The nostalgia for rural America doesn’t seem to take into account that it’s dying faster than urban America. A 2024 USDA report found that disease-related deaths among adults ages 25 to 54 were a staggering 43% higher in rural areas than in urban areas in 2019, up from just 6% higher in 1999. As urban areas have lowered natural causes morbidity rates, rural areas have worsened—significantly.

Even more troubling is how stark these disparities are becoming for women and Indigenous peoples, especially Indigenous women. The 25-to-54 age range is designated prime working age, or when we should at least be healthy enough to work. Unfortunately, over the last 25 years, we’ve been trending in the wrong direction.

How we got here

Mortality rates across metropolitan and nonmetropolitan areas had been an area of concern as early as 1990, but this initial research included both external causes of death—suicides, overdoses, accidents, violence, etc.—and natural causes of death—cancer, heart disease, respiratory disease, etc. The 2024 study examines external causes and natural causes of mortality, or NCM, separately, focusing on prime working ages.

From 1999 to 2019, the prime working age NCM gap between urban and rural areas jumped by 51 deaths per 100,000 residents. Urban areas lowered this rate by 37 percent as it increased in rural areas by 14 percent. Notably, the more rural the area, the greater the increase in NCM. Furthermore, female prime working age NCM rates grew by 16 percent over that time compared to 2 percent for males. The highest rate of NCM growth for rural women was pregnancy-related deaths, which grew by 313 percent.

Rural women are more than 60 percent more likely to die from pregnancy than urban women.¹

It’s also worth noting that nationwide, Black women are three times more likely to die from pregnancy than white women with 49.4 deaths per 100,000 births compared to just 14.9.²

Indigenous peoples experience some of the poorest health outcomes, and they’re even graver in rural areas. There was a 39 percent increase in NCM prime working age males and 55 percent increase for Indigenous women.

The compounding burden

The factors driving this gap aren’t a mystery. Rural America carries a compounding burden across nearly every social and health indicator, and the deficits reinforce each other. Lower education and higher poverty feed higher rates of chronic disease, which feed higher mortality. And the health care system built to interrupt that cycle is stretched thinnest exactly where the need is greatest.

A $50 billion band-aid

Clearly, rural health needs transformed. What’s also becoming clear is that the Rural Health Transformation Plan is unlikely to do so. The 2025 budget reconciliation bill cut an estimated $911 billion from federal Medicaid spending and the Affordable Care Act marketplace. KFF estimates that just Medicaid reductions could be $137 billion over ten years in rural areas.³ This was why $50 billion in funding over five years was added to that bill as the Rural Health Transformation Program.

I guess we need to first state the obvious: $50 billion is a lot less than $137 billion. States can use just 15 percent of their allocations to pay providers for patient care and prohibits capital construction in most cases. The Centers for Medicare and Medicaid Services director, Dr. Mehmet Oz, said these funds are to “not to pay operating expenses,” but instead “right-size the system and to deal with the fundamental hindrances of improvement in rural health care.” The administration expects states to accomplish this through technology, which is where the vast majority of this money will be spent.⁴

Also obvious but evidently needs explanation: the proficiency of a hospital’s technology is irrelevant if a hospital is closed. I wrote about how low patient volume and high fixed costs make rural healthcare more of a gamble than an investment. Since 2005, nearly 200 rural hospitals have completely or partially closed, and more than 400, more than 20 percent of all rural hospitals, are at risk of closure.⁵ To fire a flare into a minefield, nearly 1 in 4 people in rural areas are covered by Medicaid. The program being decimated by this same bill is essential to keeping rural hospitals open. This software had better be good.

A map of rural health fund allocations looks almost nothing like a map of rural need. The law requires that half of all funds are distributed equally across approved states—no matter what. This means that though large rural states like Texas, Alaska, and California received the biggest awards, the spending per rural resident is dwarfed by predominantly urban states like Massachusetts and New Jersey. Texas is receiving just $66 dollars per rural resident while Rhode Island gets a whopping $6,305.⁶

Moreover, as we’ve learned, rural healthcare needs are not neatly distributed. States with the lowest rural mortality rates have been awarded about twice as much funding per rural resident than states with the highest rural mortality rates. States most at risk, like Mississippi, Kentucky, and Tennessee, will receive an average of $104 per rural resident compared to states with better health outcomes like Connecticut and Vermont, which average $233 per rural resident.⁷

The math doesn’t add up

According to KFF, “it is highly unlikely that any state will receive more money from the rural health fund than it will lose from the historic cuts to federal funding for health care.”⁸ Wyoming, as a nonexpansion and almost entirely rural state, was initially projected to be the nation’s largest beneficiary of rural health funds.⁹ But as of late April, Wyoming’s rural health fund dollars are in red tape limbo. The state’s application, along with Colorado and West Virginia, is still under CMS review.

