Bridging the Distance: How the U.S. Department of Health and Human Services Supports Rural Communities

Last updated 4 months ago. Our resources are updated regularly but please keep in mind that links, programs, policies, and contact information do change.

The U.S. Department of Health and Human Services (HHS) plays a vital role in addressing unique health challenges faced by approximately 61 million Americans living in rural areas. Rural communities often face barriers including geographic isolation, fewer healthcare providers, limited specialty care access, higher chronic disease rates, and economic factors that impact health.

HHS utilizes programs, policies, and partnerships across its agencies to improve health outcomes, enhance care access, and build sustainable healthcare infrastructure in rural America.

Key HHS Agencies for Rural Health

Several HHS agencies spearhead efforts specifically tailored to rural health needs.

Federal Office of Rural Health Policy (FORHP)

Established in 1987, the Federal Office of Rural Health Policy (FORHP), housed within the Health Resources and Services Administration (HRSA), serves as the primary focal point for rural health within HHS. Its core mission is increasing care access for underserved populations in rural communities through grant programs and public partnerships.

FORHP advises the HHS Secretary on how federal policies, particularly Medicare and Medicaid, affect rural residents’ care access, rural hospitals’ financial viability, and healthcare professional availability.

FORHP’s key objectives include:

• Ensuring rural healthcare facilities’ availability and financial stability
• Developing and evaluating new payment models
• Maintaining adequate workforce
• Optimizing telehealth and health IT
• Improving population health
• Addressing health disparities
• Ensuring access to essential services like emergency medical services

FORHP achieves this through four main divisions:

Community Based Division (CBD): Provides direct support to community organizations for service delivery and health networks, encouraging collaboration.

Hospital State Division (HSD): Supports State Offices of Rural Health and rural hospitals (especially Critical Access Hospitals) through programs like the Medicare Rural Hospital Flexibility (Flex) Program and the Small Hospital Improvement Program (SHIP).

Policy Research Division (PRD): Coordinates policy analysis, funds Rural Health Research Centers, and staffs the National Advisory Committee on Rural Health & Human Services (NACRHHS). It monitors policy changes, analyzes their impact, and uses research to understand rural challenges.

Rural Strategic Initiatives Division (RSID): Focuses on piloting new programs and addressing emerging strategic priorities.

FORHP also oversees specific initiatives like the Black Lung Clinics grant program and collaborates extensively across HHS and with other federal partners. It serves as a national knowledge center, striving to build state and local capacity.

Centers for Medicare & Medicaid Services (CMS)

The Centers for Medicare & Medicaid Services (CMS) oversees the nation’s largest health insurance programs, Medicare and Medicaid, crucial funding sources for rural providers and beneficiaries. Recognizing unique challenges in rural healthcare delivery, CMS established a Rural Health Strategy in 2016 (updated in 2022/2023 via the Framework for Advancing Health Care in Rural, Tribal, and Geographically Isolated Communities).

The strategy’s core objectives include:

• Applying a rural lens to CMS programs and policies to avoid unintended negative consequences
• Improving care access through provider engagement, support, and maximizing practice scope
• Advancing telehealth and telemedicine to overcome distance barriers
• Empowering rural community patients with information and tools
• Leveraging partnerships to achieve strategic goals

CMS actively addresses the unique economics of rural healthcare, monitors market impacts, reduces regulatory burden where possible, and encourages rural stakeholder participation. The CMS Rural Health Council, composed of agency experts, guides these efforts, focusing on access, economics, and innovation.

CMS engages stakeholders through mechanisms like Rural Health Open Door Forums and utilizes Regional Office Rural Health Coordinators for technical assistance. Key focus areas include supporting Rural Health Clinics (RHCs), Critical Access Hospitals (CAHs), Federally Qualified Health Centers (FQHCs), and improving rural maternal health outcomes.

The updated CMS Framework for Advancing Health Care in Rural, Tribal, and Geographically Isolated Communities outlines six key priorities:

• Applying a community-informed geographic lens
• Improving data collection
• Strengthening the workforce
• Optimizing technology
• Expanding coverage and services access
• Driving innovation/value-based care

Centers for Disease Control and Prevention (CDC)

The Centers for Disease Control and Prevention (CDC) protects public health through disease prevention and control, environmental health, emergency preparedness, and health promotion. The CDC recognizes that rural residents often face higher rates of chronic diseases (heart disease, cancer, obesity), premature death, and specific risks like unintentional injuries (motor vehicle crashes, opioid overdoses) and suicide compared to urban counterparts.

