 years because of its national defense installations and high-technology industries. Huntsville considers itself the star of Alabama. As such, it has become a star in the fight for better community health through the creation of Healthy Huntsville. This effort focuses on the core concepts of nutrition and exercise to encourage its residents to embrace healthy lifestyles.

 

The state of Alabama is divided into eight Public Health Districts and each Public Health District Office is overseen by a district health officer or district administrator. District offices manage CHDs in all 67 counties. CHD staff work to preserve, protect, and enhance the general health and environment of the community by:

• Providing health assessment information to the community
• Providing leadership in public health policy
• Assuring access to quality health services and information, preventing disease, and enforcing health regulations

ADPH operates on a mission to promote, protect, and improve Alabama’s health with a focus on healthy people and healthy communities. In 2019, ADPH leadership released a 5-year strategic plan. The plan focuses on five main areas and goals which are outlined below:

 

Health Outcome Improvement

Goal:  Improve specific health outcomes or health disparities so that Alabama is a healthier place to live and work

 

Financial Sustainability

Goal:  Increase available funds to continue to promote, protect, and improve the health of Alabamaians

 

Workforce Development

Goal:  Strengthen the performance and capacity of the ADPH workforce so that the ability to serve our customers increases

 

Organizational Adaptability

Goal:  Adapt to changes in the healthcare environment so that programs and processes are increasingly effective and efficient

 

Data-Driven Decision Making

Goal:  Become data-driven in analysis and decision-making so that leaders and programs make informed decisions

 

In 2021, the ADPH Office of Health Equity and Minority Health (OHEMH) was re-imagined. After structural inequities were magnified during the COVID-19 pandemic, OHEMH developed a 3-year plan for elevating health equity throughout departmental programs and policies. Utilizing data to identify communities at the highest risk of poor social determinants of health, the office, and its partners seek to deliver intentional strategies that will support access to healthcare resources for underserved and rural populations, improve culturally and linguistically appropriate communication around healthcare issues, and develop health equity plans to address future public health emergencies at the community and state levels.

 

In 2023, the OHEMH will host a series of health literacy programs to further equip communities to deal with future public health emergencies. Additionally, OHEMH plans to include healthcare assessments of unincorporated and rural communities; development of emergency preparedness plans that recognize the distinct needs of specific disabled populations rather than grouping disabled populations into one broad category; COVID-19 testing in communities without access to free testing; development of community ambassadors/trusted community health workers to share public health information and prevention resources; and development of youth leadership groups and community advisory committees that focus on community wellness and prevention.

 

The State of Alabama CSHCN Program is administered by CRS, a division of ADRS. CRS’ mission embodies the principles of comprehensive, community-based, and family-centered care. The mission of CRS is to enable children and youth with special health care needs and adults with hemophilia to achieve their maximum potential within a community-based, culturally competent, family-centered, comprehensive, coordinated system of services. Coordinated health services are delivered via 14 community-based offices across 7 districts.

 

SELECTED CHANGES IN ALABAMA'S POPULATION /ECONOMIC ENVIRONMENT AND POVERTY LEVELS/TRENDS IN NUMBERS OF ALABAMA TITLE V-SERVED PERSONS

 

Total Population

 

According to the 2021 1-year estimate from the American Community Survey (ACS), 5,039,877 people reside in Alabama.

 

Looking at the single race category, 65.1 percent (3,281,881/5,039,877) were White and 25.9 percent (1,305,106/5,039,877) were Black. Asians only make up 1.4 percent (68,813/5,039,877) of Alabama’s population. Within the Asian population, Koreans and Asian-Indian are the largest groups residing in Alabama. Looking at ethnicity, 95.3 percent (4,802,443/5,039,877) were non-Hispanic and only 4.7 percent (237,434/5,039,877) were of Hispanic origin. Within the Hispanic population, the three largest ethnic groups were Mexican, Puerto Rican, and Cuban.   

 

0-24 Year-Old Residents

For 2021, ACS grouped Alabamians who were under 24 years old into five groups. In total, 1,588,669 were 24 years old or younger. A more detailed age breakdown is as follows:  18.3 percent (290,091/1.588,669) were 5 years or younger; 18.8 percent (298,540/1,588,669) were between 5 and 9 years old; 21.3 percent (337,730/1,588,669) were between 10 and 14 years old; 21.3 percent (338,347/1,588,669) were between 15 and 19 years old; and 20.4 percent (323,961/1,588,669) were between 20 and 24 years old.  

