Capital Funding for Rural Healthcare
Capital funding sources allow for investment in healthcare infrastructure, including the construction, renovation, or expansion of rural healthcare facilities. Capital investments can also be made through the purchase and installation of major equipment and technology. Some capital funding sources also look at operational needs to ensure that a facility has the operational funding it needs to increase efficiency and quality of care. Finding funding for capital projects is a major concern for many rural healthcare facilities.
The ability of a healthcare facility to meet the needs of a rural patient population is directly related to the efficiency, size, and quality of the facility and its equipment. According to the 2008 Rural Hospital and Renovation Expansion Study, updated facilities and equipment impact the ability of a rural community to recruit and retain health professionals, improve patient safety, expand services, and increase satisfaction rates of these factors play a role in the overall operational cost, making capital investments an important part of financial viability.
Needs for healthcare capital are many in rural communities. As mentioned in Critical Access Hospital Replacement Process: The Manual, many small rural hospitals were built in the Hill-Burton era of the 1940s and 1950s. Faced with aging infrastructure, many hospital leaders must consider and undertake major capital projects such as renovation or replacement of the facility. In addition to bricks and mortar, capital projects may include patient redesign, which includes facility design elements and equipment needed to manage patient flow and reduce patient stress. In recent years, another pressing capital funding need has been the purchase and installation of electronic health records and telehealth systems, which can add significant hardware, software, implementation, and data compilation costs.
Successfully funding a capital project can require blending multiple sources and types of funding, including public grant and low-interest loan programs as well as private sources, such as foundations and local donors. Blending funding sources can be especially effective for larger projects, such as hospital building and major renovations.
This guide brings together resources for running successful capital campaigns and provides information on current capital funding needs of rural hospitals, clinics, and other providers of healthcare services. This guide also lists federal, state, and foundation funders that are interested in supporting capital projects.
Frequently Asked Questions
- What are the major federal grant or loan programs that support capital projects for rural healthcare facilities?
- Which foundations support capital projects for rural healthcare facilities?
- What types of low-interest loan programs are available to rural healthcare facilities for capital investment projects?
- What other avenues of funding are available to finance capital projects for rural medical facilities?
- Can for-profit healthcare facilities apply for grant funds, or are only nonprofit organizations eligible?
- What is a loan guarantee and how can it help fund a capital project in a rural hospital or a clinic?
- Are there funding programs that specifically support electronic health record implementation or telehealth projects in rural healthcare facilities?
- What are some strategies to running a successful fundraising campaign for capital projects?
- What is an Essential Community Facility and how can it help rural healthcare facilities access capital?
- What is a Community Development Financial Institution and how do they help rural healthcare facilities?
- What are State Health Facilities Finance Authorities and how can they help with capital funding?
What are the major federal grant or loan programs that support capital projects for rural healthcare facilities?
When healthcare facilities undertake a capital project that will require significant fundraising, grant and loan programs play an important part to achieving a monetary goal. While healthcare facilities are eligible for many grant programs, the majority of grants available are for programmatic costs and do not allow for purchases of major equipment, construction, renovation, or expansion. It is important to look for programs that specifically state that they will fund capital projects.
Here is a list of federal agencies that fund capital projects for rural healthcare facilities. Please note that the application cycles for these programs may or may not be open at this time.
|Program Name||Eligible Organizations||Maximum Amount||Funding Uses|
|Administration for Children and Families (ACF)|
|Community Economic Development Projects||Nonprofit Community Development Corporations with or without a 501(c)(3) status||$800,000||Expansion, construction
In many cases, this funding is tied to the number of jobs created.
