Improving Health in America’s Heartland: HRSA Programs for 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 Health Resources and Services Administration (HRSA), a key agency within the U.S. Department of Health and Human Services (HHS), enhances health outcomes and promotes health equity for all Americans.

This mission is particularly important for populations facing barriers to care, including those who are geographically isolated or economically vulnerable – characteristics often found in rural communities. HRSA leads diverse programs specifically designed to strengthen healthcare services in these essential parts of the United States.

At the center of these efforts is HRSA’s Federal Office of Rural Health Policy (FORHP). Established by Congress in 1987, FORHP serves as the primary federal entity dedicated to rural health issues. Its mandate includes:

• Administering grant programs to build healthcare capacity at local and state levels
• Coordinating rural health-related activities across HHS
• Analyzing the potential effects of federal policies on rural residents
• Advising the HHS Secretary on matters impacting rural hospitals
• Maintaining a national clearinghouse for rural health information

FORHP acts as a central hub, ensuring that rural challenges such as geographic isolation, workforce shortages, and economic constraints are addressed cohesively. This centralized approach prevents duplication of efforts and fosters a more effective strategy for improving the health of the nearly 63 million people residing in rural America.

Understanding Rural Health Challenges

Rural communities across the United States face unique health challenges that frequently lead to significant health disparities compared to urban areas. Evidence shows higher rates of chronic diseases, increased mortality from the five leading causes of death (heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke), and overall lower life expectancy in rural areas. This phenomenon has been termed the “rural mortality penalty,” a gap that has widened over time. In 1999, the age-adjusted death rate was 7% higher in rural areas than urban ones; by 2019, that difference had grown to 20%.

Several interconnected factors contribute to these persistent disparities:

Geographic Isolation

Significant distances to healthcare facilities, coupled with limited public transportation options and sometimes poor road conditions, create substantial barriers to accessing timely care, including primary, preventive, specialty, and emergency services.

Socioeconomic Factors

Rural areas often contend with higher rates of poverty (15.4% rural vs. 12.3% urban in 2021) and lower median incomes ($52,023 rural vs. $73,557 urban in 2021). Educational attainment, while increasing, also lags behind urban areas, particularly for higher education. These factors impact individuals’ ability to afford healthcare, maintain healthy lifestyles, and access resources supporting overall well-being.

Healthcare Workforce Shortages

A persistent challenge is the maldistribution and shortage of healthcare professionals. Rural areas struggle to attract and retain physicians, specialists, nurses, dentists, and behavioral health providers. Fewer than 8% of physicians practice in rural areas, and nationwide shortages, particularly in primary care, are projected to continue. This scarcity directly limits access to essential services.

Limited Access to Specialized Care

The availability of medical specialists and subspecialists is significantly lower in rural regions. Residents often face the burden of traveling long distances, incurring costs for transportation, lodging, and time off work, to receive specialized treatments. Finding specialists for referrals can be difficult for rural primary care providers.

Infrastructure Limitations

Challenges extend beyond healthcare facilities. Limited access to reliable broadband internet hinders the adoption and effectiveness of telehealth services, a potentially crucial tool for overcoming distance barriers. Furthermore, rural public health agencies often operate with inadequate funding and technological resources, limiting their capacity for surveillance, prevention, and response.

The persistence and widening of some rural-urban health disparities, despite decades of federal programs, suggest the deep-rooted nature of these challenges. Factors such as the aging rural population, ongoing economic shifts, and emerging health threats necessitate continuous adaptation and innovation. HRSA’s programs are strategically designed to address these multifaceted issues by strengthening local healthcare infrastructure, bolstering the workforce, promoting innovative care delivery models like telehealth, and targeting specific health crises prevalent in rural settings.

Defining “Rural” for Program Eligibility

Understanding how HRSA defines “rural” is essential, as eligibility for many federal grants and program benefits depends on meeting specific geographic criteria. A location’s designation can determine whether a hospital qualifies for special reimbursement, if a community can apply for certain grants, or if a provider’s practice site is eligible for loan repayment programs.

