The NCSL Blog


By Kelsie George

Rural residents across the U.S. may be at higher risk for severe illness from COVID-19 due to the aging population, higher rates of underlying chronic disease, and higher likelihood of having a disability.

Farmers standing in field backlit by sunCombined with limited health care infrastructure and greater travel times to access in-person care, these challenges limit access to critical health care for the approximately 20% of Americans that live in rural communities. 

Today, Nov. 19, is National Rural Health Day, an annual celebration of rural communities and their success in addressing their unique challenges in accessing and delivering health care services. This day is an opportunity to recognize the positive things that are taking place in rural health. 

For example, amid the COVID-19 pandemic, states are ensuring access to quality health care for rural residents through several policy strategies—such as bolstering telehealth services and supporting rural hospitals and health facilities.

Bolstering Telehealth Access and Coverage

Patients and providers are seeking opportunities to access and deliver health care services during the COVID-19 public health crisis. Bolstering telehealth access and coverage is one way states are enhancing access to care, especially for large rural populations.

On the payment front:

  • Colorado required Medicaid reimbursement for telehealth services at the same rate as in-person services for Rural Health Clinics, federal Indian Health Service facilities, and Federally Qualified Health Centers.
  • Florida appropriated $4 million to implement a pilot project to provide behavioral telehealth services to children in public schools, with a focus on rural communities.
  • Michigan expanded originating sites (the patient’s location during a telehealth visit) to include in-home and in-school settings.
  • In part to ensure access to telehealth services, Mississippi authorized grant funding for the COVID-19 Broadband Provider Grant Program Fund to expand rural broadband capacity and facilitate telemedicine, remote work and distance learning. 

Supporting Rural Hospitals and Health Facilities

Health care infrastructure presents a challenge for rural communities given the potentially long distances to health facilities, the large geographic areas health facilities serve, and the shortage of health professionals in rural regions. Many of these barriers to access are exacerbated by the COVID-19 pandemic.

To address increasing rural hospital closures, Georgia established the Rural Center for Health Care Innovation in 2018 to evaluate the health data workforce data and develop mandatory Hospital Board and Executive Leadership Training, which has trained more than 250 rural hospital leaders to date. Georgia also increased appropriations in 2020 for the Rural Hospital Stabilization Program (originally established in 2014) from $3 million to $15 million. Washington exempted Rural Health Clinics from the state’s Certificate of Need review process if they provide services in designated home health shortage areas within the state.

While many of these issues are not new, state legislatures continue to explore options and opportunities to prevent the spread of COVID-19 and ensure access to care for rural populations across the country.

This resource is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $853,466 with 100% funded by HRSA/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government.

Additional Resources

Kelsie George is an intern in NCSL’s Health Program.

Email Kelsie

Actions: E-mail | Permalink |

Subscribe to the NCSL Blog

Click on the RSS feed at left to add the NCSL Blog to your favorite RSS reader. 

About the NCSL Blog

This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.