In 2023, CDC established the Office of Rural Health (ORH) within its National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and Workforce. ORH’s mission is leading CDC’s rural public health strategy, coordinating across agency programs, and collaborating with partners to improve health and well-being in rural America. The CDC’s Rural Public Health Strategic Plan focuses on advancing partner engagement, strengthening infrastructure and workforce, advancing science, and improving preparedness and response capacity.

CDC activities impacting rural health include:

• Funding state and local health departments and community organizations for interventions (e.g., High Obesity Program, Overdose Data to Action, arthritis management programs, cancer screening)
• Conducting research and surveillance on rural health disparities (e.g., reports on leading causes of death, chronic disease prevalence)
• Developing tools and resources (e.g., Rural Emergency Preparedness and Response Toolkit, PLACES data tool, Interactive Atlas of Heart Disease and Stroke)
• Promoting telehealth to improve access to chronic disease management and specialist care
• Supporting initiatives like electronic case reporting (eCR) in Critical Access Hospitals

Substance Abuse and Mental Health Services Administration (SAMHSA)

The Substance Abuse and Mental Health Services Administration (SAMHSA) leads public health efforts to advance the nation’s behavioral health, reducing substance abuse and mental illness impact on America’s communities. SAMHSA recognizes the specific behavioral health challenges in rural areas, including access barriers and workforce shortages.

SAMHSA supports rural communities through:

Grant Programs: Funding initiatives like the Rural EMS Training Grant, Rural Opioid Technical Assistance Regional Centers (ROTA-R), youth treatment programs (SYT-I, TREE), Building Communities of Recovery (BCOR), and prevention programs (SPF-PFS).

Technical Assistance: Providing support through Technology Transfer Centers (ATTC, MHTTC, PTTC) and specific programs like ROTA-R.

Data Collection & Resources: Gathering data on substance use and mental health treatment facilities (e.g., N-SUMHSS, DAWN, TEDS) and providing resource libraries and evidence-based practice guides.

Treatment Locators: Offering tools like FindTreatment.gov, the Buprenorphine Practitioner Locator, and the Early Serious Mental Illness Treatment Locator to help individuals find care.

Collaboration: Working with states, communities, and tribal organizations on behavioral health initiatives.

Other Contributing HHS Agencies

While FORHP, CMS, CDC, and SAMHSA have prominent roles, other HHS agencies contribute significantly:

• Agency for Healthcare Research and Quality (AHRQ): Produces evidence to make healthcare safer, higher quality, more accessible, equitable, and affordable, including research relevant to rural settings.
• Administration for Children and Families (ACF): Funds state, local, and tribal organizations for family assistance, child support, child care (including rural initiatives in partnership with USDA), Head Start, and child welfare.
• Administration for Community Living (ACL): Increases access to community support and resources for older Americans and people with disabilities, populations often concentrated in rural areas.
• Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC): Supports health IT adoption and information exchange, crucial for overcoming distance barriers in rural healthcare.
• Administration for Strategic Preparedness and Response (ASPR): Leads national preparedness for disasters and public health emergencies, including support for rural healthcare system readiness through programs like the Hospital Preparedness Program (HPP).
• Indian Health Service (IHS): Provides comprehensive health services to American Indians and Alaska Natives, many of whom reside in rural and remote areas.

Supporting Rural Healthcare Access and Infrastructure

HHS employs several key mechanisms to ensure rural residents can access care and facilities remain viable.

Rural Health Clinics (RHCs)

Established in 1977, the Rural Health Clinic (RHC) program aims to increase primary care access for Medicare and Medicaid beneficiaries in underserved rural areas. RHCs receive enhanced reimbursement rates, often an All-Inclusive Rate (AIR) per visit, to help cover costs in areas where patient volume might be low.