HRSA’s Federal Office of Rural Health Policy employs a nuanced approach rather than a single definition. This reflects the complex reality that “rural” encompasses diverse contexts, from remote frontier areas to communities on the fringes of metropolitan centers that still face significant healthcare access barriers. FORHP utilizes data and delineations from multiple federal sources, including:

• The Office of Management and Budget (OMB): Provides definitions for metropolitan (metro) and non-metropolitan (non-metro) counties. FORHP generally considers all non-metro counties as rural.
• The U.S. Census Bureau: Classifies areas as “urban” based on population and housing density thresholds (areas not classified as urban are considered rural).
• The U.S. Department of Agriculture’s Economic Research Service (ERS): Developed tools like the Rural-Urban Commuting Area (RUCA) codes and the Road Ruggedness Scale (RRS) that allow for finer-grained analysis at the census tract level.

FORHP combines these sources to create its operational definition of rural, aiming to better capture characteristics relevant to healthcare access, such as low population density and geographic isolation. Key components include:

• Non-metropolitan counties (as defined by OMB)
• Outlying metropolitan counties that do not have any population within an urban area of 50,000 or more people
• Specific census tracts within metropolitan counties identified using RUCA codes (generally codes 4 through 10, representing smaller towns and isolated rural areas)
• Certain large or rugged census tracts within metropolitan counties that have lower population densities and specific RUCA codes (codes 2 or 3)

This multi-faceted definition allows HRSA to target resources more precisely. As of the 2020 Census and using OMB’s July 2023 county delineations, FORHP’s definition classifies approximately 20.3% of the U.S. population (62.8 million people) and 87.4% of the nation’s land area as rural.

Checking Eligibility

To determine if a specific address or county qualifies as rural under FORHP’s definition for grant purposes, potential applicants should use the Rural Health Grants Eligibility Analyzer. It’s critical to carefully read the specific Notice of Funding Opportunity (NOFO) for any grant program, as eligibility requirements and definitions can sometimes vary.

HRSA’s Strategic Goals for Rural Health

HRSA’s diverse programs for rural health are guided by a strategic framework aimed at achieving measurable improvements in health and healthcare delivery. While specific strategic plans are updated over time, the core mission and goals demonstrate a consistent, long-term commitment. Key strategic goals include:

Improve Access to Quality Health Services

This fundamental goal involves concrete steps to increase the capacity of healthcare services and infrastructure, particularly expanding the availability of comprehensive primary and preventive care in underserved and rural areas. It also emphasizes fostering innovative healthcare delivery models, such as team-based care and telehealth, to overcome geographic and workforce barriers. Improving the quality and effectiveness of services through better care coordination is also key.

Foster a Healthcare Workforce for Current and Future Needs

Recognizing that services cannot be delivered without providers, this goal focuses on ensuring rural and underserved communities have well-trained, diverse health professionals. Strategies involve expanding training opportunities, equipping the workforce to address social determinants of health and emerging needs (like SUDs or maternal mental health), increasing cultural competency, and aligning training, recruitment, and retention efforts to place providers where the need is greatest.

Achieve Health Equity and Enhance Population Health

This goal aims to reduce health disparities among vulnerable populations. It involves leveraging community partnerships, addressing social determinants of health, integrating public health and primary care services, using evidence-based decision-making to target disparities, and promoting illness prevention and healthy behaviors.

Optimize HRSA Operations and Strengthen Program Management

This internal goal ensures accountability and effectiveness. It emphasizes using data and evidence to drive decisions, implementing value-based approaches to optimize financial investments for better patient outcomes, and partnering with stakeholders to improve program performance.

These strategic goals are interconnected. Progress in one area often depends on or contributes to progress in others. Many HRSA programs are designed to have multifaceted impacts, addressing several strategic objectives simultaneously.

HRSA Rural Health Program Categories

HRSA employs a multi-pronged strategy to improve rural health, utilizing various program types that address different facets of the healthcare system. The following table provides a high-level overview of the main categories of HRSA’s rural health efforts.

Note: FORHP is the Federal Office of Rural Health Policy; BHW is the Bureau of Health Workforce; MCHB is the Maternal and Child Health Bureau; OAT is the Office for the Advancement of Telehealth.

