Despite the many unique challenges facing nonurban communities, there’s much to celebrate when it comes to state health policy efforts in rural America. Tomorrow is National Rural Health Day, which the National Organization of State Offices of Rural Health promotes as an opportunity to showcase rural America’s community-minded spirit—“the power of rural”—along with state successes in improving access to care in rural communities.
The health disparities between rural and urban areas—higher rates of heart disease, cancer and unintentional injury to name a few—are well documented. Poorer health outcomes and barriers to services in rural areas are due to several factors, including longer travel distances to providers, lack of broadband connectivity and high uninsured rates.
State policymakers, however, are finding innovative ways to support rural communities by addressing the COVID-19 crisis, ensuring access to rural health facilities and transforming rural behavioral health delivery.
Bolstering Vaccine Uptake in Rural Communities
Rural Americans are dying of COVID-19 at more than twice the rate of urban residents, according to the Rural Policy Research Institute. Additionally, rural vaccination rates lag behind those in urban areas, with 44.1% of adults in rural counties being fully vaccinated compared with 56% of adults in urban counties, as of October.
State policymakers are pursuing various strategies to increase vaccination rates in rural communities. Many states are expanding scope of practice requirements to allow additional types of providers to administer COVID-19 vaccines—a strategy researchers see as beneficial in rural communities with health care workforce shortages.
At least nine states enacted legislation to authorize pharmacists to administer the vaccine. And several states, including Indiana, Minnesota, Tennessee and Wisconsin, enacted legislation or pursued regulatory action allowing vaccinations by dentists.
Some states are tailoring vaccination plans for rural areas. Michigan legislation required the state health department to include rural independent pharmacies in its vaccine distribution efforts. South Carolina legislators funneled some of their $208 million in vaccine funding toward a vaccination plan for rural and underserved areas. Some states—such as Kentucky, Mississippi and North Carolina—allocated funding for free or reduced cost rides to vaccination sites to assist those without transportation.
Safeguarding Rural Hospitals
Rural hospitals have been on the front lines providing necessary services throughout the pandemic—all while facing continued financial strain and workforce shortages. There are, however, promising signs rural hospital closures have slowed for now. While there were 19 closures across 11 states in 2020, making it the worst year on record, only two rural hospitals have closed so far in 2021.
One factor potentially staving off further closures is the influx of federal dollars allocated to rural providers during the pandemic. For example, the American Rescue Plan Act included $8.5 billion to support rural hospitals and other rural providers in their COVID-19 vaccination and testing efforts, as well as to ensure their long-term financial stability.
Certain states have created additional funding opportunities of their own. Kansas established $10 million in grants for rural hospitals to change their health care delivery model—such as acquiring telehealth technologies—to better meet local community needs. Illinois allocated $150 million to implement “transformation plans” for safety net and critical access hospitals, with the goal of improving health care outcomes, reducing disparities and enhancing health care delivery and coordination in rural and underserved communities.
Improving Access to Behavioral and Mental Health Services
Rural communities experience both a high prevalence of behavioral health disorders and a shortage of behavioral health workers. To counter these challenges, state policymakers looked to a variety of approaches during 2021 legislative sessions to bolster access to behavioral and mental health services.
Many states are increasing access to virtual behavioral health via computer or phone. Some states—such as Iowa, Massachusetts, Nebraska and Rhode Island—enacted legislation in 2021 requiring private insurers to reimburse specifically for virtual mental health services at the same rate as in-person services. Arkansas permanently included Medicaid reimbursement for virtual behavioral health after the public health emergency ends.
At least 29 states permanently expanded access to audio-only telephone consultations beyond the COVID-19 state of emergency. Many health experts see audio-only services as particularly conducive to virtual behavioral health and an important option for those in areas with poor broadband connectivity.
Some states are looking beyond telehealth to expand access to behavioral health providers. Montana and Washington revised licensing and certification requirements for addiction counselors. Minnesota outlined the scope of practice authority for peer support specialists—individuals with a history of behavioral health challenges—and other mental health providers. Colorado specified that peer support specialists are eligible for Medicaid reimbursement.
These represent just some of the ways states have tackled barriers to care in rural areas. And, as rural communities continue to grapple with myriad health challenges, policymakers and rural health leaders will be championing these successes and more during tomorrow’s National Rural Health Day and beyond.
Jack Pitsor is a policy associate in NCSL’s Health Program.