Eligibility and Requirements:

• Location: Must be in a non-urbanized area (as defined by the U.S. Census Bureau) that is also designated as a Health Professional Shortage Area (HPSA), Medically Underserved Area (MUA), or Governor-designated shortage area within the last four years. The “Am I Rural?” tool can help determine geographic eligibility.
• Staffing: Must employ a team approach, utilizing physicians working with non-physician providers. A Nurse Practitioner (NP), Physician Assistant (PA), or Certified Nurse Midwife (CNM) must be on-site providing patient care at least 50% of the time the clinic operates. Waivers for staffing requirements may be available under specific circumstances.
• Services: Required to provide outpatient primary care, basic laboratory services, and first-response emergency care.
• Certification: Facilities apply for certification through their State Survey Agency and CMS. Accreditation is not required for RHC status, but facilities must meet federal requirements outlined in 42 CFR Parts 405 and 491.

CMS provides resources and guidance through the Rural Health Clinics Center.

Critical Access Hospitals (CAHs) and the Flex Program

Recognizing small rural hospitals’ financial vulnerability, the Critical Access Hospital (CAH) designation was created by the Balanced Budget Act of 1997. CAHs are small, geographically isolated hospitals that receive cost-based reimbursement from Medicare for most inpatient and outpatient services, helping maintain financial viability.

Eligibility and Requirements:

• Location: Must be in a rural area (or treated as rural) and located more than a 35-mile drive (or 15 miles in mountainous terrain/secondary roads) from another hospital or CAH, unless designated as a “necessary provider” by the state before 2006.
• Size: Maintain no more than 25 acute care inpatient beds (can be used as swing beds for post-acute care). May operate separate 10-bed psychiatric and/or rehabilitation distinct part units.
• Length of Stay: Maintain an annual average length of stay of 96 hours or less for acute care patients.
• Emergency Services: Provide 24/7 emergency services.
• Certification: Must meet Medicare Conditions of Participation (CoPs) outlined in 42 CFR 485 Subpart F.

To support CAHs, HRSA’s FORHP administers the Medicare Rural Hospital Flexibility Program (Flex). Flex provides grants to State Offices of Rural Health (SORHs). SORHs use these funds (estimated $28.7M in FY 2019) to offer technical assistance and support to CAHs within their state, focusing on:

• Quality improvement and reporting (a required program area)
• Financial and operational improvement (a required program area)
• Population health improvement
• Rural Emergency Medical Services (EMS) integration
• Support for facilities converting to CAH status

The Flex program aims to ensure CAHs provide high-quality care aligned with community needs, remain financially stable, adapt to change, and integrate patient care across the rural health system. Resources like the Flex Monitoring Team provide data and research on CAHs. CMS provides information for CAHs via resources like the “Information for Critical Access Hospitals” booklet.

Telehealth Expansion

Telehealth is a critical tool for overcoming distance barriers and expanding access to specialty care, mental health services, and chronic disease management in rural areas. HHS promotes telehealth through policy, reimbursement changes, and grant funding.

Policy & Reimbursement: CMS has expanded Medicare coverage for telehealth services, particularly during and after the COVID-19 public health emergency, and continues to explore flexibilities, including in new payment models. The CMS Rural Health Strategy explicitly aims to reduce barriers like reimbursement issues and cross-state licensure.

HRSA’s Office for the Advancement of Telehealth (OAT): Within FORHP, OAT administers grant programs to support telehealth infrastructure, service delivery, research, and technical assistance. Key OAT programs include:

• Telehealth Resource Centers (TRCs): Twelve Regional and two National centers provide training, support, and information to help organizations implement and sustain telehealth programs.
• Telehealth Network Grant Program (TNGP): Supports networks using telehealth to improve services, particularly rural tele-emergency services.
• Evidence-Based Tele-Behavioral Health Network Program (EBTNP): Funds networks using telehealth to increase access to behavioral healthcare, focusing on direct-to-consumer models.
• Telehealth Centers of Excellence (COE): Funds academic medical centers to assess telehealth effectiveness in rural areas and develop sustainable models.
• Telehealth Broadband Pilot (TBP) Program: Examines broadband capacity and links communities to funding to address gaps.

Other Funding: NIH offers grants supporting technology development and health IT to reduce disparities. USDA also provides loans and grants (e.g., Distance Learning and Telemedicine Grants, Community Facilities Program) that can fund telehealth infrastructure. HHS collaborates with USDA and the Federal Communications Commission (FCC) through initiatives like the Rural Telehealth Initiative (RTI) to coordinate efforts on broadband expansion and telehealth access.

