This Is Rural Health

What happens when California’s fastest-growing older population lives in communities where housing is scarce, healthcare can be hours away, and essential support services are difficult to find? For rural older adults, these challenges are already a reality—and they are only becoming more urgent.

In this episode of the California State Rural Health Association Podcast, we hear from Dr. Pauline DeLange Martinez, a public health researcher and gerontologist at the UC Davis Betty Irene Moore School of Nursing’s Family Caregiving Institute. Dr. DeLange Martinez brings together research, community engagement, and policy expertise to examine how California can better support older adults and family caregivers in rural communities.

Dr. DeLange Martinez explores why action is needed now. Nearly one in eleven Californians age 65 and older lives in a rural community, while rural counties have a higher proportion of older adults and higher rates of disability. Even more striking, California’s population age 85 and older is projected to increase by 158% between 2025 and 2040—creating an urgent need to rethink how rural communities approach aging, healthcare, housing, and caregiving.

Drawing on a two-year Rural Master Plan for Aging initiative involving three California regions and 227 community participants, Dr. DeLange Martinez shares findings from older adults, caregivers, healthcare providers, and community leaders. The conversation examines three critical areas:

• Housing: Hidden homelessness, rising costs, manufactured-home challenges, limited affordable housing, and the impact of disasters such as wildfires.
• Long-Term Services and Supports: The growing pressure on family caregivers, shortages of direct care workers, limited rural services, and the need for better navigation and caregiver support.
• Healthcare: Long travel distances, provider shortages, delayed care, chronic disease, behavioral health needs, dementia care, transportation barriers, and persistent inequities affecting rural older adults.

The episode also explores practical policy recommendations, including expanding home- and community-based services, strengthening the rural direct care workforce, improving transportation, increasing telehealth and community paramedicine, expanding geriatric expertise, and ensuring that older adults are meaningfully included in California’s Rural Health Transformation Plan.

But perhaps the most important takeaway is that rural California is not one-size-fits-all. From wildfire recovery in the North State to nutrition access in the Central Valley and extreme geographic isolation in the Inland Empire, rural communities have very different needs—and effective policy must give local communities the flexibility to identify and address their own priorities.

Listen to this important conversation to learn what rural aging looks like today, what California can do to prepare for the future, and why supporting older adults must be central to achieving true rural health equity.

• Meet the Researcher
• Why Rural Aging Needs Action
• Master Plan for Aging and Rural Initiative
• Housing Instability Solutions
• Caregiving and Workforce Gaps
• Healthcare Fixes and Final Takeaways

The CSRHA has been a go-to resource for rural healthcare and community leaders since 1995. The CSRHA brings an accumulation of actionable insights to the next generation of rural healthcare leaders. 

For more behind the scenes of this podcast follow @CSRHApodcast on Twitter or @csrha.advocate on Facebook.

If you enjoy This Is Rural Health, we could use your support! Please consider leaving a 5-star rating and review, and share it with someone who needs to hear this!

Learn more about the CSRHA at csrha.org.

• LinkedIn

Resources

• California Master Plan for Aging
• California Home & Community-Based Services (HCBS) Gap Analysis
• National Rural Age-Friendly Initiative — National Rural Health Association
• Dementia Care Aware

What if the key to strengthening rural healthcare isn't doing more—but working smarter, together?

In this episode of the California State Rural Health Association Podcast, we bring you a thought-provoking conference panel featuring Sylvia Trujillo, healthcare policy and regulatory attorney and leader at the California Telehealth Resource Center (CTRC), and Dr. Martin Entwistle, Chief of Medical Affairs at Marshall Medical Center. Together, they explore how rural healthcare organizations can move beyond simply adopting technology to building sustainable, scalable systems that improve patient care while protecting the future of rural hospitals.

Drawing on Marshall Medical Center's real-world experience, Dr. Entwistle shares how his team shifted from fragmented digital initiatives to a comprehensive strategy centered on telehealth, remote patient monitoring, artificial intelligence, and value-based care. Rather than chasing every new technology, they focused on governance, infrastructure, partnerships, and workflows that could grow with their organization and support long-term success.

The conversation also tackles some of rural healthcare's biggest challenges—including workforce shortages, reimbursement, interoperability, financial sustainability, and the risk of losing patients to larger health systems. Sylvia explains how collaboration, strategic planning, and the California Rural Health Transformation Fund can help organizations build stronger regional networks that keep specialty care and healthcare dollars within rural communities.