Key HRSA Programs for Rural Health Improvement

The following sections describe specific HRSA programs, categorized by their primary focus area, offering a clearer picture of how federal support translates into tangible actions and improvements for rural health across the United States.

Strengthening Rural Communities

These programs empower rural communities to lead the charge in addressing their own unique health needs. They focus on fostering collaboration among local entities, supporting community-based organizations, and expanding healthcare access from the ground up.

Rural Health Care Services Outreach Program

This community-focused grant program aims to expand and improve healthcare delivery by addressing specific, locally identified health needs within rural communities. A core principle is fostering collaboration through consortia of local healthcare providers, social service agencies, and other community partners.

The program strongly encourages the use of evidence-informed or evidence-based models to ensure interventions are effective and sustainable. A significant component is the Healthy Rural Hometown Initiative (HRHI) track, which specifically targets interventions aimed at the five leading causes of avoidable death in the U.S.: heart disease, cancer, unintentional injury (including substance use disorder), chronic lower respiratory disease, and stroke.

The program provides grant funding to community consortia, enabling them to implement innovative projects that expand clinical services and overall service capacity. Awardees also receive targeted technical assistance from the HRSA-funded Georgia Health Policy Center.

The Outreach program has a track record of supporting sustainable change. Studies indicate that a high percentage (four out of five) of grantees within HRSA’s Community-Based Division, which includes Outreach, sustain their project efforts even after the federal funding period ends.

Specific examples showcase the program’s versatility:

• A community-wide approach to treating SUDs in New Mexico
• A community paramedicine program bringing primary care to high-risk patients in Missouri
• The transition of a chronic disease program to online services in Pennsylvania
• The expansion of school-based oral healthcare in Louisiana
• Behavioral health services via a network in Oregon/Washington
• A mobile team addressing SUDs in Pennsylvania

For more information, visit HRSA’s Rural Community Programs or the Rural Health Information Hub for success stories.

Rural Health Network Development Programs

These programs use the strategy of network development to link rural healthcare participants together, enabling them to achieve greater collective capacity to overcome local challenges and improve care.

The RHND Planning Program supports the crucial initial phase of network building. It provides one year of grant funding to help organizations, particularly those without a history of formal collaboration, plan and develop integrated rural healthcare networks. The focus is on establishing or improving local capacity and care coordination in underserved communities.

The RHND Program (Regular) targets already established, mature rural health networks. It provides funding to support these existing networks in implementing innovative solutions to local healthcare needs, encouraging them to continue working towards key legislative aims: achieving efficiencies, expanding access to and improving the quality of basic healthcare services, and strengthening the rural healthcare system as a whole.

Network Development grants have enabled diverse projects:

• A South Dakota network used Planning and Development grants to increase palliative care knowledge among professionals, students, and the community
• An Arizona network implemented mobile telehealth units and care coordinators to improve emergency care access
• A Vermont network utilized funding to enhance access to behavioral health and developmental disability services

For more information, visit HRSA’s Rural Community Programs or the Rural Health Information Hub.

Rural Health Care Coordination Program

This program promotes the expansion and improvement of healthcare service delivery in rural areas specifically through the implementation of comprehensive care coordination strategies. It aims to better integrate disparate parts of the healthcare system within rural communities and simultaneously strengthen the care coordination workforce itself.

The program provides grant funding over a four-year period. The first year is designated as a planning year, allowing grantees time to develop robust strategies, build partnerships, and establish infrastructure before moving into implementation during years two through four.

Applicants must select one primary focus area from a list of significant rural health challenges: heart disease, cancer, chronic lower respiratory disease, stroke, or maternal health. They are expected to propose innovative, community-wide approaches that link health and human services to address the chosen focus area and its underlying risk factors.

For more information, see the funding opportunity details or visit HRSA’s Rural Community Programs.

Small Health Care Provider Quality Improvement Program

This program specifically targets rural primary care providers—such as Critical Access Hospitals (CAHs), Rural Health Clinics (RHCs), or networks of small rural providers—to support their efforts in planning and implementing quality improvement (QI) activities.