 

Live Births

According to numbers retrieved on March 25, 2022, from the National Center for Health Statistics website, in 2020, there were a total of 57,647 live births to Alabama residents, a slight decrease (approximately 1.7 percent) from the 58,615 live births in 2019 for the state. There were 5,233 (approximately 9.1 percent) live births to mothers of Hispanic origin in the same year. Of the non-Hispanic mothers, approximately 56.7 percent were White; 30.8 percent were Black; 1.5 percent were Asian; 0.2 percent were American Indian or Alaska Native; and approximately 0.07 percent were Native Hawaiian or Other Pacific Islander.

 

The charts below reflect additional vital statistics data.

Vital Statistics, 2020-2021

Source: ADPH 2021 Annual Report

 

Source: ADPH 2022 Annual Report

 

 

Alabama’s Leading Causes of Death, 2020-2021

Source: ADPH 2021 Annual Report

 

Source ADPH 2022 Annual Report

 

ECONOMIC ENVIRONMENT AND POVERTY LEVELS

According to ACS, 16.1 percent (794,326/4,920,613) of those who resided in Alabama during 2021 were below the FPL. Compared to other racial groups, African-Americans have the highest percentage of 26.0 percent (327,284/1,260.356) within their group. Comparing the percentages for the ethnicity groups, those with Hispanic origin had the highest percentage of 24.5 percent (56,551/230,804).

 

TRENDS IN NUMBERS OF ALABAMA TITLE V-SERVED PERSONS

 

Per guidance on the completion of Forms 5a and 5b, the methods used for calculating the entries have changed; thus, data reported in this application/annual report will not be directly comparable to previous years. From our annual report year 2021, there were 1,725 pregnant women; 12,833 CSHCN; and 46,189 “Others” served under Title V.

 

CRS staff continually participate in community awareness and outreach activities to educate individuals about services for CYSHCN and their families. The following figures represent trends in CYSHCN who received services directly from CRS. In FY 2022, CRS served 13,777 CYSHCN, an increase of 7.36 percent over FY 2021. Of the 13,777 served, 82 percent were under the age 16. In FY 2021, CRS served 12,833 CYSHCN, an increase of 6.13 percent over FY 2020. The 2021 increase is attributed to clinics resuming operations after the brief shutdown in FY 2020 due to COVID-19 and is in line with normal growth.

 

CRS staff reached approximately 86,610 CYSHCN and their families via incoming toll-free calls, information and referrals, Parent and Youth Connection and ADRS Facebook pages, ADRS/CRS website, outreach activities, local hearing screenings, and FVA activities. The FY 2022 number reached is 40 percent over the 2019 pre-COVID-19 number reached of 62,000. The increase in the number reached is largely due to an increased use of social media.

 

Issues important to understanding the health needs of the state's population include the healthcare environment, selected changes in the state’s population, the number of state Title V-served individuals, funding issues, and special challenges in the delivery of services to CYSHCN. Also key to understanding the health needs of the state's Title V populations are salient findings from the current five-year  comprehensive  Needs Assessment and priority MCH needs based on these findings which are discussed further in this MCH report/application.

 

THE HEALTH CARE ENVIRONMENT

 

Changes that have occurred in Alabama's healthcare environment have caused a shift in the provision of direct medical services from CHDs to private providers. This shift has been especially evident with respect to the provision of services to pregnant women, children, and youth. Because the shift continues to affect ADPH's role in providing services, salient history and current conditions concerning the healthcare environment are both summarized here.

 

 

Care Coordination Program

 

EPSDT Care Coordination Program

ADPH in partnership with Alabama Medicaid provides EPSDT care coordination services to Medicaid-eligible infants and children with elevated lead levels, infants with failed hearing screenings, and infants with questionable or unsatisfactory newborn screenings in the hospital. Care coordination services are comprehensive services that assist eligible individuals in gaining access to needed medical, social, educational, and other services. Non-Medicaid recipients receive care coordination services from ADPH central office staff in FHS. In FY 2022, ADPH provided case management services to 3,354 infants who did not pass the Newborn Screening or Newborn Hearing Screening at birth and 1,177 children with an elevated BLL. FY 2022 ended with 7 full-time equivalents (FTEs) providing services to the identified infants and children.

