covid19 response… · just sendyouremailaddress bytextmessage: text agrisafe to22828togetstarted....

COVID19 ResponseWe’ll begin at 11am Central Time

Contact Information Natalie Roy, MPH

Executive DirectorAgriSafe Network Phone: 985‐845‐1116Email: [email protected]

How we Protect:1. Ongoing needs assessment of Ag producer needs (following Total Farmer Health)2. Train rural health professionals across the nation 3. Establish partnerships with NIOSH Ag Centers, rural research centers, and other NPOs4. Maintain a culture of readiness and organizational expectation to protect and respond

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Thursday, April 16th Topic Overview

• AgriSafe - Natalie Roy• Topic – Rural Epidemiology of Covid-19

• AgView Solutions – Shay Foulk• Topic – Farm Financial Assistance Options During the Pandemic and Beyond

• National Rural Health Association– Max Isaacoff- Government Affairs and Policy Manager

• Topic – Rural Health Care Update and the Actions Related to Covid-19 for Rural Health Provider

• National Farm Medical Center – Florence Becot- Associate Research Scientist • Topic – Farm Families Health Insurance Coverage in the U.S. and the Impacts

of Covid-19

Why is AgriSafe doing this? The benefits of a “think tank” forum on Covid-19

Keep the industry informed and obtain detailed information about personal and group feelings in agriculture on Covid-19

Provide a forum for agriculture workers to keep up with impact trends in the industry as well as foster communication between Ag industry leaders

Provide a broad range of accurate information for individuals who are seeking clarification

Foster a sense of unity! We are in this together!

Please feel free to share your resource links here!

Open and close your control panel

Join audio:• Choose Computer Audio or• Choose Phone call and dial in

using the information provided

Submit questions and comments viathe Questions panel or Chat panel

Your Participation

Attendee Participation

Resource Gathering – How will we track it?

AgriSafe Learning Lab AgriSafe Members can log in to access recordings in the Learning Lab Non-members can set up a free guest account to view the COVID-19

recordings and many others

FREE Remote Training Courses in our Learning Lab2 Course Learning Paths FREE of Charge:

Safety in Agriculture: The goal of this series of training is to reduce occupational injuries and illness among agricultural producers with a targeted focus on female producers.

Invest in Your Health: AgriSafe is offering this Train-the-Trainer series to anyone with youth (ages 14-23 yrs). These series of modules walks through 5 target areas with an instructor guide included with each topic.

Registration for these courses take place in the AgriSafeLearning Lab, if you are not an AgriSafe member you can still register as a guest account and take these courses free of charge.

Membership and Certifications

Membership Exclusive Trainings: If you are interested in more online offerings from AgriSafe you can become a member today. You can find our membership information at agrisafe.org

Certifications: Each participant will receive a certificate of completion for each course topic that can be used to fill educational credits or turned into their supervisors as part of their remote work training responsibilities.

AgriSafe hopes these resources can help individuals on their path to being more effective regardless of where they are.

A recording of this webinar and other resources will be available on this page:

https://learning.agrisafe.org/covid19-response

Additional Info:

Presenter Contact: Gwen ParkerAgriSafe Senior Workforce Training and

Development [email protected]

Resources Contact:Katherine Feemster

AgriSafe Intern – MPH Graduate Student at Tulane University, Public Health and

Tropical [email protected]

Shay FoulkFarm Financial Assistance-Discussion from Farmer Perspective

• [email protected]• Agviewsolutions.com• Podcast- Ag View Pitch

Speaking: Shay Foulk Ag View Solutions [email protected] Podcast: Ag View Pitch

My WorkAg View Solutions and Farming

Half the U.S. and Canada

35-50 operations ranging 600-35,000 acres at any one time

Many also have other businesses

Farm NW Illinois

Have been dealing with the turmoil personally and first-hand for those who have questions

Goal: help provide perspective on what is going on, answer some questions, explain some of the faults


CARES Act$2.2 TRILLION

$9.5 Billion for food producers Specialty crops, dairy, livestock, etc.

$14 Billion to Commodity Credit Corporation 2020 programs to support farmers through this

Open to all crops

In addition to MFP 2nd and 3rd Tranche Payments as well as Price Loss Coverage and Dairy Margin Coverage

NEW support programs for 2020


Why this is a good thing:

$3.20 cash corn and $8.46 cash beans

Dollar is still strong

Dollar is strong ag tends to suffer

Cheaper products from other parts of the world

Need the support

Cost of Production on Average: Corn- $3.68 Beans - $9.17

MFP made farmers break even/slight profit last year


Paycheck Protection ProgramSmall Business Administration

Potentially forgivable loans at low interest rate

1% over two years

Based on Payroll

W2’s plus Schedule C Line 31 and Schedule F Line 34 (Max $100,000)