What this means for families

As a new mom, I find the life-threatening dangers of pregnancy—of having a family—in rural America shameful. In the last five years, more than 100 rural hospitals have closed labor and delivery units.¹⁰ Nearly 50 percent of all births in rural communities are covered by Medicaid.¹¹ To recap, we gutted the system that was barely keeping hospitals afloat by nearly one trillion dollars. The innovative, once-in-a-lifetime solution to this problem? Give $50 billion back.

“Rural Health Transformation will not save a single hospital in our state. I don’t think it will save a single hospital nationally,” the director of the Nebraska Rural Health Association said. It seems unlikely, then, that it will save any of those rural Americans who are dying at tragically young ages at a much faster rate than their urban counterparts. It’s all but certain to increase mortality rates for rural women due to pregnancy. I shudder to think how high that ceiling will get for Black and Indigenous women.

We need to know why rural Americans are dying younger than they should, so we must demand that government invests in research like the USDA report. We need to keep hospitals open, so we must demand that our government fund Medicaid. We need Americans to live longer, healthier lives, so we must demand that our government actually transforms rural health care.

Sources

1. Urban-rural differences in pregnancy-related deaths, United States, 2011–2016 ↩
2. Racial Disparities in Maternal and Infant Health: Current Status and Key Issues ↩
3. Comparing States’ Rural Health Fund Allotments to Medicaid Spending Cuts Can Be Misleading ↩
4. Here’s what to know about the $50 billion states are getting for rural health ↩
5. Why Rural Hospitals Are Facing A Funding Crisis – And How It Could Get Worse ↩
6. First-Year Rural Health Funds Awards Range From Less than $100 Per Rural Resident in Ten States to More than $500 in Eight ↩
7. Analysis of the Rural Health Transformation Program ↩
8. Comparing States’ Rural Health Fund Allotments to Medicaid Spending Cuts Can Be Misleading ↩
9. State-Level Impacts of Key Medicaid Provisions in the One Big Beautiful Bill Act ↩
10. Positive Outliers: How Some Rural Communities Maintain Access to Labor and Delivery Services ↩
11. Fact Sheet: Medicaid ↩
12. Rural Poverty & Well-Being ↩
13. Educational attainment in rural America rises, but urban areas widen the degree gap ↩
14. The Urban-Rural Digital Divide in Internet Access and Online Activities During the COVID-19 Pandemic ↩
15. Chronic health conditions and healthcare affordability issues among U.S. rural and urban adults ↩
16. U.S. Obesity Rate Changes Differ for Rural and Urban Areas, as Well as Across Regions ↩
17. Trends in Rural and Urban Cigarette Smoking Quit Ratios in the US From 2010 to 2020 ↩
18. Availability of healthcare providers in rural areas lags that of urban areas ↩
19. Health Insurance Coverage in Rural and Urban Areas in the U.S., 2023 ↩

The post In Name Only: The Rural Health Transformation That Isn’t appeared first on Collective Health Trust.

The Request

MHCC sought financing from the Trust to support their proposed acquisition of Summit Medical Center in Natrona County. We reviewed their application materials in full and consulted with legal counsel before reaching our decision.

A Binding Contractual Obligation
We operate under governing agreements that carry real legal weight. One of those agreements — which defines our relationship with Banner WMC — expressly prohibits us from providing monetary support to a healthcare provider that competes in the same geographic market as Banner WMC, unless a narrowly defined exception applies.

Our review determined that approving this loan would result in direct overlap in core clinical services within Natrona County, constituting support to a competing provider under the terms of the agreement. We also carefully evaluated whether any exceptions applied — including non-competing services related to behavioral health or care primarily directed to medically underserved or indigent populations. The request did not meet the criteria for any permissible exception.

As fiduciaries, we are bound by the agreements that govern our work. We do not have discretion to approve a transaction that would place the Trust in direct violation of its contractual obligations.