 

Title X Care Coordination Program

Care coordination services are provided through a Title X Supplemental Grant for women seeking family planning services in underserved communities. Care coordinators provide family planning support and related health services that will improve the overall health of individuals in underserved counties. The counties served are Barbour, Bibb, Blount, Bullock, Butler, Chambers, Chilton, Dallas, Fayette, Hale, Lowndes, Macon, Marengo, Pike, Randolph, Russell, Shelby, Walker, Wilcox, and Winston. Care coordinators provide FP risk assessments and assist women in reducing the rate of unplanned pregnancies, sexually transmitted infections, and cervical cancer. In FY 2022, ADPH provided Title X case management services to 2,109 patients. 

 

Early Head Start Care Coordination Program

ADPH in partnership with the Department of Human Resources (DHR) provides long-term care coordination services to children attending an Early Head Start Program or Family Day Care Home participating in the Early Head Start (EHS) Child Care Partnership Grant (EHSCCP). The goal is to ensure that children’s medical and early learning needs are met as they enter the public school system. Children ages 6 weeks old through 4 years of age attending an EHS program or daycare participating in the EHSCCP Program are eligible. If a child enrolled in a center or EHS program is identified as having special needs, the care coordinators assist the centers and the parent/guardian as needed to obtain an individualized family service plan (IFSP). Care coordinators can help with accessing community resources and support services; free children’s books and educational material; services that support early learning, health, and family wellbeing; services for special needs; choosing a doctor or dentist; scheduling an appointment; and appointment reminders. In FY 2022, ADPH provided EHS case management services to 917 patients.

 

Collaboration between CRS and Medicaid

 

The Alabama Medicaid Commissioner has emphasized children's issues as an agency priority and specific Medicaid staff members are assigned to work with CRS. Meetings between Medicaid and CRS are held quarterly to discuss any issues or concerns regarding services provided to Medicaid recipients with special healthcare needs. If issues arise outside the quarterly meetings, the CRS Medicaid liaison will contact Medicaid to discuss them. In addition, CRS staff participate in advisory committees and work groups associated with various Medicaid initiatives.

 

To ensure consistent quality, statewide standards of care, and access to community-based clinical services, Medicaid and CRS have negotiated a list of approved multidisciplinary clinics. CRS operates these clinics within Medicaid’s Children's Specialty Clinic Services Program requirements, which include that the required practitioners be credentialed in accordance with Medicaid Administrative Code. CRS clinics employ physicians, nurses, social workers, physical therapists, audiologists, nutritionists, occupational therapists, and speech/language pathologists (SLP). CRS works with Medicaid to add new specialty clinics or modify existing clinics as needed.

 

Throughout the COVID-19 pandemic, CRS worked closely with Medicaid to maintain a continuum of service delivery for Medicaid recipients in the state. CRS is continuing to work closely with Medicaid as the COVID-19 public health emergency (PHE) comes to an end. Medicaid is providing ongoing guidance regarding coverage changes due to the ending of the PHE and changes resulting from the Medicaid COVID-19 unwinding. CRS leadership is ensuring staff are provided with the most up-to-date information. The ADRS Commissioner and other state agency leaders advocated to continue coverage for telemedicine visits which were enacted as part of the PHE. As a result of these efforts, Medicaid announced the implementation of a Telemedicine Policy effective June 1, 2023.

 

CRS is a direct provider with Medicaid for audiological services, hearing aids, and related supplies, thereby providing better coordination of these services for Medicaid-eligible CRS clients. CRS reviews all statewide requests to Medicaid for augmentative communication devices (ACDs) and houses all Medicaid prior authorization (PA) requests for ACDs. CRS is the only provider of medically necessary orthodontia for Medicaid recipients. CRS works closely with the Medicaid Dental Director regarding coverage for medically necessary orthodontia services.

 

CRS has an ongoing collaboration with Medicaid to meet Health Insurance Portability and Accountability Act (HIPAA) standards for privacy and billing. CRS staff have access to Medicaid eligibility data for confirming coverage as outlined in the provider agreement between Medicaid and ADRS.

 

Medicaid Family Planning Waiver and Related Issues

 

The 1115(a) Family Planning Waiver Proposal, submitted by ADPH and Medicaid to the Health Care Financing Administration (HCFA) in FY 1999, was implemented in October 2000. [HCFA became the Centers for Medicaid and Medicare Services (CMS)]. This waiver, called Plan First, expanded Medicaid eligibility for FP services to 133 percent of the Federal Poverty Level (FPL) for women ages 19-55 years of age. The Plan First FP Program includes coverage for women ages 19 to 55 with incomes up to 141 percent of FPL. Coverage for men aged 21 and older with incomes up to 141 percent of FPL for vasectomies only. A standard income disregard of 5 percent of the FPL is applied if the individual is not eligible for coverage due to excess income. In November 2016, Medicaid submitted a waiver amendment to add care coordination for males enrolled in Plan First to receive vasectomies and vasectomy-related services.