The overarching goal is to foster a culture of continuous quality improvement and enhance the delivery of cost-effective, coordinated, culturally appropriate, and equitable healthcare services within rural primary care settings. A key aim is preparing these often resource-limited providers to successfully participate in the evolving landscape of quality reporting and value-based payment programs.

The program provides grant funding to support QI initiatives. Program objectives include improving patient health outcomes, enhancing chronic disease management capabilities, and increasing the engagement of patients and their caregivers in their own care. Applicants are required to use an evidence-based model or promising practice and are strongly encouraged to address underlying factors contributing to rural health disparities.

For more information, visit HRSA’s Rural Community Programs.

Bolstering Rural Hospitals and State Capacity

Rural hospitals are often critical anchors in their communities, providing essential services and significant employment. State-level coordination is also vital for a cohesive approach to rural health. These HRSA programs provide foundational support to maintain and enhance the viability and effectiveness of these key institutions and state structures.

State Offices of Rural Health Program

Established in 1991 and consistently funded since, the SORH Program is a cornerstone of federal-state partnership in rural health. Its primary purpose is to strengthen rural healthcare delivery systems within each state by maintaining a dedicated focal point—the State Office of Rural Health—in all 50 states.

These offices serve as crucial institutional infrastructure, linking small rural communities with state and federal resources and expertise to develop long-term solutions to rural health challenges. The SORHCDP complements this by funding activities to enhance SORH leadership, collaboration, and educational capabilities.

HRSA provides annual grant funding to each state to operate its SORH. SORHs, in turn, perform several mandated and optional core functions:

• Information Clearinghouse: Collecting and disseminating information on rural health issues, research findings, and innovative delivery approaches
• Coordination: Facilitating coordination of rural health activities within the state to maximize resources and avoid duplication
• Technical Assistance: Identifying relevant federal and state programs and providing TA to rural entities
• Workforce Support: Engaging in activities related to recruiting and retaining health professionals for rural service

In 2021 alone, the 50 SORHs provided technical assistance to over 24,000 rural entities nationwide and conducted over 18,000 webinars and 53,000 in-depth phone interactions to address rural needs. The program’s importance is underscored by its reauthorization by Congress through 2027.

For more information, see HRSA’s SORH Program page or visit the National Organization of State Offices of Rural Health to find your state’s SORH.

Medicare Rural Hospital Flexibility Program

Established by the Balanced Budget Act of 1997 in response to widespread rural hospital closures, the Flex Program is designed to stabilize and strengthen the rural healthcare infrastructure. Its primary mechanism is enabling small rural hospitals to achieve Critical Access Hospital (CAH) designation.

This designation allows hospitals meeting specific criteria (e.g., ≤25 beds, rural location, distance requirements, 24/7 emergency care) to receive cost-based reimbursement from Medicare, a crucial factor for financial viability. Beyond designation, the Flex Program provides grants to states to support CAHs in improving quality of care, enhancing financial and operational performance, addressing population health needs, and integrating EMS.

HRSA awards Flex grants to states (usually administered by the SORH). States then fund activities across five key program areas:

• CAH Quality Improvement (Required): Supporting quality reporting and implementation of QI initiatives
• CAH Financial and Operational Improvement (Required): Providing TA and resources to strengthen hospital finances and operational efficiency
• CAH Population Health Improvement (Optional): Supporting CAHs in addressing broader community health needs
• Rural EMS Improvement (Optional): Assisting with the integration and sustainability of rural EMS
• Innovative Model Development (Optional): Allowing states to support novel approaches to rural care delivery

The Flex program has been instrumental in maintaining access to hospital care in many rural areas through the financial stability offered by CAH designation. In FY20, 45 states received approximately $28.5 million in Flex funding. Performance data shows significant engagement and improvement: 98% voluntary quality reporting among CAHs, 74% of CAHs reporting improvement after QI initiatives, and 43% showing improved financial measures following Flex activities.

For more information, visit the Flex Monitoring Team or the Rural Health Information Hub CAH Topic Guide.

Small Rural Hospital Improvement Program

SHIP provides targeted financial support to the nation’s smallest rural hospitals (those with 49 or fewer beds) to help them adapt to the evolving healthcare environment, particularly regarding value-based purchasing and care delivery reforms.

