Imagine living in a rural community and needing access to emergency healthcare. The closest hospital to you is 40 miles away, but that hospital recently had to shut its doors due to a lack of funding. You now have to travel an additional 30 miles to the next closest hospital. What was already a long distance to access emergency healthcare has now almost doubled.
Unfortunately, many Americans find themselves in situations similar to the scenario above.
The Situation
More than 60 million Americans—or 20% of the U.S. population—live in rural communities, yet barely 10% of physicians practice in rural communities.1,2 Research indicates that rural citizens face a lack of access to healthcare services. This lack of access has been attributed to rural citizens facing worse healthcare outcomes than urban citizens.3
| Quick Facts |
|---|
| More than 4 million rural citizens do not have access to a hospital in the county they live in.4 |
| 35% of the nation’s community hospitals are located in rural communities, yet 71% of the community hospitals that closed from 2017–2021 were located in rural communities.5,6 |
| For every 100,000 rural residents, there are 40 primary care providers.4 |
| 90% of rural counties do not have enough primary care providers to serve their citizens.3 |
Evidence shows citizens of rural communities face more numerous and complex medical conditions than their urban counterparts.7 However, despite their higher medical needs, these citizens have more limited access to healthcare.1 More than 100 (or 4%) of rural hospitals in the U.S. closed from 2013 through 2020, largely due to the financial strain caused by inadequate health insurance payments.8 Further, more than 600 rural hospitals—roughly 30% of all rural hospitals in the U.S.—are currently at risk of closing, according to 2023 data from the Center for Healthcare Quality and Payment Reform.9
As hospitals in rural communities close, rural residents face less access to the medical care they need.1
The Remedy
Improving access to healthcare and healthcare outcomes in rural communities is multifaceted and will require multiple interventions. A key factor in keeping the current rural medical facilities open is the availability of financial assistance to help reduce their financial burden and decrease their risk of closure. The U.S. Department of Health and Human Services (HHS) and the Health Resources and Services Administration (HRSA) allocates millions of dollars in federal funding annually to support and enhance healthcare access in rural communities.
With several funding opportunities available, let’s take a closer look into some of the specific funding programs designed to enhance rural healthcare.
Rural Hospital Programs
HRSA provides grants to fund programs that are designed to support rural hospitals. Examples of these grants include:10
- State Offices of Rural Health (SORH) Program – Designed to connect communities with state and federal resources that can help them develop long-term remedies to the health problems rural citizens face.
- Small Rural Hospital Improvement Program (SHIP) – Funds grant programs through state governments to help improve the operations of rural hospitals with fewer than 50 beds.
- Rural Veterans Health Access Program (RVHAP) – Funds grants to healthcare organizations that serve veterans who live in rural communities to help improve healthcare access for veterans.
- Medicare Rural Hospital Flexibility Program (Flex) – Funds programs to support critical access hospitals (CAHs), which helps improve the financial health of hospitals as well as enhances the quality of rural healthcare. This can improve the overall health of those living in rural communities.
Rural Community Programs
HRSA also provides grants to communities to help them address their healthcare challenges and increase access to healthcare facilities. Examples of these grants include:11
- Rural Health Network Development Planning Program – Supports the planning and development of integrated healthcare networks that can help rural stakeholders overcome challenges related to healthcare.
- Rural Health Care Services Outreach Grant Program – A community-based grant designed to increase the healthcare delivery in rural communities.
- Rural Maternity and Obstetrics Management Strategies Program (RMOMS) – A grant program designed to improve rural access to obstetrics and maternity care.
While this article only highlights a few funding opportunities available to help improve rural healthcare, more assistance and grants exist to address specific healthcare needs in rural communities. These include funding for healthcare workforce training, mental health services, opioid response efforts, and more.
In addition, healthcare providers exploring opportunities to improve financial sustainability in rural areas also may consider seeking designation as a rural health clinic (RHC) or federally qualified health center (FQHC) look-alike. While both options offer access to enhanced reimbursement rates, there are important distinctions between them.
RHCs have less stringent governance compliance requirements, and the designation is easier to obtain, provided the organization meets the criteria of being in a rural area, a health professional shortage area (HPSA), or a medically underserved area (MUA), with a mid-level provider employed for at least 50% of the clinic's operating hours. On the other hand, FQHCs must navigate more complex regulations, including maintaining a board made up of 50% patients, which can limit control for existing healthcare organizations, but the look-alike designation provides access to the 340B drug pricing program and higher Medicare reimbursement.
At Forvis Mazars, we understand the complexities healthcare entities face and that applying for and managing federal funds can be daunting. Federal funding comes with a host of regulatory and compliance requirements that are constantly evolving. However, with the support of an experienced advisor, rural healthcare facilities can be better positioned to effectively navigate these challenges to support the selected programs designed to enhance their community’s healthcare services.
How Forvis Mazars Can Help
Our dedicated Grants Management team at Forvis Mazars has extensive experience with federal, state, and local grants. We assist clients throughout the grant life cycle, from researching and applying for grants to help managing awarded funds. Whether you need help with one part of the process or in-depth support, our team is here to guide you every step of the way.
If you have questions or need assistance, please reach out to a professional at Forvis Mazars.
- 1“Why Health Care Is Harder to Access in Rural America,” gao.gov, May 16, 2023.
- 2“Addressing Rural Health Challenges Head On,” Missouri Medicine, 2017.
- 3“Structural Urbanism Contributes to Poorer Health Outcomes for Rural America,” healthaffairs.org, December 2019.
- 4“Geographic Variation in Spatial Accessibility of U.S. Healthcare Providers,” journals.plos.org, 2019.
- 5“Fast Facts: U.S. Rural Hospitals Infographic,” aha.org, 2023.
- 6“Fast Facts on U.S. Hospitals, 2024,” aha.org, 2024.
- 7“Quantifying Rural Disparity in Healthcare Utilization in the United States: Analysis of a Large Midwestern Healthcare System,” journals.plos.org, 2022.
- 8“The Crisis in Rural Health Care,” ruralhospitals.chqpr.org.
- 9“Rural Hospitals at Risk of Closing,” chqpr.org.
- 10“Rural Hospital Programs,” hrsa.gov, July 2024.
- 11“Rural Community Programs,” hrsa.gov, September 2024.