The Future of Rural Health Needs You

By Carrie Cochran-McClain, Chief Policy Officer of the National Rural Health Association 

Rural health care is in danger. Since 2010, 140 rural hospitals have closed, leaving many communities without access to health care. In rural areas, this can create a domino effect of other hardships—a hospital often serves as the largest employer in a community, and when these facilities shut down, the hardware store or restaurants nearby often face similar fates. Put simply, when a rural hospital shutters, it becomes harder for the town itself to survive.

The COVID-19 pandemic exacerbated existing strains on the rural health safety net. Prior to the pandemic, rural health care providers were dealing with uncertain and unstable reimbursements and a depleted workforce. During the pandemic, Rural communities were hit disproportionately hard, with 24 more deaths per 100,000 residents than their urban counterparts. The high rural mortality rate is due to several factors including a higher proportion of older residents, greater prevalence of pre-existing conditions and comorbidities, historically underfunded rural health care infrastructure, and limited access to public health information. 

Congress supported funding for rural health care in the fiscal year (FY) 2022 budget, yet as the country rebounds from COVID-19, continued investments in FY 2023 are necessary to ensure rural providers can remain viable and care for their rural populations.

Full funding of the rural health safety net in FY 2023 will be a turning point for rural providers. While current spending for rural health discretionary programs is relatively small, it plays a critical role in solidifying the fragile health care infrastructure in rural communities. The National Rural Health Association (NRHA) has identified several key FY 2023 priorities that if addressed, will improve rural health care access and affordability across the country.  

Congress should maintain funding for key rural health infrastructure programs like the State Offices of Rural Health Program, which supports efforts to enhance and coordinate rural health initiatives statewide. Rural Health Care Services Outreach community-based programs encourage an evidence-based approach to population health that can be replicated from one community to the next, as well as development of collaborative networks among rural health care providers to achieve project goals.

Congress should provide increased funding for the Medicare Rural Hospital Flexibility (FLEX) Program in FY 2023. FLEX Program grants help provide state-specific solutions to primary care in rural communities. Within the FLEX Program, Congress must continue funding for the Rural Emergency Hospital (REH) Technical Assistance Program. In January 2023, the REH designation is expected to be supported by CMS. Continued technical assistance is needed to ensure rural providers have the resources to transition to this new hospital designation.

To prevent future inequities as seen during the pandemic, Congress should establish an Office of Rural Health within the Centers for Disease Control and Prevention (CDC) with an appropriation to operate the office. Rural communities face more barriers to care than urban counterparts. A rural-focused office will help facilitate coordination of public health investments within rural communities and be a direct resource for rural providers. NRHA believes an Office of Rural Health is a logical next step in meeting the CDC’s rural-focused efforts outlined in FY 2022.

Included in President Biden’s FY 2023 budget request is a rural health clinic (RHC) initiative to help improve access to behavioral health care in rural communities. Unfortunately, finding behavioral health providers to work in underserved areas is difficult, and the behavioral health needs of rural populations often go unmet. The $10 million proposal for a new RHC Behavioral Health Initiative would cover the salary and other startup costs of hiring behavioral health providers in rural health clinics. This initiative, if approved, would be the first congressionally appropriated federal grant program specifically for federally certified RHCs. 

The president’s budget also proposes to modernize Medicare mental health benefits by allowing RHCs to bill for licensed professional counselors and marriage and family therapist services. Recognizing these professionals would help address the workforce crisis, and with this funding RHCs could utilize the RHC Behavioral Health Initiative to bring more behavioral health professionals to rural, underserved populations.

Additionally, NRHA believes it is important to expand the Rural Residency Planning and Development Program in FY 2023. Workforce shortages plague rural health providers across the nation. Increases in rural residency training programs will lead to more physicians choosing to practice in rural locations, as data shows individuals who train in rural areas are more likely to stay in rural areas.

In addition to workforce shortages, rural communities are being hit by hospital and service closures. As mentioned above, 140 rural hospitals have closed since 2010. To help combat hospital closures, NRHA asks Congress for increased funding for the United States Department of Agriculture Rural Hospital Technical Assistance program. The funding would help hospitals better manage their financial business strategies and could be a lifeline for more than 450 vulnerable hospitals throughout the country.

As an alternative to full closure, a vulnerable rural hospital often cuts services. Maternal health care deserts are becoming more common following the elimination of obstetrical services in rural hospitals. In FY 2022, Congress provided significant resources to help address maternal health care desserts through the passage of the Rural Maternal and Obstetric Modernization of Services (RMOMS) Act to help build out maternal health resources in rural communities. It is imperative for Congress to provide full funding to this program in FY 2023 to help improve devastating rural maternal health outcomes.

The last two years have been difficult for rural providers, but Congress has the opportunity to improve rural health care outcomes as we put the COVID-19 pandemic behind us. NRHA is hopeful the FY 2023 appropriations process will be the starting place for the revitalization of rural health care.

For more information on rural health advocacy, visit https://www.ruralhealth.us/advocate.