Rural Americans continue to grapple with significant challenges accessing health care services. Perennial issues—such as rural hospital closures, health care workforce shortages, lack of broadband connectivity, high uninsured rates and others—contribute to poorer overall health outcomes for rural residents compared to their urban counterparts.
Yet, state policymakers have demonstrated great ingenuity in enhancing rural health care delivery systems and supporting access to care for resilient rural communities. As state legislators assess evidence-informed strategies, NCSL provides reliable, nonpartisan policy research and information on a number of rural health topics.
This web page is a compilation of NCSL resources on several key policy areas related to rural health. These include general rural health topics, health care workforce and scope of practice, telehealth, rural health facilities and specific health care services in rural communities. It also highlights key federal agencies and resources on strengthening rural health.
A variety of strategies exist to address rural health disparities and improve health care access. The following resources provide an overview of policy options relating to rural health, including strategies and experiences specific to the COVID-19 pandemic.
Health Workforce and Scope of Practice
To mitigate workforce shortages and enhance the capacity of the existing rural health workforce, many states have modified scope of practice (SOP) laws for various non-physician providers, including primary care and behavioral health providers. Additionally, states have established, or pursued federal funding opportunities relating to, health provider recruitment and retention programs.
NCSL maintains the Scope of Practice Policy website, which includes in-depth information on SOP laws across all 50 states as well as a searchable state legislative database. Other NCSL publications highlight state legislative actions and trends relating to SOP and provider recruitment and retention.
Telehealth is another avenue to combat workforce shortages, long travel distances to health facilities and limited access to specialty services. State telehealth policy areas include private insurance and Medicaid coverage, provider licensing requirements, behavioral health services, broadband connectivity and other topic areas.
NCSL tracks all introduced and telehealth legislation relating to state responses to the COVID-19 pandemic in the State Action on COVID-19 Database, as well as enacted legislation involving innovative state telehealth strategies in the Health Innovations State Law Database.
The State Telehealth Policies webpage provides a 50-state overview of Medicaid and private insurance coverage for telehealth and a complete list of our many telehealth publications. Additional resources relevant to rural health are listed below.
Rural Health Facilities
Rural health facilities, such as hospitals and federally designated Rural Health Clinics, contribute to overall community well-being and provide access to care in communities across rural America. The following resources touch on a number of state strategies to safeguard these vital facilities, such as state grant programs, alternative payment models and more.
Specific Health Care Services
From adequate prenatal care to essential behavioral and mental health services, state lawmakers have undertaken several strategies to improve access to a range of health care services for rural residents. The following resources examine state initiatives focused on specific types of health care services, including primary care, behavioral and mental health, oral health, maternal health and more.
Many federal agencies provide funding, conduct research and offer technical assistance relating to rural health including the Health Resources and Services Administration (HRSA) and the Centers for Disease Control and Prevention (CDC).