Whether you're leading a rural hospital, community health center, clinic, or healthcare organization, this episode offers practical insights on:

• Building scalable digital health programs instead of isolated projects
• Using telehealth and remote patient monitoring to improve access and outcomes
• Creating successful hub-and-spoke partnerships that strengthen rural care
• Preparing for value-based care and future reimbursement models
• Leveraging available funding and no-cost technical assistance to support digital transformation

If you're wondering how rural healthcare can remain financially viable while embracing innovation, this conversation provides both a roadmap and a call to action.

Listen now to discover how strategic partnerships, thoughtful planning, and digital transformation can help rural communities deliver better care—without leaving patients behind.

• CTRC Mission and Audience Pulse
• Marshall Case for Virtual Care
• Hub and Spoke Partnerships
• Building Infrastructure to Scale
• Rural Transformation Fund Takeaways

The CSRHA has been a go-to resource for rural healthcare and community leaders since 1995. The CSRHA brings an accumulation of actionable insights to the next generation of rural healthcare leaders. 

For more behind the scenes of this podcast follow @CSRHApodcast on Twitter or @csrha.advocate on Facebook.

If you enjoy This Is Rural Health, we could use your support! Please consider leaving a 5-star rating and review, and share it with someone who needs to hear this!

Learn more about the CSRHA at csrha.org.

• LinkedIn

• LinkedIn

Resources

• California Telehealth Resource Center
• California State Office of Rural Health
• U.S. Department of Health & Human Services
• Marshall Medical Center

What if one of the most important healthcare partners in your community isn't a clinic or hospital—but your local library?

In this episode of the California State Rural Health Association Podcast, Lisa Lindsay, Library Programs Consultant with the California State Library, shares how rural libraries are evolving into trusted community health hubs. Drawing on more than 20 years of experience in public libraries, Lisa reveals how libraries are helping bridge healthcare gaps through innovative partnerships, trusted relationships, and creative programming that reaches people where they already feel comfortable.

From telehealth access and blood pressure monitor lending programs to emergency preparedness, literacy services, nutrition education, and health resource fairs, Lisa demonstrates how libraries are addressing the social drivers of health in ways many healthcare organizations have yet to discover. She also shares inspiring examples from rural and tribal communities across California, highlighting how collaboration between libraries, public health agencies, nonprofits, and healthcare providers is creating healthier, more connected communities.

Whether you're a rural healthcare leader, public health professional, librarian, or community advocate, this conversation will challenge the way you think about community partnerships—and reveal why libraries may be one of healthcare's most underutilized assets.

In this episode, you'll learn:

• Why libraries have become trusted access points for health information and services.
• How rural libraries are expanding access through telehealth, health screenings, and wellness programming.
• The impact of the Rural Health Connections Project across California.
• How partnerships with organizations like the American Heart Association are improving cardiovascular health through the Libraries with Heart initiative.
• Practical ideas for healthcare organizations looking to collaborate with local libraries to better serve rural communities.

Healthcare doesn't only happen in hospitals and clinics—it happens wherever people gather, learn, and trust. This episode offers a fresh perspective on building healthier rural communities through unexpected partnerships.

Listen now to discover why the future of rural health may begin with a library card.

• LinkedIn

Resources

• Rural Health Connections Project (California)
• Libraries with Heart (American Heart Association partnership)
• California State Library (Library Programs & Rural Initiatives)

The CSRHA has been a go-to resource for rural healthcare and community leaders since 1995. The CSRHA brings an accumulation of actionable insights to the next generation of rural healthcare leaders. 

For more behind the scenes of this podcast follow @CSRHApodcast on Twitter or @csrha.advocate on Facebook.

If you enjoy This Is Rural Health, we could use your support! Please consider leaving a 5-star rating and review, and share it with someone who needs to hear this!

Learn more about the CSRHA at csrha.org.

What happens when hospitals are asked to do more with less—while navigating sweeping legislative changes, funding uncertainty, and growing regulatory pressure? In this episode of the California State Rural Health Association Podcast, Dietmar Grellmann breaks down the policy landscape that will shape the future of healthcare in California, with major implications for rural hospitals and the communities they serve.

Drawing on his expertise in healthcare policy and advocacy, Dietmar provides an inside look at the California legislative session, where nearly 1,800 bills were introduced, and explains which proposals could have the greatest impact on hospitals. From the California Hospital Association's sponsored legislation to the growing influence of the Office of Health Care Affordability, he explores how reimbursement, hospital financing, workforce challenges, and regulatory mandates are converging at a critical moment for healthcare providers.