Divide by 12

Times 2.5

To help with: Payroll, Interest on Mortgage Payments, Utilities

ALL small businesses with less than 500 employees


Clarifications Only based on payroll

Does NOT exclude farms

Regardless of CCC or FSA programs

Self employed are currently not eligible as of last night

Funds open until June 30th but will run out

Possibly by the end of the week

Will most likely be a second round of PPP

Lending Institutions cannot deny amount based on what they think will be forgiven

Lenders only there to facilitate

To clarify…. This is all still being worked through and changes daily


Issues Lending and SBA communication- good but could be better

Government = 1 WEEK (amazing)

Right now, farmers not eligible for “small business” loans= not for self-employed

How do you calculate it? Farmers typically show a zero or a negative on taxes for trades

Details on loan forgiveness- where the funds can be used, in effect for February 14th and nothing after

How will interest be paid on the loan forgiveness and when will It technically be due?

Based on payroll, not what may be forgiven

H2A and B does not qualify for PPP (fraud and jail)

Contract Labor does not qualify (can apply separately)

More details to come…


What We Can Do Better Distribution of Information

Radio, News, Social Media – repeatability

Talk with lenders if you have any questions

Primary point of contact

Get all information organized

Tax information, payroll information, etc. (see above)

Take advantage of these programs

Farmers are clearly not exempt from economic downturn

Look out for the health of family and friends in agriculture

Not all doom and gloom, but certainly not sunshine and rainbows


Other things to consider: 2nd PPP payment/application period with more funds

3 months?

Probably can’t reapply

Record Keeping

China Trade Deal Extension on Purchasing?

EIDL Economic Injury Disaster Loan

Not for farmers YET- farm groups working hard on it

Maybe $1,000/employee for payroll as a grant

Pull from PPP total, but guaranteed

A lot of state programs and other resources availableSpeaking: Shay Foulk Ag View Solutions [email protected] Podcast: Ag View Pitch

Resources/Where To Turn Paul Neiffer

Shay Myers

Onion Farmer Western U.S.- LinkedIn

SBA

Your Lending Institution

Our podcast- Ag View Pitch

Farm Health Series

Maintain current information on the topic and try to provide perspective

Questions? Thank you


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Help Us Advocate for Rural Health

Click Here to Let Us Know About Your Advocacy Efforts

• Send a sample email/letter (provided by NRHA staff) to your Members of Congress • Connect• Get five other advocates you know to do the same

• Attend a local town‐hall • Engage with NRHA Advocacy online!

• Social Media: Twitter, Facebook, LinkedIn• Emails: Maggie Elehwany, Max Isaacoff, Mason Zeagler

Rural Hospital Closure Crisis

Update:

• Thus far in 2020, nine rural hospitals have closed:• Three have recently closed and announced impeding closure: WV, OH, and

KS• After 2019’s record setting year, the 2020 outlook looks similar

• Rural hospital closures are extending ambulance transportation times and can lead to increases in rates of inpatient mortality

• Rural hospital closures also impact workforce shortages (they have a compounding impact on access to health care in rural areas)

• NRHA’s 1‐pager on rural hospital closures will be included on Connect

COVID‐19 and Rural Health:CARES Act Summary• Increases Access to Capital for Rural Providers

• Establishes a $100 billion fund to ensure health care providers, including those in rural areas, continue to receive the support they need for COVID‐19 related expenses and lost revenue;

• Allows rural providers to seek relief through Small Business Administration programs, including the Paycheck Protection Program loans that can be forgiven, debt relief and economic injury disaster loans;

• Enables hospitals to receive an advance on Medicare payments—with Critical Access Hospitals (CAHs) able to secure up to 125%—to infuse needed cash‐flow.

• Provides Funding for Rural Health Centers and Programs • Provides $1.32 billion in supplemental funding to community health centers (CHCs), including those providing care in rural

areas;• Extends mandatory funding for programs crucial to rural areas: Community health centers; National Health Service Corps

(NHSC); and Teaching Health Center Graduate Medical Education Program (THCGME).

• Increases Payments to Rural Providers• Suspends the Medicare sequester to increase payments for rural hospitals and providers by 2%;• Increases Medicare payment to a hospital for a COVID‐19 admission by 20%, helping certain rural hospitals;• Increases Medicare payments for physician services by not applying a geographic adjustment that hurts rural areas;• Delays reductions in the portion of Medicaid payments to hospitals for treating low‐income and uninsured patients;• Prevents reductions in payment for durable medical equipment, including oxygen and wheelchairs, that disproportionately

hurt rural suppliers;• Prevents reductions in payments to clinical laboratories to ensure patients can get needed testing.