 

UAB evaluates the implementation of Plan First. The evaluation determines progress on six goals: enrolling 80 percent of eligible women under age 40, maintaining a high level of awareness of the Plan First Program among enrollees, increasing utilization of Plan First services by enrollees to 70 percent, increasing the portion of Plan First enrollees who receive smoking cessation services to 85 percent, maintaining birth rates among Plan First participants, and making sterilization services available to income-eligible men over age 21. According to the Plan First Market Analysis report, the Alabama Family Planning Program provides services to approximately 33 percent of all Plan First enrollees statewide. The evaluation determined the program paid for itself by reducing costs associated with births and noted participants with the lowest birth rates are those who received risk assessments or care coordination and those who use Title X Family Planning services. The waiver has been extended through September 2022. Medicaid has consistently expanded services with each renewal, most recently adding care coordination services for males seeking sterilization services.

 

The State Children's Health Insurance Program (CHIP)

 

CHIP was added to the Social Security Act by the Balanced Budget Act of 1997. Alabama was the first state in the nation to have a federally approved CHIP. The Bureau of Children’s Health Insurance administers ALL Kids, Alabama’s separate CHIP. ALL Kids provides comprehensive health coverage to eligible children and uses the Blue Cross Blue Shield of Alabama provider network. In addition to the ALL Kids Program, as a result of provisions in the Affordable Care Act, CHIP also funds a group of Medicaid-eligible children (MCHIP), which is administered by Medicaid. In FY 2022, there were 195,948 children enrolled in CHIP with 71,151 enrolled in ALL Kids and 124,797 enrolled in MCHIP.

 

CHIP also developed the ALL Babies Program. ALL Babies is a collaborative project between CHIP and FHS, with a focus on pregnant women and unborn babies in Montgomery, Macon, and Russell Counties. Medical insurance coverage is provided to women who are not eligible for insurance allowing access to prenatal care. ADPH provides care coordination services to pregnant women and their infants up to 3 months of age that qualify for ALL Babies Health Insurance. The goal is to reduce infant mortality and poor pregnancy outcomes. Pregnant women and/or their infants in Montgomery, Macon, and Russell Counties qualify for care coordination services. Care coordinators help participants gain access to medical care, health education, and other services and resources. Care coordinators educate mothers on safe sleep practices, WIC, breastfeeding, the importance of dental care for mother and baby, developmental milestones, etc. They also aid with medical appointments for the mother and baby and refer to community agencies for needs such as food, utilities, rental assistance, diapers, and clothing. Care coordination uses culturally and linguistically appropriate services to address the health beliefs, practices, and needs of diverse participants. During FY 2022, the program provided coverage to 711 enrollees.

 

CRS Services to Certain Medicare Enrollees

 

In FY 2022, CRS served 50 clients with Medicare benefits. All clients were adults with bleeding disorders. CRS assisted clients with Medicare coverage to select the health plan option that best addressed their needs and helped them locate Medicare pharmacies for factor treatment of bleeding disorders. In FY 2022, CRS paid insurance premiums for 13 clients with bleeding disorders.

 

Special Challenges in Delivery of Services to CYSHCN

 

Addressing the service delivery needs of Alabama's CYSHCN presents special challenges due to CYSHCN often needing services from multiple systems. Service delivery can be further compounded by barriers to accessing care such as a family’s financial circumstances, geographic location, and low health literacy. These barriers became even more apparent during the pandemic.

 

The COVID-19 PHE ending and unwinding of the COVID-19 Medicaid continuous coverage requirement could bring additional challenges for CYSHCN and their families. Currently, over 75 percent of individuals receiving services through CRS are Medicaid recipients. CRS care coordinators are working to mitigate potential delays in care due to families not having current Medicaid EPSDT screenings or experiencing a loss of Medicaid coverage. Families in need of updated EPSDT screenings could face long delays due to children making up 66 percent of Alabama’s Medicaid population. This could be especially challenging for CYSHCN as they are often seen by specialty providers with a limited number of appointments. Care coordinators are also educating families about the importance of notifying Medicaid of any changes to their contact information to avoid missing important notifications regarding eligibility. All CRS staff members are working to ensure CYSHCN and their families receive the most up-to-date information regarding Medicaid coverage and other impacts related to the PHE ending.