The program aims to ensure these hospitals can invest in necessary hardware, software, and training to improve quality reporting, participate in new payment models like Accountable Care Organizations (ACOs) or shared savings programs, and enhance financial operations.

HRSA allocates SHIP funds to participating State Offices of Rural Health based on the number of eligible hospitals in their state (approximately $12,000 per hospital in FY20). The SORH acts as a fiscal intermediary, verifying hospital eligibility and distributing funds. Hospitals typically select investments from an approved list of activities related to value-based purchasing readiness, payment bundling, ACO participation, quality improvement data collection, and financial/operational improvements.

In 2021, SHIP funds were widely used by participating hospitals: approximately 52% invested in improving patient satisfaction (often linked to HCAHPS reporting required for value-based purchasing), nearly 25% supported telehealth implementation, and almost 23% were used to comply with price transparency regulations.

For more information, visit HRSA’s SHIP overview or the National Rural Health Resource Center SHIP TA page.

Building the Rural Health Workforce

A sufficient supply of well-trained and distributed healthcare professionals is fundamental to ensuring access to care in rural America. HRSA invests heavily in programs designed to address rural workforce shortages through training, recruitment incentives, and retention strategies.

Rural Public Health Workforce Training Network Program

This program aims to expand public health capacity in rural and tribal communities by supporting healthcare job development, targeted training, and job placement. It specifically focuses on building the workforce in four critical tracks:

1. Community Health Support (e.g., Community Health Workers)
2. Health IT and/or Telehealth Technical Support
3. Community Paramedicine
4. Case Management and/or Respiratory Therapy

The program provides grant funding to establish or strengthen rural health networks composed of local healthcare providers, social service organizations, and educational institutions. These networks develop and implement formal training and/or certification programs within the designated workforce tracks.

RPHWTN grants are actively helping rural facilities cultivate and retain local talent. Success stories include:

• A Florida network assisting partners with workforce development and technology training programs
• A Missouri project creating healthcare career ladders
• A Texas program supporting respiratory therapy training
• A Virginia initiative focused on health IT training
• The Montana Office of Rural Health/AHEC utilizing RPHWTN funding for its Community Health Support Workforce Training Program

For more information, visit HRSA’s Rural Community Programs or the Rural Health Information Hub RPHWTN page.

Rural Residency Planning and Development Program

This program directly tackles the rural physician shortage by funding the creation of new, sustainable rural residency training programs. It supports the development of programs, including integrated rural track programs (RTPs), that achieve accreditation from the Accreditation Council for Graduate Medical Education (ACGME).

The underlying strategy is based on evidence that physicians are significantly more likely to practice in or near the location where they complete their residency training. By investing in the creation of training infrastructure within rural areas, RRPD aims to “grow their own” physician workforce.

The program provides grant funding to cover the significant start-up costs associated with establishing a new residency program. Eligible expenses include accreditation fees, curriculum development, faculty recruitment and development, and resident recruitment efforts. A dedicated RRPD Technical Assistance program provides crucial support via webinars, expert advisors, toolkits, and resources.

As of August 2024, grantees had successfully established 46 new accredited rural residency programs, creating 575 approved new residency positions specifically located in rural areas, and had enrolled over 460 resident physicians into these rural training tracks.

For more information, visit HRSA’s RRPD Program Page.

National Health Service Corps Rural Focus

For over 50 years, the NHSC has been a primary federal program aimed at increasing access to primary care (medical, dental, and behavioral health) in underserved communities. It achieves this by offering scholarships and educational loan repayment to healthcare clinicians in exchange for a commitment to serve in designated Health Professional Shortage Areas (HPSAs), many of which are located in rural America.