Resources like Telehealth.HHS.gov provide information for providers and patients.

Strengthening the Rural Health Workforce

Attracting and retaining qualified healthcare professionals is a persistent challenge for rural communities. HHS invests significantly in programs designed to build and support the rural health workforce pipeline.

National Health Service Corps (NHSC)

The National Health Service Corps (NHSC), administered by HRSA’s Bureau of Health Workforce (BHW), provides scholarships and loan repayment assistance to primary care, dental, mental/behavioral health, and maternal care providers who commit to serving in designated Health Professional Shortage Areas (HPSAs), many of which are rural.

NHSC Scholarship Program: Offers scholarships covering tuition, fees, educational costs, and a living stipend to students in eligible disciplines (physician, dentist, NP, PA, CNM). In return, scholars commit to a minimum of two years of full-time service at an NHSC-approved site upon graduation/residency completion. Eligibility requires U.S. citizenship/national status, full-time enrollment in an accredited U.S. program, and no conflicting service obligations. Apply via the NHSC website.

NHSC Loan Repayment Program (LRP): Provides loan repayment assistance to licensed clinicians already working or applying to work at an NHSC-approved site in a HPSA.

• Awards: Up to $75,000 (primary care) or $50,000 (all others) for a two-year, full-time service commitment; up to $37,500 (primary care) or $25,000 (all others) for a two-year, half-time commitment (private practice ineligible for half-time). Funds are tax-exempt.
• Eligibility: U.S. citizen/national, licensed in an eligible discipline, working at an NHSC-approved site, with qualifying student loan debt. Eligible disciplines include physicians (MD/DO, including psychiatry), dentists, PAs, NPs, CNMs, health service psychologists, LCSWs, psychiatric nurse specialists, MFTs, and LPCs. Apply via the NHSC website.

NHSC Rural Community Loan Repayment Program (Rural Community LRP): Specifically targets clinicians providing substance use disorder (SUD) treatment in rural HPSAs. Offers up to $100,000 (full-time) or $50,000 (half-time) for a three-year service commitment. Preference is given to sites receiving RCORP funding. Apply via the NHSC website.

NHSC Substance Use Disorder (SUD) Workforce LRP: Similar to the Rural Community LRP but for SUD clinicians serving in any HPSA (rural or urban). Offers up to $75,000 (full-time) or $37,500 (half-time) for a three-year commitment. Apply via the NHSC website.

NHSC Students to Service (S2S) LRP: Provides up to $120,000 in loan repayment to medical, nursing, PA, and dental students in their final year in return for a three-year, full-time commitment in a HPSA. Apply via the NHSC website.

Since its inception, the NHSC has placed tens of thousands of providers in underserved areas, significantly impacting care access. Studies suggest NHSC presence is associated with improvements in community health outcomes and physician supply in rural counties.

Nurse Corps

Also administered by HRSA’s BHW, the Nurse Corps program offers scholarships and loan repayment specifically for nurses and nurse faculty.

Nurse Corps Scholarship Program: Pays tuition, fees, educational costs, and a monthly stipend for nursing students. In return, graduates work for at least two years at an eligible Critical Shortage Facility (CSF) located in a HPSA. Eligibility requires U.S. citizenship/national/lawful permanent resident status and enrollment in an accredited U.S. nursing program. Apply via the BHW website.

Nurse Corps Loan Repayment Program (LRP): Repays up to 85% of unpaid nursing education debt for RNs, APRNs, and nurse faculty working full-time for two years in a CSF or eligible nursing school. Participants can receive 60% over two years, with an optional third year for an additional 25%. Funds are taxable. Eligibility requires a license, education from an accredited U.S. school, and full-time work in an eligible setting. Apply via the BHW website.

Training and Development Programs

HHS supports various programs aimed at training healthcare professionals with experience in rural and underserved settings:

Rural Residency Planning and Development (RRPD) Program: Provides grants (up to $750,000) to help establish new, sustainable physician residency programs (Family Medicine, Internal Medicine, Psychiatry, General Surgery, OB/GYN, Preventive Medicine) where residents train primarily (>50% time) in rural locations. The goal is increasing the number of physicians practicing in rural areas. Eligible applicants include GME consortia, rural hospitals, and rural community-based ambulatory settings. Contact: [email protected].