— Eric Nelson, Chairman, Natrona Collective Health Trust Board of Directors

The Broader Healthcare System at Stake

Beyond our legal obligations, we evaluated what this transaction could mean for healthcare in Natrona County at a system level. Rural healthcare markets operate with limited patient volume, constrained workforce capacity, and financial structures that depend on stability across the entire system. Duplicating core hospital services in such a market can fragment patient volume, strain staffing, and put essential services at risk — particularly those serving uninsured and underinsured residents.

Banner WMC is Wyoming’s only Level II trauma center and the region’s primary referral hospital, providing 24-hour access to general surgery, orthopedics, neurosurgery, anesthesiology, emergency medicine, and critical care. These are not just institutional assets — they are community assets that draw patients and providers from across the state and anchor our local healthcare economy.

When patient volume, reimbursement, or workforce stability is eroded in ways that weaken these core services, the consequences are not just institutional — they are medical and economic for Natrona County as a whole.

— Eric Nelson, Chairman, Natrona Collective Health Trust Board of Directors

We also weighed the financial scale of the request. A loan of $29.2 million would significantly limit our capacity to continue community investments that address barriers to care, support prevention efforts, and direct resources to vulnerable populations across Natrona County.

Our Commitment Going Forward

This decision was not made lightly. We recognize the genuine challenges facing healthcare providers in our region, and we remain open to future proposals that are consistent with our governing agreements and that clearly advance care for underserved populations or address unmet community health needs.

Our decision is about honoring the agreements that guide our work and about protecting a resilient healthcare system that serves all residents equitably. We have a responsibility to ensure that the healthcare system in Natrona County remains strong, stable, and sustainable for the long term.

— Eric Nelson, Chairman, Natrona Collective Health Trust Board of Directors

We conveyed our decision directly to the Board of Directors of Memorial Hospital of Converse County and the Board of County Commissioners of Natrona County on Feb. 20, 2026.

The post Why We Said No: Our Decision on the Memorial Hospital of Converse County Loan Request appeared first on Collective Health Trust.

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We’re excited to officially introduce The Collective Space, our shared meeting and event space located within our new downtown home at 421 S Center St. We’re offering this space at no cost to qualifying, mission-aligned organizations, because we believe strong communities are built when people have places to come together.

Whether you’re hosting a board meeting, planning a retreat, or facilitating a training or workshop, The Collective Space was designed to support meaningful, community-centered work.

What is The Collective Space?

The Collective Space is a flexible, fully accessible meeting and event space inside our Trust headquarters located in downtown Casper. This 100-year old building was thoughtfully revitalized to serve as a modern community asset.

The space is well suited for:

• Board and committee meetings
• Retreats and planning sessions
• Trainings and workshops
• Community forums and speaker events
• Film screenings and small conferences

The space is equipped with audiovisual technology for meetings, presentations, and video conferencing. Furniture can be arranged to fit your needs, and our staff will work with you ahead of time to make sure the setup supports your event.

Who can use the space?

Generally, the Collective Space is available to individuals and groups who work to benefit wellbeing of our community and its residents. This includes:

• Nonprofit organizations
• Community-based groups
• Organizations hosting events that benefit the communities we serve

Each host organization designates a representative who is responsible for the event and for ensuring all guidelines are followed.

What we don’t host

The Collective Space is not available for:

• Fundraising events
• Political lobbying, campaigns, or partisan activities
• Commercial or for-profit events
• Private celebrations such as weddings or birthday parties
• Events that conflict with our mission or values
• Events that discriminate based on protected characteristics

If you’re unsure whether your event fits within these guidelines, we encourage you review our Collective Space Use Agreement  for full details.

A few frequently asked questions

Is there a rental fee?
No. We do not charge room rental fees for qualifying organizations. Some external costs — such as catering, specialized audiovisual equipment or furniture, or additional staffing — may be the responsibility of the host organization.

When can events be held?
The space was designed to allow for events during or after business hours. Additional coordination may be required to host events during evening and weekend hours.

Can we serve food?
Yes. You may bring your own food, order delivery, or work with a caterer. Alcohol is not permitted at events hosted by outside organizations.

Do hosts need to sign anything?
Yes. All approved events require the host organization to review, sign, and comply with our Collective Space Use Agreement, which outlines expectations around accessibility, safety, inclusiveness, and care of the space.

How to request the space

Our booking page is now live, and we will begin hosting events in the new year. Visit The Collective Space page on our website for links to room details, our use agreement, and the booking page. All requests will be reviewed prior to finalizing the booking, and our staff will reach out to help coordinate your needs to make your event a success.

