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National Conference of State Legislatures
Rural Health Brief
How Can Rural Development and Health and Human Services Improve Small Communities:
The Role for States
Synopsis of a Meeting Sponsored by HRSA's Federal Office of Rural Health Policy
May 2003

For More Information:
Tim Henderson, NCSL @ 202/624-3573
Marcia Brand, Federal Office of Rural Health Policy @ 301/443-0835 

On April 24, 2003, NCSL convened a one-day national meeting in Boston, Massachusetts of state lawmakers and rural and economic development, health and human service officials representing 20 states and American Samoa to debate and discuss opportunities for states to effectively link their rural development initiatives to improving small town health care and human services (see attached agenda). The meeting addressed three major themes: 

• How Rural Development Can Be a Player in Improving Health Care in Small Communities, through development of comprehensive state rural development organizations and creation of public telecommunications infrastructures,
• Using Economic Development to Strengthen the Rural Workforce and its Implications for Health and Human Services, particularly through the involvement and resources of state workforce investment boards and state health workforce commissions, and
• Finding Models to Improving Financial Access to Health and Human Services in Rural Areas, through outreach and service to rural Medicaid and TANF-eligible populations.

The meeting convened with a series of NCSL-facilitated panel and small group discussions among participants structured to maximize audience participation and allow ample time for general discussion. Lawmakers in attendance learned about and debated the relevance of the above issues to their states and reached the following conclusions:

1. Tight budgets are requiring most states to find new ways to structure and finance health and human services by reexamining the cost and effectiveness associated with categorical funding and service delivery. Particularly for many rural areas, there is an increasing need for greater coordination and integration of such services and programs to sustain or improve the access-to-care infrastructure as well as economic security. 
2. State rural development activities are particularly effective when organized to address a wide array of financial and service delivery challenges in rural communities. Health care services are an important part of this strategy. A comprehensive and permanent approach to rural development involving health care has been institutionalized in North Carolina, Pennsylvania and Texas.

• A recent comprehensive study of the viability of the Texas' rural areas by a select committee of the House of Representatives called on the state to create a new state agency (Office of Rural Community Affairs) devoted to developing rural policy for Texas, foster development of rural community leadership capacity, and to extend telecommunications services and enhance economic diversification in rural areas. Health care is an important component-the state's Center for Rural Health is part of the new agency, and the new agency head is formerly the director of the rural health office.  

1. Health care services are an important proven factor in the economic viability of many rural communities.

• Using an economic multiplier, the health care system in one rural Oklahoma county generates over 600 jobs with incomes of $11.7 million and local retail sales of $4.6 million.
• Similarly, statewide Medicaid spending in Alaska impacted the creation of 285 jobs and over $12 million in income in 2001. In total, the state's investment of $150 million in Medicaid created over 9,000 jobs and generated more than $346 million in income.

1. The economic incentives of federally-funded, state workforce investment boards (WIBs)-whose mission is to partner with business, labor and the public sector to alleviate state and local workforce needs and sustain a high-skill economy-and the expertise of state health workforce planning commissions, can be important resources for addressing critical shortages of health care workers in many rural communities.

• The legislature in Washington directed the state's WIB to convene a health care personnel shortage task force to identify ways to increase education and training program capacity for health care personnel and improve student recruitment into health careers. Resulting from the task force's recommendations, the WIB now provides grants to all local WIBs to establish and expand health skills panels, whose charge is to identify health personnel shortages in their areas and to design and implement strategies to remedy the shortages.
• A local WIB in Texas is working aggressively with area hospitals and training programs to address nursing shortages by providing funding and expertise to market health care careers, expand educational capacity, and improve the work environment and staff retention.
• In Georgia, WIB funds are used to fund education scholarships for nurses and certified nurse aides, and-coupled with local foundation funding-to provide cancelable loans for training of new nursing faculty. In addition, the state's health workforce policy advisory committee, established in 2000, has provided extensive documentation and analysis on workforce shortages across this largely-rural state and identified policy recommendations to address the shortages.

1. Rural low-income populations have distinct needs for health and human services that need to be addressed.

• The Rural Families Program in Illinois has done extensive research on the needs of rural youth and on parenting in farm families and its impact on the successful development of rural youth and their retention in rural communities.
• In Oklahoma, Medicaid's unique program for rural recipients-SoonerCare Choice-is a primary care case management program that enhances access to health care by streamlining eligibility requirements, dedicating community outreach workers, assuring large provider participation, and establishing performance incentive payments for participating providers.

There was a consensus among workshop attendees for NCSL to convene additional forums for state officials that discuss challenges and opportunities for improving state rural health care programs and policy.

National Conference of State Legislatures

 AGENDA