The NHSC offers several loan repayment programs:

• NHSC Loan Repayment Program: Up to $50,000 (potentially $75,000 for certain medical roles) for a 2-year full-time commitment
• NHSC SUD Workforce LRP: Up to $75,000 for a 3-year full-time commitment at an NHSC-approved SUD treatment site
• NHSC Rural Community LRP: Specifically targets clinicians providing SUD treatment in rural HPSAs, offering up to $100,000 for a 3-year full-time commitment
• NHSC Students to Service LRP: Offers up to $120,000 to students in their final year of training for a 3-year full-time commitment

The NHSC Scholarship Program covers tuition, fees, other educational costs, and provides a living stipend for students pursuing eligible primary care health professions degrees in exchange for a service commitment post-graduation.

HRSA reports recruiting over 24,000 new primary care providers to practice in HPSAs through unprecedented investments in NHSC loan repayment. The Corps includes over 7,900 behavioral health providers, many addressing the opioid crisis. NHSC clinicians serve at over 7,800 sites nationwide.

For more information, visit the NHSC Main Portal, Loan Repayment Programs, or the NHSC Scholarship Program.

Bureau of Health Workforce Training Grants with Rural Impact

The Bureau of Health Workforce manages a portfolio of over 60 grant programs aimed at strengthening the nation’s health workforce across various disciplines. While not all are exclusively rural, many have components or priorities that significantly benefit rural areas by funding training programs designed to prepare professionals for rural practice or located in rural areas.

Examples with demonstrated rural relevance include:

• Advanced Nursing Education Workforce (ANEW) Program: Specifically designed to increase the number of primary care nurse practitioners trained and prepared to practice in rural and underserved settings. Data from recent academic years show a high percentage of ANEW trainees receiving clinical training in rural areas (48% in AY18-19, 52% in AY17-18)
• Other Advanced Nursing Education Programs: Programs like ANE-SANE (Sexual Assault Nurse Examiners) sometimes include training components or placements in rural settings
• Title VII (Health Professions) and Title VIII (Nursing) Programs: These long-standing legislative authorities support education in fields like primary care medicine and nursing, with an emphasis on addressing geographic maldistribution

For more information, visit BHW Programs Overview.

Addressing Specific Rural Health Crises and Needs

Beyond strengthening general healthcare infrastructure and workforce, HRSA operates targeted programs designed to combat acute health crises that disproportionately affect rural areas or address the unique health needs of specific rural populations.

Rural Communities Opioid Response Program

RCORP is a major, multi-year HRSA initiative specifically created to address the devastating impact of the opioid epidemic (and increasingly, other substance use disorders including psychostimulant use) in rural communities. Its overarching goals are to reduce the morbidity and mortality associated with SUD/OUD by improving access to and coordinating prevention, treatment, and recovery services.

The program provides funding through a suite of distinct grant programs that allow communities to target specific needs along the continuum of care. Examples include:

• RCORP-Implementation: Supports the establishment and expansion of SUD/OUD prevention, treatment, and recovery services
• RCORP-Overdose Response: Addresses immediate needs to reduce overdose deaths
• RCORP-MAT Access: Focuses specifically on increasing access to Medication-Assisted Treatment
• RCORP-Neonatal Abstinence Syndrome: Addresses the needs of infants born with NAS and their families
• RCORP-Behavioral Health Care Support: Integrates behavioral health services with SUD treatment
• RCORP-Child and Adolescent Behavioral Health: Focuses on the specific needs of youth
• RCORP-Psychostimulant Support: Addresses the rising challenge of psychostimulant misuse

RCORP grants are enabling rural communities to implement innovative and impactful programs. Summit Healthcare in Arizona used RCORP funding to embed peer support specialists in their emergency department, resulting in documented improvements in patient flow, reduced repeat visits, faster treatment placements, and significant Medicaid cost savings.

For more information, visit HRSA’s RCORP Portal or the Rural Health Information Hub RCORP Page.

Black Lung Clinics Program

This long-standing program targets a specific occupational disease prevalent in coal mining regions. Its primary goal is to reduce the morbidity and mortality associated with coal mine dust lung disease (CMDLD), commonly known as black lung disease.