 

Despite the PHE ending, CRS has worked to permanently implement some of the safety practices implemented during COVID-19. These practices include utilizing screening procedures, managing waiting areas, and limiting the number of individuals that can accompany the child to the clinic. Parents and caregivers provided feedback that these measures increased their confidence in bringing their CYSHCN to CRS offices. Our mission has always been to provide quality clinical services to CYSHCN and their families, and we are continuing to meet their needs.

 

CRS faced continued challenges in rural areas. The state is largely rural, with greater population concentrations surrounding three larger urban areas (Mobile, Birmingham, and Huntsville). In rural areas, more risk factors exist that could potentially increase the percentage of CYSHCN in the general child population, such as higher poverty levels and lower education levels. According to the U.S. Department of Agriculture Economic Research Service, the poverty rate in rural Alabama is 17.5 percent, compared with 14.1 percent in urban areas of the state, and 17.2 percent of the rural population has not completed high school. In 2019, 21.9 percent of Alabama’s children ages 0-17 lived in poverty.

 

Comprehensively meeting the needs of CYSHCN in rural areas is even more difficult due to transportation barriers and limited access to providers with specialized experience in treating complicated health issues. Specialists and allied health professionals with pediatric experience are mainly located in the larger urban areas, necessitating travel to access them. In general, the state has poor public transportation systems. Although private programs exist in some areas and reimbursement for transportation is provided through various sources (including Medicaid and CRS), the state lacks the infrastructure to meet transportation needs in all locations. Thus, CRS continues to have an integral direct service role in the state's system of care for CYSHCN through its 14 community-based offices. Via the provision of multidisciplinary medical specialty and evaluation clinics, care coordination, and family support throughout the state, more CYSHCN have access to care in their home communities. Public/private partnerships, including agreements with the state's two tertiary-level pediatric hospitals, enable CRS to bridge gaps in the system of care, thereby increasing the state's capacity to address the health, social, and educational needs of Alabama's CYSHCN.

 

Health Care Coverage and Healthcare Provider Access

 

Oral Health

 

Alabama is on the verge of a dental provider crisis. From the early 1970s until the early 1980s, federal dollars provided a means to enlarge the UAB School of Dentistry and accept more students – about 169 during those 10 years. When funding stopped, and larger numbers of dentists were graduating, the accepted class size was reduced back to the original size of 57 per year. Those excess graduates from the 70s and 80s began to reach retirement age around 2015, leading to a decrease in the number of dentists in the state that Alabama is still experiencing today. Additionally, an increase in the number of out-of-state students has resulted in less retention of graduates in the state.

 

In 2017, the Alabama Dental Association leadership became aware of an aging dentist workforce in the state, and considering the potential consequences to dental care if this issue wasn't addressed, the American Dental Association Health Policy Institute began to collect and analyze data on practicing dentists in each Alabama county. The findings were concerning and there has been little positive change in the subsequent years.

Alabama’s only dental school is located in Birmingham, which sits in Jefferson County. Many dentists are either leaving the state or staying in Jefferson County. Data from the Board of Dental Examiners of Alabama indicated between the years 1990 to 2014, an average of 25 of 57 (43 percent) graduates per class did not practice in Alabama in 2017. These graduates either no longer had an Alabama dental license or had one but lived out of state. Further, in 2017 there were more dentists in Jefferson County alone (545) than in our 54 non-urban counties (455). The American Dental Association Health Policy Institute reports from 2017 and 2022 revealed the following:

 

• In 2017 Alabama was last in the country in terms of dentists per 100,000 population with 41 dentists per 100,000. Alabama remains 51st in the country.
• In January 2017, 706 of 2,127 (33 percent) practicing dentists were 60+ years of age and that number increases as the counties become smaller in population and more rural.
• In 2022, there were 150 fewer dentists aged 60+ than in 2017 and there were 75 fewer dentists in the 60-64 age category than in 2017.
• Overall, there was a net loss of 34 dentists from 2017 to 2022. While 29 counties had fewer dentists in 2022 than in 2017, 20 counties gained dentists and 18 counties remained the same.
  • In our smallest 25 counties, 10 of them lost dentists, and in our 13 most urban counties 7 lost dentists.
• Females comprised 23 percent of the state's dentists in 2017, with 80 percent (400 of 499) practicing in the 9 largest counties. Between 2017 and 2022, there was a net loss of 150 male dentists and a net gain of 116 female dentists.
  • There was a net gain of 21 female dentists in our profoundly rural 41 counties and a net loss of 9 male dentists.