COVID‐19 and Rural Health:CARES Act Summary

• Increases Rural Telehealth Use and Infrastructure• Allows Medicare beneficiaries to receive care in their home from a remote physician;• Enables Community Health Centers and Rural Health Clinics to provide remote care to beneficiaries in their home;• Allows beneficiaries on home dialysis to receive all required visits in their home from a remote nephrologist;• Enables home health agencies to use technology, including remote monitoring, to deliver needed care;• Allows physicians and nurse practitioners to recertify hospice care for beneficiaries via telehealth;• Reauthorizes Health Resources and Services Administration (HRSA) grant programs that promote the use of

telehealth technologies for health care delivery, education and health information services, including in rural areas;• Extends HRSA rural health care services outreach, rural health network development and provider quality

improvement grant programs to strengthen rural community health by focusing on quality improvement, increasing health care access, coordination of care and integration of services.

• Increases Flexibility to Improve Rural Health Care• Allows physician assistants and nurse practitioners to order home health services in Medicare and Medicaid,

enabling patients to get quicker access to care in their home;• Waives Medicare requirements to enable hospitals to efficiently transfer patients to an appropriate post‐acute

facility setting, freeing‐up needed hospital beds;• Enables Medicare beneficiaries to fill a prescription for up to 90‐days to ensure they have an adequate supply of

needed medications.

NRHA Asks Moving Forward:Immediate relief is needed to keep rural provider’ doors open:

1. The $100 billion provider grant program must proportionately be available for rural providers. Rural providers care for

20% of the nation’s population. Rural Americans, because they are proportionately older and with higher percentages

of comorbidities, are extraordinarily vulnerable to COVID‐19. Without the inclusion of a 20% rural set‐aside, we believe

that small, rural and isolated providers may not be able to access the funds before they are depleted by other facilities.

2. Ensure Medicare accelerated payments are effective for rural providers. Unless modified, the Medicare advance

payment provisions will not provide relief for rural providers. Why? The advance payments are loans that will have to

be repaid to CMS with interest if delinquent. Struggling rural hospitals, who likely have negative operating margins on

the last several costs reports, will not risk becoming indebted to CMS and subjected to costly audits. Medicare advance

payments must allow loan forgiveness comparable to SBA loans (i.e., loan forbearance can occur for small rural

providers if payment is used for patient care, staff salaries, utilities, or mortgage/lease.

3. Ensure PPP can be utilized by small rural public hospitals. It is unclear whether one‐third of all rural hospitals can

access this important program. Congress must ensure that county and publicly owned rural hospitals can access the

Paycheck Protection Program in CARES.

Congressional Letters

• Encourage your legislators in the House of Representatives to sign‐on to the Paycheck Protection Program (PPP) letter led by Congressman Smith and Arrington.

• Letter: Rep. Smith/Arrington• Link for Member to sign‐on

• Encourage your legislators in the Senate to sign‐on to the rural priorities letter led by Senators Hyde‐Smith and Manchin.

• Letter: Sen. Manchin/Hyde‐Smith

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Farm Families’ Health Insurance Coverage in the midst of COVID-19

Florence BecotApril 16, 2020

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COVID-19 Ag Task Force

Farm families’ health insurance coverage

Impact of COVID‐19 on health insurance coverage

Health insurance options

Additional resources

Outline

Farm families’ health insurance coverage

How Does Health Insurance Impact?

• Economic development through food and agriculture

• Farm and Ranch • Development •Workforce Vitality• Risk Management•Quality of Life• Family Health

4 Year Research and Extension Project

Principal investigators

• Shoshanah Inwood at The Ohio State University

• Alana Knudson at the Walsh Center for Rural HealthAnalysis at NORC

HIREDnAg data

• Longitudinal farm and ranch household interviews

• Farm and ranch household survey• Data collected: February‐April 2017• Randomly selected farmers• 1,292 completed surveys

• 10 case study statesCA, KY, MA, MI, MS, NE, PA, UT, VT, WA

Farm families’ health needs

About 2/3 had a pre‐existing health condition

About 1/3 had a health problem that makes it difficult to farm

3/4 said that health insurance is an important or very important farm business risk management strategy

Sources of health insurance coverage

Besides public plans and on average:

Cheaper option Most expensive option

Health insurance and economic vulnerability

Farm families’ confidence in ability to pay for a major illness or injury without going into debt

Health insurance arrangements associated with how farm families responded

Impact of COVID-19 on health insurance coverage

Data: U.S. Bureau of Labor Statistics Current Population Survey

Rapid changes in the labor markets

Drops in farm income

Disclaimer

• Health insurance is COMPLICATED

• Health insurance options and rules vary by state and individual’s situations

• Focus is on providing general information about options and resources on where to find information

Key resources


Options vary based on source of coverage and state of residence:

• If loss of off‐farm employment coverage:• Continuation of Health Coverage (COBRA)• Special enrollment period on the health insurance Marketplace

• If farm or household income drops and have Marketplace plan• Update income information

• If do not currently have coverage

Additional resources

Key health insurance coverage resources

• Health insurance marketplace• 1‐800‐318‐2596• www.healthcare.gov• https://localhelp.healthcare.gov/

• Local insurance agents

• States departments of health services, insurance

• Smart Choice and Smart Use Health InsuranceTM Consumer Resources: • https://extension.umd.edu/insure

Health insurance and health care for farmers

• Research findings on health insurance and additional resources targeted to farmers• www.hirednag.net

• Supporting the mental health of farm families in the North Central region• May 6th webinar: http://bit.ly/3b8jcVgmentalhealth• Article: https://www.joe.org/joe/2019december/rb1.php

Contact information

[email protected]

715‐389‐9379

@FarmMedicine@nccrahs@umash_umn

Covid‐19 and Rural AmericaEmma BergqvistAgriSafe Intern

Epidemiology MPH candidateTulane School of Public Health and Tropical Medicine

Why the rural population is at risk

AGE POOR HEALTH

RURAL MORTALITY PENALTY

OUT OF STATE TOURISTS

Stratified Health Data

Adjusted numbers: rural areas are going to be hit

harder

New cases on the left versus new cases by 10k population on the right

Maps from University of Chicago , Center for Spatial Data Science, as of 4/7/2020 5

Adjusted numbers: rural areas are going to be hit

harder

Death count total on the left versus Death count by 10k population on the right


Case fatality rate by county


What can be done?

Contact tracing

• Used in Wuhan• UK scientists suggest for “containment phase”

• Via phone or door to door• Rural areas are community based

Examples of Contact Tracing Working

Massachusetts Utah Apple and Google Apps

guidelines

Prevent importation

Early action/detection

Telehealth

Disinfecting and Protective wear

Targeting key populations

References1. Symens, A., Trevelyan, E. (2019) The Older Population in Rural America https://www.census.gov/content/dam/Census/newsroom/press‐kits/2019/paa/paa‐

poster‐older‐population.pdf

2. Center for Disease Control (2017) About Rural Health https://www.cdc.gov/ruralhealth/about.html

3. Center for Disease Control (2020) Groups at Higher Risk for Severe Illness https://www.cdc.gov/coronavirus/2019‐ncov/need‐extra‐precautions/groups‐at‐higher‐risk.html

4. Cosby, A. G., McDoom‐Echebiri, M. M., James, W., Khandekar, H., Brown, W., & Hanna, H. L. (2019). Growth and Persistence of Place‐Based Mortality in the United States: The Rural Mortality Penalty. American journal of public health, 109(1), 155–162. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6301407/

5. University of Chicago Center for Spatial Data Science (2020) U.S. Covid‐19 Atlas https://geodacenter.github.io/covid/#

6. Healy, J., Tavernise,S., Gebeloff, R., Cai,W., (2020) Coronavirus Was Slow to spread to Rural America Not Anymore. https://www.nytimes.com/interactive/2020/04/08/us/coronavirus‐rural‐america‐cases.html?action=click&module=Spotlight&pgtype=Homepage

7. Wang C., Liu L., Hao, X., Guo H., Wang Q., Huang, J., He N., Yu H., Lin X., Pan A., Wei S., Wu, T. (2020) Evolving Epidemiology and Impact of Non‐pharmaceutical Interventions on the Outbreak of Coronavirus Disease 2019 in Wuhan, China. https://www.medrxiv.org/content/10.1101/2020.03.03.20030593v1?fbclid=IwAR0upgJcwM77L3gLTVZrKYnLhyYiGieJ9s9pmtepVTiNsFVycaUkTx7Gjns

8. Chinese Center for Disease Control (2020) Technical Guidance for Prevention and Control of Audio and Video Training Coursewear

9. Dwinell, J. 2020 Massachusetts hailed as coronavirus contact tracing model to opening up economy [web] https://www.lowellsun.com/2020/04/13/massachusetts‐hailed‐as‐covid‐19‐contact‐tracing‐model‐to‐opening‐up‐economy/

10. Apple (2020) Apple and Google partner on COVID‐19 contact tracing technology. [web] https://www.apple.com/newsroom/2020/04/apple‐and‐google‐partner‐on‐covid‐19‐contact‐tracing‐technology/

11. Collins,L.M. (2020) Tracking the unseen: How public health workers chase COVID‐19 in Salt Lake County [web] https://www.deseret.com/indepth/2020/4/11/21215652/salt‐lake‐county‐contact‐tracing‐covid‐19‐coronavirus‐utah‐public‐health

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