The conversation also examines the potential effects of federal Medicaid funding changes, ongoing efforts to preserve access to care through California's provider tax program, and the legal battles surrounding affordability targets and insurer reimbursement practices. Dietmar discusses why rural hospitals face unique challenges under statewide policies, the promise—and pitfalls—of artificial intelligence in healthcare, proposed psychiatric staffing regulations, and what emerging political developments could mean for hospitals in the years ahead.

Whether you're a rural healthcare leader, policymaker, clinician, or advocate, this episode offers valuable context for understanding the complex decisions being made today—and why they matter for the future of healthcare access across California.

In this episode, you'll learn:

• Why California's legislative session could significantly impact rural hospitals.
• How state and federal policy changes may affect hospital funding and financial stability.
• What the Office of Health Care Affordability means for hospitals across the state.
• The latest on Medicaid financing, provider tax reform, and reimbursement challenges.
• How the California Hospital Association is advocating for rural healthcare through legislation and litigation.
• Why workforce shortages, behavioral health regulations, and AI policy remain major priorities.

If you want to better understand the forces shaping California healthcare—and what rural hospitals are doing to adapt—this is an episode you won't want to miss. Tune in for an insider's perspective on the policies, challenges, and opportunities that will define the future of rural health.

• LinkedIn

Resources

• California Hospital Association (CHA)
• Office of Health Care Affordability (OHCA)
• California Health Benefits Review Program (CHBRP)
• California Department of Health Care Access and Information (HCAI)

The CSRHA has been a go-to resource for rural healthcare and community leaders since 1995. The CSRHA brings an accumulation of actionable insights to the next generation of rural healthcare leaders. 

For more behind the scenes of this podcast follow @CSRHApodcast on Twitter or @csrha.advocate on Facebook.

If you enjoy This Is Rural Health, we could use your support! Please consider leaving a 5-star rating and review, and share it with someone who needs to hear this!

Learn more about the CSRHA at csrha.org.

Rural healthcare is facing one of its most pivotal moments in decades. With major Medicaid changes, a historic $50 billion Rural Health Transformation Fund, workforce shortages, and growing pressure on hospitals and providers, the decisions being made in Washington today will shape the future of rural communities for years to come.

In this episode, we sit down with a leading policy expert from the National Rural Health Association (NRHA) to unpack the rapidly evolving healthcare landscape and what it means for rural providers, patients, and community leaders across the country.

From Capitol Hill politics to federal funding opportunities, our guest breaks down the key healthcare issues dominating the national conversation, including Medicaid reform, Medicare Advantage challenges, workforce shortages, telehealth expansion, AI in healthcare, pharmacy benefit manager (PBM) reform, and the long-awaited Farm Bill. We also explore the Rural Health Transformation Program—one of the largest federal investments in rural healthcare in generations—and what states must do to secure and sustain funding.

The conversation dives into the realities facing rural hospitals and clinics, the impact of federal policy changes on healthcare access, and the innovative solutions emerging across the country to strengthen rural health infrastructure and improve outcomes.

Whether you're a healthcare executive, policymaker, provider, educator, or advocate, this episode offers valuable insight into the opportunities and challenges shaping the future of rural health.

If you care about the future of healthcare access in rural America, this is a conversation you won't want to miss. Tune in for an inside look at the policies, funding, and innovations that could redefine rural healthcare for the next generation.

The CSRHA has been a go-to resource for rural healthcare and community leaders since 1995. The CSRHA brings an accumulation of actionable insights to the next generation of rural healthcare leaders. 

For more behind the scenes of this podcast follow @CSRHApodcast on Twitter or @csrha.advocate on Facebook.

If you enjoy This Is Rural Health, we could use your support! Please consider leaving a 5-star rating and review, and share it with someone who needs to hear this!

Learn more about the CSRHA at csrha.org.

Dr. Ramiro Zúñiga, Chief Medical Officer for Health Net Medi-Cal, brings nearly three decades of experience as a board-certified family physician serving rural and underserved communities across California. At Health Net, he co-leads contractual, compliance, and regulatory efforts for the Medi-Cal line of business while providing strategic and operational direction for quality improvement, utilization management, and clinical programs.