We can’t wait to see how you use the space!

The post Welcome to The Collective Space appeared first on Collective Health Trust.

Formed in 2021, NCSJ is a cross-sector coalition dedicated to creating safer, healthier communities by addressing the overlap between behavioral health and the criminal justice system. The council brings together law enforcement, health care providers, service agencies, and people with lived experience to identify solutions that reduce recidivism, improve access to treatment, and strengthen public safety. The 2025 Summit built on years of coordinated efforts by these partners to analyze data, improve systems of care and close service gaps for individuals with mental health and substance use disorders in Natrona County. 

Importantly, the Summit also included individuals with lived experience of the justice system. Their voices guided discussions and reminded participants that successful reentry depends on coordinated systems, not just individual determination.  

To bring those lived experiences to life, officials and services providers participated in a reentry simulation illustrating the challenges people face after incarceration. The exercise, which included treatment, probation, housing, transportation and financial obligations, revealed how difficult it can be to reestablish stability after release. 

“The simulation gave people on the other side a taste of how difficult it is to meet even the most basic needs said Kristy Oster, Health Trust director of community engagement. “The human and financial cost of reentry failure is enormous, and it has generational impacts on families.” Treating this population with dignity and respect was a pervasive theme throughout the Summit, underscoring that meaningful change begins with how communities view and value every person. 

The rest of the Summit was devoted to mapping Natrona County’s Sequential Intercept Model—a nationally recognized framework used to identify how and where people with behavioral health needs encounter the justice system. Through this process, participants highlighted existing strengths, service gaps and opportunities to improve coordination across agencies. 

The final day featured a presentation from Krista Goldstine-Cole, who shared findings from her recent Homelessness Pathway Study, tracking nearly 20 individuals in Natrona County to understand how they became homeless. Her report provided crucial data linking housing instability, behavioral health and justice involvement.  

Throughout the event, facilitators praised Natrona County for its existing collaboration and measurable progress in improving outcomes for justice-involved individuals. 

“The old way of thinking was that once we put someone in jail, our work was over,” Natrona County Sheriff John Harlin said. “But we’ve learned that our job is much bigger than that. If we want to keep people out of jail, it’s going to take our entire community working together to treat the people who need help today and prevent this cycle from continuing.” 

A comprehensive report from the Sequential Intercept Mapping session will be released later this year. NCSJ will use the findings to guide its 2026 priorities, focusing on reducing recidivism, improving behavioral health outcomes, and creating a safer, healthier Natrona County.

The post Natrona Council for Safety & Justice concludes summit on mental health and the criminal justice system appeared first on Collective Health Trust.

This fall, the Trust awarded general operating grants to organizations whose work primarily serves Natrona County residents. Funded areas include mitigating adverse childhood experiences (ACEs), promoting positive childhood experiences (PCEs), expanding access to mental and behavioral health services, supporting early childhood development and advocacy.

“In just five years, we’ve invested more than $64 million to strengthen the health and wellbeing of Natrona County residents today—and to build a healthier future for generations to come. Our nonprofit partners make that future more attainable every day,” said Trust CEO Beth Worthen.

The list of the 2025 fall grant recipients is below, and full details of the Trust’s past and current nonprofit partners can be found on its website.

*Denotes new partner

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“It was about the money, kind of,” she said with a laugh. “I didn’t have a job at the time. My mom is connected with nonprofits and wanted me to do this. But then when I went, I realized this is actually cool.”

Youth Takeover Week was the most recent installment of the Trust’s participatory grantmaking initiatives. Between July 28-August 1, twenty-one Natrona County young people between the ages of 13-19 were selected through an application process to lead the grantmaking process – identifying existing third spaces to fund and reviewing applications for the planning of a new third space.

Natalie didn’t know any of the other participants when she walked in on day one, and as someone who describes herself as having “introverted energy,” she thought she’d sit quietly on the sidelines. Instead, she found herself energized by the experience — especially the chance to hear local nonprofits present their ideas. “I felt like I was on a board,” she said. “I really liked listening to their pitches.”

From listening to leading

One thing she heard again and again from her peers stuck with her: there’s nothing to do here for us.

“There are activities for little kids, and things for adults to do, but nothing for that in-between age,” she said, referencing herself and her peers.

The lack of opportunities for teens to gather and connect became the seed for a new idea.

