Rural older adults navigating both Medicare and Medicaid face some of the most complex challenges in our healthcare system, and Lutheran Services in America went directly to the source to understand why.
In July 2025, Lutheran Services in America launched Rural Voices 2025: Elevating the Resilience of Rural Older Adults Navigating Medicare-Medicaid, in partnership with The SCAN Foundation. This human-centered initiative reflects Lutheran Services in America’s longstanding leadership in rural aging, and its belief that the people closest to a problem hold the most important insights for solving it. Drawing on our network’s Rural Aging Action Network and in partnership with Lutheran Social Service of Minnesota and Lutheran Social Services of South Dakota, Lutheran Services in America engaged dual-eligible older adults across rural Minnesota, North Dakota, and South Dakota — communities that are too often invisible in national policy conversations yet disproportionately burdened by access barriers and system complexity.
Working with Public Policy Lab and The People Say, Lutheran Services in America conducted in-depth, human-centered interviews with 16 rural older adults whose stories now contribute to a growing national archive of firsthand insights. These are not data points. They are detailed, lived accounts of what it actually takes to age in place in rural America: navigating fragmented care, confusing benefits, workforce shortages, and policies that weren’t designed with them in mind.
The findings are now available, and urgently relevant. Lutheran Services in America’s newly released e-report, “Rural Voices Shaping Transformation,” translates these experiences into a clear roadmap for change: simplifying eligibility and enrollment, reducing administrative burden, improving benefit communication, and modernizing policies that inadvertently penalize rural older adults with farm-based assets. At a moment when federal policy affecting older adults is shifting rapidly, this report offers policymakers, providers, and advocates concrete, community-grounded direction.
To extend the reach of these findings, Lutheran Services in America hosted the webinar “From the Ground Up: Using Rural Voices to Build Better Policy for Aging Americans,” the recording of which is available. Together, the report and webinar equip anyone working in aging, rural health, or policy with the evidence and tools to act.
Lutheran Services in America is actively sharing these findings with policymakers, faith and aging partners, and advocates nationwide. The goal is clear: systems that honor the dignity and complexity of aging in place, wherever someone calls home.
Read the report. Watch the webinar. Join the effort. To learn more or explore partnership opportunities, contact Regan McManus.
Regan McManus, Director of Aging Initiatives at Lutheran Services in America.
Rural Voices 2025 kicked off at the end of July in rural South Dakota and Minnesota — two states where older adults are underrepresented in policy and disproportionately impacted by provider shortages, limited infrastructure, and fragmented healthcare systems. In partnership with Public Policy Lab, Lutheran Social Service of Minnesota, and Lutheran Social Services of South Dakota, human-centered interviews were conducted with older adults who are dual-eligible (receiving Medicare and Medicaid) to learn what rural older adults need to age in place, the barriers they face in navigating healthcare systems, and how faith-based nonprofit services contribute to their wellbeing.
The response has been overwhelmingly positive. One resident calls Temi her go-to partner for a daily game of solitaire (no more shuffling required!). Another resident uses Temi as a walking companion who plays favorite hymns along the way and helps her stay physically active while bringing joy in her daily routine. Moreover, staff and family caregivers report seeing improved moods and stronger daily engagement.