Teaching Health Center Graduate Medical Education (THCGME) Program: Trains residents in community-based outpatient settings, with over 93% training in medically underserved or rural communities.

Area Health Education Centers (AHEC) Program: Builds a pipeline of trainees with experience in rural and underserved areas, focusing on primary care recruitment, training, and retention.

Nursing Education Programs: HRSA offers various grants supporting nurse training, practice, quality, retention, and advanced nursing education, often benefiting rural areas.

Behavioral Health Workforce Development Programs: Enhance training for professionals and paraprofessionals, including experience in treating SUD.

State Loan Repayment Program (SLRP): HRSA provides grants to states to operate their own loan repayment programs, complementing federal efforts.

Addressing Specific Rural Health Challenges

Beyond foundational support, HHS directs resources towards specific health issues prevalent or particularly challenging in rural America.

Mental and Behavioral Health & Substance Use Disorder (SUD)

Access to mental health and SUD services is often limited in rural areas due to workforce shortages, distance, stigma, and lack of specialized services. HHS agencies work to expand access and treatment capacity.

SAMHSA Initiatives: As detailed earlier, SAMHSA provides grants (e.g., Rural EMS Training, ROTA-R, youth treatment, recovery communities, prevention), technical assistance (TTCs), data, and resources focused on behavioral health. The Behavioral Health Treatment Services Locator helps locate facilities. SAMHSA also promotes evidence-based practices and supports the integration of behavioral health with primary care.

HRSA’s Rural Communities Opioid Response Program (RCORP): This major FORHP initiative provides multi-year funding to rural consortia to strengthen and expand SUD/OUD prevention, treatment, and recovery services. RCORP includes various grant tracks like Implementation, Impact, Pathways (youth-focused), and technical assistance (RCORP-TA).

Workforce Support: NHSC and Nurse Corps programs offer specific tracks or enhanced funding for behavioral health and SUD providers serving rural areas (e.g., NHSC Rural Community LRP, NHSC SUD Workforce LRP). HRSA also funds Behavioral Health Workforce Development programs.

CMS Policies: CMS works to improve access through policies allowing RHCs and FQHCs to bill for services provided by Licensed Professional Counselors and Marriage and Family Therapists, and leveraging telehealth flexibilities for behavioral health.

CDC Efforts: The CDC tracks drug overdose trends in rural areas (which are often higher than urban rates) and funds programs like Overdose Data to Action to build state/local prevention capacity.

Maternal and Child Health

Rural areas often face obstetric unit closures, long travel times for prenatal and delivery care, and workforce shortages, contributing to disparities in maternal and infant outcomes. HHS, particularly HRSA’s Maternal and Child Health Bureau (MCHB), implements programs to address these issues.

Maternal and Child Health Bureau (MCHB): Strengthens public health systems for mothers, children, and families, reaching millions annually. MCHB supports state Title V block grants, funds Healthy Start programs in high-disparity communities, supports the Maternal, Infant, and Early Childhood Home Visiting Program, and runs the National Maternal Mental Health Hotline (1-833-TLC-MAMA).

FORHP’s Rural Maternity and Obstetrics Management Strategies (Rural MOMS) Program: Funds networks to improve access to and delivery of maternity care in rural areas. Apply via Grants.gov.

Workforce Development: HRSA funds programs to train OB/GYNs, nurse midwives, doulas, and other perinatal professionals, with specific initiatives targeting rural needs, such as OB/GYN rural track residencies. NHSC and Nurse Corps also support maternal care providers.

CMS Initiatives: CMS focuses on improving rural maternal health care access and outcomes, leveraging partnerships and providing resources.

Recent Investments: In June 2024, HRSA announced $15 million in new investments specifically for rural maternal health needs. HRSA’s Enhancing Maternal Health Initiative has focused on strengthening work in 11 states and DC.

Chronic Disease Prevention and Management

Rural populations experience higher rates of many chronic diseases, influenced by factors like health behaviors (smoking, nutrition, physical activity), care access, and socioeconomic characteristics.

