Enhance Funding for Local Rural Health Programs

ACTION NEEDED:

Urge your members of congress to support increased funding and further support for local rural health initiatives that increase access to care and support the vitality of rural communities. Additionally, urge Congress to continue to support funding for critical programs under the Federal Office of Rural Health Policy (FORHP) at or above the enacted Fiscal Year (FY) 2024 funding level.

BACKGROUND: 

Counties are essential in strengthening rural health services, with 61 percent of local health departments serving rural counties, defined as those with populations under 50,000. Over 46 million people, or 15 percent of the U.S. population, live in rural areas, where they face higher disparities in chronic diseases and increased mortality from preventable causes. Rural communities experience provider shortages, healthcare facility closures and long travel times for care, making local health services increasingly critical. The Federal Office for Rural Health Policy (FORHP) funds grants to expand access to care, build health capacity and provide technical assistance to rural hospitals. In FY 2023, FORHP awarded over $335 million in grants, including the Rural Public Health Workforce Training Network and Targeted Technical Assistance for Rural Hospitals. To continue these essential programs, we urge Congress to fund FORHP at or above FY 2024 levels of $364 million.

Counties manage Medicaid services across rural, suburban and urban areas, where Medicaid covers 17 percent of non-elderly adults and 47 percent of children in rural regions. Protecting Medicaid funding is essential to sustain healthcare services and providers in these communities, especially for Emergency Medical Services (EMS). EMS serves as a vital safety net in rural areas but is plagued with workforce shortages and underfunding. NACo supports increasing reimbursement rates for rural EMS providers from Medicare, Medicaid and the VA, and advocates for the permanent adoption of COVID-19 era reimbursements for certain EMS services.

POLICY RECOMMENDATIONS:

• Fund Rural Health Programs: Support the Federal Office of Rural Health Policy (FORHP) at or above FY 2024 funding levels ($364 million) to maintain critical rural health initiatives.
• Strengthen Medicaid and Medicare for Rural Access: Protect Medicaid funding and increase reimbursement rates for rural EMS providers. Reform Medicare policies to eliminate urban-rural payment differences and fully fund programs that support rural hospitals and health services.
• Incentivize Rural Health Professionals: Implement tax relief and incentives for health professionals and National Health Service Corps members practicing in underserved areas, and support reforms to Graduate Medical Education (GME) programs to address the shortage of primary care providers.
• Expand Rural Telehealth: Extend Medicare reimbursement for telehealth services; expand Health Services Outreach grants; and support initiatives for rural health research, farm safety and state rural health development.
   

KEY TALKING POINTS:

• Seventy-one percent of the decline of hospitals across communities in the U.S. from 2017 to 2021 were rural hospitals, according to the American Hospital Association. Of those hospitals, 612 were owned by state and local governments.
• Rural hospitals depend significantly on Medicaid, Medicare and other government programs to maintain operations, with Medicare contributing nearly half of their revenue. However, reimbursement rates have not kept up with the rising costs of delivering care.
• According to the Maine Rural Health Research Center, rural counties are more likely than urban counties to have ambulance deserts, where access to an ambulance station is more than 25 minutes away. Four out of five counties have at least one ambulance desert. Due to this, rural residents may wait up to 30 minutes for emergency services.
• Congress should appropriate FY 2025 funding for the Federal Office of Rural Health Policy that is at or above the FY 2024 level of $364 million.