Many Alabama counties continue to be at risk of significant loss of dental services in the near future. The following is a list of counties at greatest risk:

• Greene and Clay Counties have no dentist.
• Coosa County has one dentist; That dentist is over 60 years of age and practices 2 days a week.
• Lowndes County has a Federally Qualified Health Center (FQHC) that has rotating dental staff from neighboring Montgomery County. The clinic is open 4 days per week.

• Perry and Fayette Counties have only 1 dentist, each 50-55 years of age.

• Four counties have 100 percent of their dentists aged 60+ years of age.
• Four counties have between 60-83 percent of their dentists 60+ years of age.
• Five counties have 50 percent of their dentists 60+ years of age.

 

ADPH Office of Telehealth

 

The Telehealth Program equips 66 CHDs with telehealth carts that use digital technology to supply medical care, health education, and additional public health services. Collaborating with 15 healthcare agencies, ADPH staff facilitate services such as nephrology, neurology, cardiology, behavioral health, and HIV follow-up. The telehealth equipment is also utilized by ADPH staff for meetings and training events.

 

The telehealth office manages several grants that provide for the deployment of carts, specialty equipment, and funding for CHD staff to operate the equipment during telehealth appointments. ADPH continues to improve and increase the opportunities to use the telehealth carts by expanding the network of partners and upgrading equipment.

 

Telehealth Program staff also manage several grants that fund the testing and mitigation of the COVID-19 virus among people who are experiencing homelessness, and the expansion of telehealth throughout Alabama hospitals. Telehealth staff work with special partners to reach patients in rural communities. The office continues to improve and increase the usage opportunities of the telehealth carts by growing its network of partners and equipment upgrades to expand the reach of healthcare access across Alabama.

 

Primary Care and Rural Health

 

The Office of Primary Care and Rural Health (OPCRH) administers programs to improve healthcare access and quality in rural and medically underserved communities. As reported in the ADPHs 2022 Annual Report, 63 of Alabama’s 67 counties have areas designated as being medically underserved. These underserved areas have a high prevalence of healthcare issues, including chronic diseases such as diabetes, hypertension, heart disease, and other challenges such as a high rate of substance abuse. OPCRH works closely with partners like the Alabama Rural Health Association, AlaHA, Alabama Primary Health Care Association, and departmental bureaus to address these health issues. Some of the major initiatives in OPCRH are the recruitment and retention of healthcare professionals and technical assistance to support 42 small, rural hospitals and health providers in transitioning to a new value-based healthcare system.

 

OPCRH utilizes a national, web-based recruitment system called National Rural Recruitment and Retention Network to recruit into medically underserved areas. During FY 2022, approximately 2,119 primary care practitioners were referred to rural hospitals and clinics in Alabama. Another recruitment program is the National Health Service Corps (NHSC), which has both scholarship and loan repayment components.

 

NHSC covers a wide array of health professionals such as physicians, dentists, nurses, and behavioral health professionals. Currently, there are 105 Alabama participants in NHSC. These programs are supplemented by a J-1 Visa Waiver Program, which enables placement of foreign-trained physicians in return for 3 years of service in medically underserved areas. There are 78 healthcare providers delivering medical care to rural and medically underserved Alabamians under the J-1 Visa Waiver Program. OPCRH assists communities in establishing Centers for Medicare and Medicaid services-certified rural health clinics. OPCRH provided technical assistance to 134 rural health clinics.

 

OPCRH collaborates with various entities to address workforce issues essential to improving the health of Alabama residents. One such initiative is the partnership with the UAB Heersink School of Medicine - Huntsville Regional Medical Campus to develop a rational service area plan designed to identify workforce shortage areas more accurately for federal designation. These areas determine eligibility for certain federal grants as well as eligibility for NHSC and the J-1 Visa Waiver Program. Alabama’s 42 small, rural hospitals are also assisted under federal grants administered by OCPRH which target improvement of operational efficiency, quality, and hospital sustainability.

 

In 2022, OPCRH worked to update the Health Professional Shortage Area designations. These areas determine eligibility for certain federal grants as well as eligibility for the NHSC Program and the J-1 Visa Waiver Program. Alabama’s 42 small, rural hospitals are also assisted under federal grants administered by OCPRH which target improvement of operational efficiency, quality, and hospital sustainability. COVID-19 continued to present many financial and operational challenges to Alabama’s rural hospitals, including an unprecedented level of hospital staff turnover. OPCRH works closely with AlaHA to provide relief and support to Alabama’s small rural hospitals