Previously Chair of the Department of Family Medicine and Residency Program Director at San Joaquin General Hospital, Dr. Zúñiga has long combined clinical leadership with system-level transformation. He is also a Volunteer Clinical Professor at the UC Davis School of Medicine and serves on multiple boards, including the Sacramento Latino Medical Association, National Hispanic Medical Association, National Hispanic Health Foundation, and the Archstone Foundation.

In this episode, Dr. Zúñiga breaks down how CalAIM is transforming care—expanding provider networks with community-based organizations, scaling Enhanced Care Management and Community Supports, shifting to outcomes-based payment, and bringing care closer to where people live and learn through school-based telehealth and mobile clinics. He also shares how Health Net is investing in a diverse, community-aligned workforce and real-time data systems to reduce emergency-department visits and readmissions.

Subscribe for more rural-health insights—and explore Health Net and CalAIM resources below.

• Introduction and Welcome Back
•  Reintroduction and Background of Dr. Zúñiga
•  CalAIM Rollout and Successes
•  Expanding the Medical Ecosystem
•  Addressing Workforce Shortages
•  Focus on Equity and Community Partnerships
•  Whole Person Care and Enhanced Care Management
•  Telehealth and Remote Care Innovations
•  Final Thoughts and Future of CalAIM

•  LinkedIn 
• https://www.linkedin.com/company/health-net

Resources

• https://bridgingthedivideca.com
• www.news.healthnet.com
• Health Net
• CalAIM (DHCS)
• Hazel Health (school-based telehealth)
• Centene Foundation – Mobile Clinics partnership

The CSRHA has been a go-to resource for rural healthcare and community leaders since 1995. The CSRHA brings an accumulation of actionable insights to the next generation of rural healthcare leaders. 

For more behind the scenes of this podcast follow @CSRHApodcast on Twitter or @csrha.advocate on Facebook.

If you enjoy This Is Rural Health, we could use your support! Please consider leaving a 5-star rating and review, and share it with someone who needs to hear this!

Learn more about the CSRHA at csrha.org.

Dr. Wade Banner is a California-board-certified dentist and founder of In Motion Dentists, one of the few practices delivering comprehensive, in-home care—everything from cleanings to crowns and root canals—for seniors, homebound patients, and people with intellectual and developmental disabilities. He also operates a specialized brick-and-mortar clinic in La Verne built for accessibility and behavioral needs.

In this episode, Dr. Banner breaks down how portable dentistry actually works (spoiler: a carry-on-sized unit and a 7-minute setup), how partnerships with Regional Centers and RDHAPs unlock access, and why treating isolated patients in urban ZIP codes can feel as “rural” as the farthest county. We dig into workflow, equipment, teledentistry collaboration, and the mindset shift new grads need to serve special healthcare needs—plus how any dentist can start with house calls on a limited basis.

Subscribe for more conversations on practical solutions for rural and hard-to-reach care. Learn more or request a ride-along via In Motion Dentists.

• Introduction and Guest Introduction
•  Dr. Banner's Journey into Mobile Dentistry
•  Working with Special Needs and Regional Centers
•  Challenges and Solutions in Rural Dental Care
•  The Importance of House Call Dentistry
•  Future of Teledentistry and RDHAPs
•  Conclusion and Contact Information

•  LinkedIn 

Resources

• In Motion Dentists
• RDHAP Connect
• San Gabriel / Pomona Regional Center
• Aseptico Portable Dental Units
• Cocoon Portable X-Ray

The CSRHA has been a go-to resource for rural healthcare and community leaders since 1995. The CSRHA brings an accumulation of actionable insights to the next generation of rural healthcare leaders. 

For more behind the scenes of this podcast follow @CSRHApodcast on Twitter or @csrha.advocate on Facebook.

If you enjoy This Is Rural Health, we could use your support! Please consider leaving a 5-star rating and review, and share it with someone who needs to hear this!

Learn more about the CSRHA at csrha.org.

JD Garza is the Associate Director of the California Area Health Education Center (AHEC), hosted at UCSF Fresno, and a board member of the National AHEC Organization. His career centers on partnering with community organizations to serve medically underserved communities. 

In this episode, JD breaks down how AHEC recruits, trains, and retains health professionals for rural and underserved areas—at scale. We get into AHEC Scholars (a two-year, interdisciplinary track with community projects), clinical placements across community health centers, and why elevating CHWs, MAs, and CNAs is key. He also shares a standout youth diabetes coaching partnership, outcomes to date, and a practical burnout-prevention curriculum (“Healing from the Heart”) co-built with Hennepin Healthcare.