BLCP provides grant funding to clinics located in or accessible to coal mining regions. These clinics are required to offer:

• Medical Services: Diagnosis and treatment of respiratory diseases
• Outreach Services: Identifying and engaging potentially eligible coal miners in the community
• Educational Services: Informing miners about black lung disease, prevention, and management
• Benefits Counseling Services: Assisting miners and their families in navigating and applying for federal Black Lung benefits

Clinics funded by BLCP are also eligible to participate in the 340B Drug Pricing Program, which allows them to purchase outpatient drugs at significantly reduced prices. Genesis Healthcare System in Ohio used 340B savings to hire a clinical pharmacist and greatly expand its Low Dose CT screening program for early lung cancer detection in miners.

For more information, visit HRSA’s Black Lung Clinics Program Information.

Delta Region Maternal Care Coordination Program

This program targets a region known for significant health disparities, particularly in maternal and infant health outcomes. Its goal is to improve and increase access to coordinated maternal and perinatal healthcare services for pregnant women and new mothers residing within 252 designated rural counties and parishes of the eight-state Delta Regional Authority (DRA) territory (Alabama, Arkansas, Illinois, Kentucky, Louisiana, Mississippi, Missouri, and Tennessee).

The program provides grant funding to organizations serving the designated rural Delta Region counties. It supports the implementation of projects designed to enhance access to care and improve the coordination of services throughout pregnancy and the postpartum period.

For more information, see HRSA’s Rural Community Programs or recent awardees.

Radiation Exposure Screening and Education Program

RESEP addresses the health consequences faced by individuals exposed to radiation resulting from historical U.S. atmospheric nuclear weapons testing and domestic uranium mining, milling, and transport. The program aims to support these individuals, many of whom reside in specific rural and tribal communities.

HRSA provides grant funding to eligible healthcare facilities located in designated high-impact states. RESEP grantees conduct:

• Outreach and Education: Informing potentially affected populations about radiogenic diseases
• Screening: Providing medical screenings to detect cancer and other radiogenic diseases
• Medical Referrals: Connecting individuals needing further diagnosis or treatment with appropriate care
• RECA Assistance: Helping eligible individuals compile documentation and file claims under the Radiation Exposure Compensation Act

For more information, see HRSA’s Rural Community Programs.

Rural Northern Border Region Programs

These programs target the specific health needs and challenges of rural communities located within the federally designated Northern Border Regional Commission (NBRC) service area, which encompasses distressed counties in Maine, New Hampshire, New York, and Vermont.

The programs offer different types of support:

• Planning Program: Provides grant funding to assist healthcare groups in identifying key health issues and engaging in strategic planning
• Healthcare Support Program: Offers targeted technical assistance to healthcare organizations, focusing on areas like mental health, substance use disorder treatment, and workforce issues
• Outreach Program: Provides grant funding to consortia of local health and social service providers to promote the delivery of new or enhanced healthcare services

For more information, visit HRSA’s Rural Community Programs.

Informing Rural Health Policy and Research

Understanding the complexities of rural health challenges and evaluating the effectiveness of interventions requires robust research and analysis. HRSA supports dedicated centers and initiatives to generate this knowledge and disseminate it to policymakers, providers, and communities.

Rural Health Research Center Program

The RHRC program funds multiple research centers across the country to conduct high-quality, impartial, and policy-relevant health services research focused on rural areas. The primary purpose is to generate evidence that assists healthcare providers, communities, and policymakers at federal, state, and local levels in better understanding the unique challenges faced by rural populations.

HRSA provides multi-year cooperative agreement funding to universities or research organizations to operate as RHRCs. Each center typically focuses on specific rural health research areas or populations. Research funded under this program is made publicly available through the Rural Health Research Gateway.

For more information, visit HRSA’s Rural Health Research and Policy Programs.

Policy Analysis Initiatives

Complementing the longer-term research of the RHRCs, these initiatives provide timely analysis and information on emerging policy issues relevant to rural health. A key component is often a “rapid response” capability, allowing HRSA and other policymakers to quickly obtain data analysis and brief reports on urgent questions affecting rural communities.

HRSA typically funds these initiatives through cooperative agreements with research organizations or policy institutes possessing strong analytical capabilities and expertise in rural health issues. Activities include analyzing proposed or enacted legislation and regulations, assessing the rural implications of broader health system trends, and providing quick turnaround data analysis.

For more information, visit HRSA’s Rural Health Research and Policy Programs.