CDC Programs: The CDC’s National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) works to improve rural health through funding, research, surveillance, and promoting telehealth.

• High Obesity Program (HOP): Funds land-grant universities working with community extension services in high-obesity counties (often rural) to improve access to healthy foods and physical activity opportunities. Since 2014, HOP has reached millions and supported policy, systems, and environmental changes. Examples include promoting Go NAPSACC in childcare, developing produce prescription programs, and creating activity-friendly routes.
• Arthritis Programs: CDC funds state health departments (e.g., Kentucky, Utah) to implement evidence-based self-management programs like Walk With Ease in rural communities, often using community health workers or remote delivery.
• Other Initiatives: CDC supports programs addressing diabetes self-management, cancer prevention/screening, heart disease/stroke prevention (e.g., Mississippi Delta Health Collaborative), and promoting healthy behaviors.

HRSA Programs: Community-based grants like the Rural Health Care Services Outreach Program often support chronic disease prevention and management initiatives. The Healthy Rural Hometown Initiative (HRHI) track specifically targets the five leading causes of avoidable death, including heart disease and cancer.

CMS Role: CMS supports chronic care management through specific billing codes and promotes value-based care models that incentivize prevention and management.

Emergency Preparedness and Response

Rural areas face unique challenges in preparing for and responding to emergencies, including distance, limited resources, workforce shortages, and communication barriers.

ASPR’s Hospital Preparedness Program (HPP): This is the primary source of federal funding for healthcare system readiness. HPP provides cooperative agreements to 62 recipients (states, territories, major cities) who then fund and support regional Health Care Coalitions (HCCs). HCCs bring together diverse healthcare entities (hospitals, EMS, public health, emergency management) to collaboratively plan, train, exercise, and respond to emergencies. HPP aims to improve patient outcomes, minimize supplemental resource needs, and enable rapid recovery. HPP focuses on four core capabilities: Foundation for Readiness, Response Coordination, Continuity of Service Delivery, and Medical Surge. ASPR provides technical assistance through resources like ASPR TRACIE. Recent updates focus on cyber and extended downtime preparedness.

CDC Resources: The CDC provides resources like the Rural Emergency Preparedness and Response Toolkit to support rural and tribal communities. CDC also administers the Public Health Emergency Preparedness (PHEP) cooperative agreement, which helps health departments build response capabilities.

Other Support: ASPR also manages programs like the Medical Reserve Corps (MRC), which received $50 million in American Rescue Plan funds via the MRC-STTRONG grant program to enhance local response capabilities, and partners with CMS on the HHS emPOWER program to protect Medicare beneficiaries reliant on electricity-dependent medical equipment. FEMA also offers preparedness grants that may benefit rural communities.

Impact, Outcomes, and Evaluation

HHS agencies track the impact of their rural health investments through data collection, program evaluations, and reporting on outcomes and success stories.

HRSA Data & Success Stories

FORHP Programs: FORHP supports Rural Health Research Centers that produce policy-relevant research on rural health issues, disseminated via the Rural Health Research Gateway. Community-Based Division grants have shown success, with many grantees sustaining efforts post-funding and demonstrating cost-effectiveness (e.g., diabetes management saving $384k annually, perinatal project saving $3.6M). The Rural Health Care Services Outreach Program highlights awardee successes, such as programs addressing SUD, chronic disease, and oral health. RCORP programs have established new SUD treatment services in over 1,500 rural communities.

Workforce Programs: The NHSC has placed thousands of providers, linked to improved health status and reduced mortality in consistently staffed rural HPSA counties. Recent investments have recruited over 24,000 new primary care providers via loan repayment and supported thousands of scholarships. Rural residency programs have produced ~100 new physicians trained in rural areas.

Maternal Health: The National Maternal Mental Health Hotline has handled over 50,000 contacts; home visiting and Healthy Start programs have expanded; nearly 2,000 birthing facilities participate in the AIM quality initiative.

Overall Accomplishments: HRSA reports significant investments, such as nearly $24 billion to keep facilities open during COVID (including $8.3B for rural providers) and record numbers of scholarships and loan repayments awarded.