At Youth Takeover Week, participants sketched out concepts for a new third space. Natalie, who has a talent for art, design, and marketing, designed a space she called “Down the Block” — a multi-purpose space for belonging and creativity. That early vision grew into something she’s now bringing to life at Kelly Walsh High School.

Recruiting the help of her friend Priscilla Morales Baca, Natalie is in the process of starting a new club at Kelly Walsh called “Trojan Time.” Unlike many existing clubs, Trojan Time is meant to be open to everyone — a hub for connection, fun, and community.

“Most clubs at school are really niche, and that impacts participation,” Natalie explained. “I wanted to create a space for anyone and everyone.”

She rattles off ideas for future events with a spark in her eye: silly Olympics with games like potato sack races, karaoke nights, a banquet of countries to share food and culture, and student-run flea markets. Some gatherings might be big and energetic; others will just be a chance to hang out and chill.

Building the foundation

Trojan Time isn’t fully up and running yet — but it’s close. Natalie and Priscilla are currently working to secure a teacher sponsor, possibly connect with the student council, and get buy-in from parents and school counselors. She’s already sketching flyers, building a website, brainstorming achievement badges, and mapping out ways to spread the word.

The goal: launch the first event this fall, start small, and build momentum.

Trusting youth

Underneath the event ideas is something bigger: a call for adults to see teens differently. “They think of youth as devious little raccoons,” Natalie said with a grin. “And yeah, some do that. But most of us are pretty chill and just want something to do. Trusting youth is the big thing. It felt freeing [at Youth Takeover Week], like I could actually share my stuff without being put off by another adult.”

Trojan Time is proof of what happens when that trust is given. From Youth Takeover Week to a high school club with big dreams, Natalie is showing that when young people are empowered, they don’t just find something to do — they create something new.

The post From Youth Takeover Week to Trojan Time: How one student is creating connection at Kelly Walsh appeared first on Collective Health Trust.

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Abbie Schaible is no stranger to the Trust; she’s been a dedicated participant in many of our community engagement initiatives. Abbie has been active with the Natrona Council for Safety and Justice and serves on the board of Thrive Together Initiative. She’s joined the work of the Youth Mental Health Collective and recently pitched in to help coordinate and facilitate the Youth Takeover Week.

Her internship started earlier this month, and she’ll be with us through the school year. We asked Abbie a few questions to get to know her better and introduce her to our friends and partners.

First, tell us a little about yourself personally.

I’m a 28-year-old Latina who grew up in Casper – I would say born and raised but technically I was born during a road trip! I was raised by my Nana, who gave me so much strength and love, while also learning valuable lessons from my parents. My upbringing was a little unconventional, but it taught me resilience, compassion, and the importance of community. I’ve been fortunate to learn from many incredible leaders in this community, and I know I wouldn’t be where I am today without them. My hope is to offer that same mentorship and encouragement to others, especially those navigating difficult circumstances.

Tell us about your education journey and how you plan to use your degree.

I’m pursuing a degree in social work with the goal of working in the macro world; focusing on policy, advocacy, and creating systemic change. I believe strongly in uplifting youth voices and building community driven solutions. My education, paired with the hands-on work I’m doing now, will help me continue building bridges between lived experience and the systems that shape people’s lives.

What made you choose this path?

I’ve always been passionate about supporting people who are often overlooked – especially at-risk youth and those impacted by systems like reentry or child welfare. My own life experiences, along with the guidance of so many amazing mentors in this community, showed me the power of having someone who believes in you. I hope to be that same mentor for others, and to help amplify voices that deserve to be heard.

What do you expect to learn during your time at the Trust?

I’ve worked with individuals from the Trust in multiple ways, and I’m so excited to continue learning from their expertise in philanthropy. I’m eager to see how initiatives are prepared, finalized, and reflected upon, and to understand the process behind thoughtful, community driven giving. I never imagined I’d be in a position like this, and I’m honored to keep asking for community perspective and youth voice. My goal is to not only learn from those at the Trust, but also to ask thoughtful questions and learn from the individuals and community we serve.

When you are not working or studying, what do you do to relax and find joy?

I usually love to stay busy and invest my time into volunteering. My friends bring me so much joy and they’ve become the version of family I always imagined one would feel. I also love creative outlets like interior design, making macramé pieces, candle-making, and thrifting.

The post Meet the intern: Abbie Schaible is already making an impact at the Trust! appeared first on Collective Health Trust.