Leveraging Technology: Telehealth Programs

Recognizing the potential of technology to overcome distance barriers, HRSA actively promotes and supports the use of telehealth to improve healthcare access and delivery in rural and underserved areas.

Office for the Advancement of Telehealth Programs

OAT works to improve access to quality healthcare through the integration of telehealth services. Its programs support direct telehealth service delivery, telehealth research, and the provision of technical assistance to providers and communities adopting telehealth.

OAT administers several grant programs and resources:

• Telehealth Network Grant Program (TNGP): Funds networks to expand access to telehealth services
• Evidence-Based Telehealth Network Program (EBTNP): Supports telehealth networks focused on behavioral healthcare in rural communities
• Telehealth Resource Centers (TRCs): A national network of 12 Regional TRCs and 2 National TRCs provides free technical assistance
• Telehealth Centers of Excellence (COE): Funds academic medical centers to examine telehealth effectiveness and best practices
• Telehealth Focused Rural Health Research Centers: Supports research centers to expand the evidence base for rural telehealth services
• Licensure Portability Grant Program: Helps states reduce barriers to telehealth practice across state lines
• Telehealth Broadband Pilot Program: Examines broadband capacity challenges for telehealth in specific rural states

For more information, visit OAT’s Main Page, OAT Grants & Programs, or the Telehealth Resource Centers.

Supporting Primary Care Access in Rural Areas

Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) are vital components of the rural healthcare safety net, providing essential primary and preventive care services. HRSA plays a key role in supporting these entities.

Bureau of Primary Health Care Support for Rural FQHCs

The Health Center Program funds nearly 1,400 health centers operating over 15,500 sites nationwide, providing affordable, accessible, high-quality primary healthcare to medically underserved communities, regardless of patients’ ability to pay. A significant portion of these health centers serve rural populations.

BPHC provides operational grant funding to eligible organizations to establish and operate FQHCs. This funding supports the delivery of required primary health services (medical, dental, behavioral health, enabling services) on a sliding fee scale based on income. FQHCs receive enhanced reimbursement rates from Medicare and Medicaid.

HRSA-funded health centers provide primary care to 1 in 10 people in the country. They have been critical in responding to public health crises like COVID-19 and the opioid epidemic. Many rural communities rely heavily on their local FQHC for accessible and affordable healthcare.

For more information, visit BPHC’s Main Page, Health Center Program Information, or use the Find a Health Center Tool.

Accessing HRSA Programs

Navigating federal programs can seem daunting, but HRSA provides numerous resources to help rural communities, healthcare providers, and organizations learn about, apply for, and benefit from its initiatives.

Finding Funding Opportunities

The primary portal for identifying current grant opportunities is the HRSA Find Grant Funding page. Users can search for open opportunities, filter by bureau (e.g., FORHP, BHW, BPHC), and view details about specific grants. Opportunities are also posted on Grants.gov.

Determining Eligibility

The Rural Health Grants Eligibility Analyzer is an essential first step for many FORHP programs. Each Notice of Funding Opportunity (NOFO) contains detailed eligibility criteria that applicants must carefully review.

Preparing and Applying

HRSA’s website offers guidance on the application process under the “Apply for a Grant” section. This includes information on mandatory registrations (like SAM.gov and Grants.gov), understanding NOFO requirements, and submitting applications through Grants.gov or HRSA’s Electronic Handbooks (EHBs).

Technical Assistance

Many HRSA programs offer specific technical assistance to applicants and grantees:

• Webinars: HRSA often holds informational webinars for specific funding opportunities
• Program Contacts: Each NOFO lists specific HRSA program contacts who can answer questions
• Dedicated TA Centers: Some programs have dedicated TA providers
• State Offices of Rural Health: SORHs are key resources for TA within each state
• Rural Health Information Hub: The RHIhub serves as a national clearinghouse offering information, resources, and assistance
• General Assistance: The HRSA Contact Center (1-877-464-4772) provides general support

By utilizing these resources, potential applicants from rural areas can better understand HRSA’s offerings, determine their eligibility, navigate the application process, and access support to develop strong proposals aimed at improving health in their communities.

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