CMS Data & Reports

Rural Health Strategy/Framework: CMS publishes annual “Year in Review” reports detailing progress on its rural health priorities. The 2024 report highlights actions like payment stability for IHS/Tribal REHs, access measures in managed care, telehealth toolkits, and health equity data definitions. The original strategy development involved extensive stakeholder listening sessions.

Quality & Outcomes Data: CMS publicly reports hospital quality measures, including outcome measures (mortality, readmissions, complications) filterable by hospital characteristics like urban/rural location via tools like the CMS Hospital Chartbook. CMS also publishes reports on Rural-Urban Disparities in Medicare.

Health Equity Framework: CMS emphasizes expanding collection and use of standardized data (including demographic and SDOH data) to track and address disparities.

CDC Reports & Success Stories

Strategic Plan & ORH: The CDC’s Office of Rural Health leads the agency’s strategy and coordinates efforts, using research and data to develop tailored resources.

Program Impact: CDC highlights successes like increased child safety seat use via the Yurok Tribe’s Buckle Up program, enhanced PE in Illinois schools, increased cancer screening in rural SC, and arthritis self-management programs in KY and UT. The High Obesity Program reached over 1.5M people with healthier food access and 1.6M with physical activity access in its initial phase, with ongoing work reaching hundreds of thousands more. Electronic Case Reporting adoption by CAHs increased significantly.

ASPR HPP Evaluation

HPP’s impact is demonstrated during responses, showing investment saves lives and improves outcomes. The program uses performance measures aligned with its four capabilities, tracked via tools like the HPP Performance Metrics Dashboard (GIS-based). Successes are shared via “Stories from the Field”.

Evaluating rural programs involves various methods like surveys, interviews, focus groups, observation, and analyzing secondary data or abstracted records. Toolkits like the RHIhub’s Evaluating Rural Community Health Programs guide offer frameworks.

Partnerships for Rural Health

Addressing rural health complexities requires extensive collaboration between federal, state, local, and tribal entities, as well as partnerships across different sectors.

State Offices of Rural Health (SORHs)

Established via federal funding since 1991, State Offices of Rural Health (SORHs) exist in all 50 states. Their purpose is strengthening rural healthcare delivery by serving as a focal point and linking rural communities with state and federal resources. HRSA provides funding to SORHs (through FORHP’s Hospital State Division) to support their core functions.

SORH Functions typically include:

• Information Clearinghouse: Collecting and disseminating data, research findings, and innovative approaches related to rural health.
• Coordination: Coordinating rural health activities and resources statewide.
• Technical Assistance: Providing TA to help rural communities meet health needs.
• Workforce Support: Encouraging recruitment and retention of health professionals in rural areas (e.g., connecting providers with 3RNet – National Rural Recruitment and Retention Network).
• Partnership Building: Strengthening state, local, and federal partnerships.

SORHs administer key federal programs locally, such as the Flex Program for CAHs and the Small Rural Hospital Improvement Program (SHIP). They often collaborate with state health departments, rural health associations, AHECs, and other stakeholders to develop state rural health plans and implement initiatives. The National Organization of State Offices of Rural Health (NOSORH) supports SORHs nationwide.

Tribal Consultation and Partnerships

HHS recognizes the sovereign status of federally recognized Indian Tribes and maintains a government-to-government relationship grounded in the Constitution, treaties, and federal law. This necessitates formal consultation processes.

HHS Tribal Consultation Policy: Based on Executive Order 13175, HHS agencies like HRSA and SAMHSA have specific Tribal Consultation Policies guiding engagement with Tribes on policies and programs that have tribal implications. The goal is meaningful information exchange and informed decision-making.

CMS Requirements: CMS requires states to consult with Tribes on Medicaid/CHIP matters affecting American Indians/Alaska Natives (AI/AN), including State Plan Amendments (SPAs) and Section 1115 waiver requests. States must describe their tribal consultation process. CMS also provides resources and technical assistance through its Tribal Affairs Group.

Programmatic Focus: Agencies tailor programs and resources for tribal communities. Examples include HRSA funding for Tribal organizations through RCORP and the Rural Tribal COVID-19 Response Program, SAMHSA’s National Tribal Behavioral Health Agenda and specific funding opportunities, ACF programs, and AoA grants. The Indian Health Service (IHS) is the primary HHS agency dedicated to tribal health.