• Introduction to JD Garza and AHEC
•  Overview of California AHEC
•  California AHEC Centers and Partnerships
•  AHEC Programs and Initiatives
•  AHEC Scholars Program
•  Burnout Prevention and Resiliency Program
•  Future Plans and Conclusion

Resources

• California Area Health Education Center (UCSF Fresno) 
• National AHEC Organization 
• HRSA Area Health Education Centers (AHEC) Program 
• Hennepin Healthcare — Institute for Professional Worklife (burnout resources)
• Stanford Youth Diabetes Coaching Program

The CSRHA has been a go-to resource for rural healthcare and community leaders since 1995. The CSRHA brings an accumulation of actionable insights to the next generation of rural healthcare leaders. 

For more behind the scenes of this podcast follow @CSRHApodcast on Twitter or @csrha.advocate on Facebook.

If you enjoy This Is Rural Health, we could use your support! Please consider leaving a 5-star rating and review, and share it with someone who needs to hear this!

Learn more about the CSRHA at csrha.org.

Ingrid Villeda is a Program & Community Engagement Specialist at the Alzheimer’s Association (Northern CA & Northern NV). She’s spent 8+ years serving older adults, people with disabilities, and caregivers—especially in Latino and rural communities—building partnerships and delivering bilingual education that actually reaches families.

In this episode, Ingrid breaks down what Alzheimer’s is (and isn’t), who’s at higher risk, and how new anti-amyloid therapies are changing the timeline for early-stage patients. We dig into the realities of rural care—limited specialists, long travel, internet deserts—and the concrete fixes that work: training primary care, leveraging Project ECHO, phone-first education, and meeting families where they already are (consulates, food banks, schools). You’ll leave with playbook-level ideas to expand access, support caregivers, and drive earlier detection in hard-to-reach places. 

•  Overview of Alzheimer's Association
•  Understanding Alzheimer's and Dementia
•  Risk Factors and Research
•  Diagnosis and Treatment Options
•  Challenges in Rural Communities
•  Addressing Rural Healthcare Obstacles
•  Behavioral Symptoms and Care Strategies
•  Resources and Conclusion

•  LinkedIn 

Resources

• https://www.alz.org 
• https://uspointer.net 
• https://www.dementiacareaware.org 
• https://projectecho.unm.edu/initiatives/alzheimers-and-dementia-care-echo/

The CSRHA has been a go-to resource for rural healthcare and community leaders since 1995. The CSRHA brings an accumulation of actionable insights to the next generation of rural healthcare leaders. 

For more behind the scenes of this podcast follow @CSRHApodcast on Twitter or @csrha.advocate on Facebook.

If you enjoy This Is Rural Health, we could use your support! Please consider leaving a 5-star rating and review, and share it with someone who needs to hear this!

Learn more about the CSRHA at csrha.org.

Kristy Bird MaKieve is the founder and CEO of Healthy Rural California, a nonprofit transforming healthcare access in Northern California’s underserved communities. A social entrepreneur and medical society leader, Kristy is spearheading graduate medical education programs, residency training, and innovative partnerships to address the rural physician shortage head-on.

In this episode, Kristy shares how Healthy Rural California launched psychiatry and family medicine residencies in Chico, why medical education is the key to reversing decades of healthcare inequity, and how her team is creating pathways for youth, medical students, and future physicians to stay and serve rural communities. She breaks down the economic ripple effects of residency programs, her vision for an interprofessional healthcare campus, and what it really takes to bring lasting health equity to the North State.

If you care about solving physician shortages, strengthening rural health, or building community-driven solutions, this conversation is a blueprint for impact.

•  Healthy Rural California's Mission
•  Challenges in Rural Healthcare
•  Graduate Medical Education Initiatives
•  Video Presentation: Residency Programs
•  Impact of Residency Programs
•  Community Health and Education Programs
•  Future Plans and Expansion
•  Conclusion and Final Thoughts

•  LinkedIn 

Resources

• California Medical Association, 
• National Rural Health Association ,
• UC Davis School of Medicine
• North Valley Community Foundation 

The CSRHA has been a go-to resource for rural healthcare and community leaders since 1995. The CSRHA brings an accumulation of actionable insights to the next generation of rural healthcare leaders. 

For more behind the scenes of this podcast follow @CSRHApodcast on Twitter or @csrha.advocate on Facebook.

If you enjoy This Is Rural Health, we could use your support! Please consider leaving a 5-star rating and review, and share it with someone who needs to hear this!

Learn more about the CSRHA at csrha.org.