Inter-Agency and Cross-Sector Collaboration

HHS frequently collaborates with other federal agencies and external partners to maximize impact in rural areas.

HHS-USDA Partnership: HHS and the U.S. Department of Agriculture (USDA) have a long-standing collaboration, formalized through agreements and initiatives, to improve rural health. This includes:

• Joint Resource Guides: Guides on topics like increasing access to rural child care.
• Financing & Technical Assistance: Linking USDA Rural Development financing (e.g., Community Facilities loans/grants for hospitals, clinics, health IT, telehealth equipment) with HHS technical assistance (e.g., ONC support for health IT adoption). USDA has invested billions in rural health infrastructure.
• Telehealth: The Rural Telehealth Initiative involves HHS, USDA (Rural Utilities Service – RUS DLT grants), and the FCC collaborating on broadband expansion and telehealth deployment.
• Nutrition & Health: Recent efforts focus on aligning nutrition programs and health initiatives under the “Make America Healthy Again” banner.
• Hospital Support: USDA funds a technical assistance program for rural hospitals administered by the National Rural Health Association (NRHA).

HHS-FCC Collaboration: Primarily focused on expanding broadband access necessary for telehealth, through the Rural Telehealth Initiative and FCC programs like the Rural Health Care program.

HHS Rural Task Force & Action Plan: HHS convenes internal task forces (like the one established in 2019) involving multiple agencies (e.g., HRSA, CMS, CDC, SAMHSA, ACF, AHRQ, IHS) to develop coordinated strategies like the HHS Rural Action Plan. This plan outlines cross-cutting activities to build sustainable models, leverage technology, ensure workforce adequacy, and improve financing. Note: The most recent comprehensive HHS-wide plan cited is from 2020/2021; subsequent updates appear more agency-specific (e.g., CMS Framework, state-level plans, or topic-specific).

State/Local/Community Partnerships: HHS programs heavily rely on partnerships with state agencies (SORHs, Health Depts), local governments, community-based organizations, faith-based groups, healthcare providers, academic institutions, and private entities for program implementation and service delivery.

Resources and Finding Assistance

HHS and its partners offer numerous resources to help rural communities, providers, and individuals find information, funding, and technical assistance.

Key Information Hubs

Rural Health Information Hub (RHIhub): Funded by FORHP, RHIhub serves as a national clearinghouse on rural health issues. It provides:

• Topic and state guides
• Funding opportunity databases
• Program models and innovations (case studies)
• Evidence-based toolkits (e.g., evaluation, transportation, SUD)
• Data tools and visualizations
• The “Am I Rural?” tool
• Information on FORHP-funded programs
• A personalized resource and referral service (1-800-270-1898, [email protected])

Rural Health Research Gateway: Supported by FORHP, this site (ruralhealthresearch.org) disseminates research produced by the Rural Health Research Centers.

ASPR TRACIE: Provides technical resources, assistance, and information exchange for healthcare preparedness and response (asprtracie.hhs.gov).

Telehealth.HHS.gov: Offers resources on telehealth for providers and patients (telehealth.hhs.gov).

Finding Funding Opportunities

Navigating the grant landscape requires looking across multiple federal platforms.

Grants.gov: The central portal for finding and applying for federal grant opportunities across all agencies (grants.gov). Specific HHS opportunities are listed here.

HRSA Funding Pages: HRSA lists its specific grant programs and deadlines (hrsa.gov/grants/find-funding).

SAMHSA Grants Page: Details SAMHSA funding opportunities (samhsa.gov/grants).

NIH Funding Opportunities: Searchable database for NIH research grants (grants.nih.gov/funding/searchguide/index.html).

ASPR Funding Pages: Information on HPP and other preparedness funding (aspr.hhs.gov/HealthCareReadiness/HPP/Pages/Funding.aspx).

RHIhub Funding Section: Curated list of opportunities relevant to rural health (ruralhealthinfo.org/funding).

Specific program contacts are often provided in funding announcements or on program webpages (e.g., RRPD: [email protected]; Outreach: [email protected]; RCORP: [email protected]; Rural MOMS: [email protected]).

Our articles make government information more accessible. Please consult a qualified professional for financial, legal, or health advice specific to your circumstances.