|Appalachian Regional Commission (ARC)|
|ARC Project Grants||Nonprofit 501(c)(3) organizations or units of local government located within the area covered by ARC are eligible||Varies by state||Equipment, construction and renovation of healthcare facilities in special cases|
|Economic Development Administration (EDA)|
|Economic Development Assistance Programs||District organizations; Indian tribes; states, cities, or subdivisions of states; institutions of higher education; nonprofit organizations||$1,250,000||Infrastructure, including water, wastewater, telecommunications and roads projects which could strengthen healthcare facilities|
|USDA Rural Development|
|Business and Industry Guaranteed Loans||A cooperative organization, corporation, partnership, or other legal entity organized and operated on a profit or nonprofit basis; An Indian tribe; A public body; An individual||$10,000,000||Purchase and development of land, expansion, renovation, equipment|
|Community Facilities Loan and Grant Program||Public entities such as municipalities, counties, and special-purpose districts, as well as non-profit corporations and tribal governments in rural areas with populations of up to 20,000||Amounts vary||Construction, expansion, renovation, or equipment for essential community facilities|
|U.S. Department of Housing and Urban Development (HUD)|
|Community Development Block Grant Program for Indian Tribes and Alaska Native Villages||Tribal governments, tribal organizations, and organizations applying on behalf of Indian tribes||$5,500,000||Construction, renovation, expansion|
|Rural Economic Development Loan and Grant Program||Local businesses, including healthcare facilities, can apply through local utilities||$2,000,000||Construction, equipment|
There are many other funders that support capital projects at the state or local level — see RHIhub's Funding and Opportunities by Topic: Capital Funding. RHIhub also offers free customized funding searches – email email@example.com for assistance.
Which foundations support capital projects for rural healthcare facilities?
Private foundations receive income from an individual, family, or a group of individuals who have specified what types of projects they are interested in funding. Most foundations typically like to be the “last in” on a capital project. That is, foundations will usually want all other funding secured, and then the foundation will come in with the funds to complete the project.
Examples of private foundations that list capital projects for healthcare facilities as a focus area include:
- Charles A. Frueauff Foundation – This foundation awards grants in 35 states. They will consider applications from hospitals and healthcare agencies for equipment purchases.
- Gladys Brooks Foundation – This foundation awards grants in 17 states. Capital funding is listed as one of the types of funding applicants may request.
- Sunderland Foundation – This foundation awards grants in 10 states. They will consider applications from healthcare agencies and hospitals for capital funding purposes.
There are many other foundations that support capital projects at the state or local level — see RHIhub's Funding and Opportunities by Topic: Capital Funding. RHIhub also offers free customized funding searches – email firstname.lastname@example.org for assistance.
What types of low-interest loan programs are available to rural healthcare facilities for capital investment projects?
The Small Business Administration (SBA) offers two types of low-interest loan programs:
- SBA 7a Loan Program – provides funds to small businesses including small healthcare practices. 7a loan funds may be used to purchase equipment or real estate; construct a new building; or renovate an existing building.
- SBA Certified Development Company 504 Loan Program – provides financing options for small businesses. Loans can be used by healthcare providers who want to build a new office, or expand or renovate an existing medical building.
USDA Rural Development tends to be the most available capital resource for rural healthcare facilities. USDA offers programs that provide low-interest loans and grants for capital funding:
- Business and Industry Guaranteed Loans – can be used to purchase and develop land or equipment, or for expansion or renovation costs. Proposed projects must improve employment and economic conditions in rural communities.
- Community Facilities Loan and Grant Program – offers loans for construction, expansion, renovations, or the purchase of equipment.
- Rural Economic Development Loans and Grants – can be used by healthcare facilities for construction or the purchase of medical equipment.
There may be other types of low-interest loan repayments offered at your state or local level — see RHIhub's Funding and Opportunities by Topic: Capital Funding. RHIhub also offers free customized funding searches – email email@example.com for assistance.
What other avenues of funding are available to finance capital projects for rural medical facilities?
When funding a capital project, it is best to gain local support before approaching federal agencies or national foundations. National funders generally have more competitive processes with longer, more time-intensive applications. Many funders also have a matching funds requirement, which can be met by initiating a local fundraising campaign.
Rural communities have a distinct interest in seeing healthcare facilities remain in their area because of the community and economic benefits they bring. For information on demonstrating the economic impact healthcare facilities have on their rural communities, see RHIhub's Community Vitality and Rural Healthcare guide.
Community fundraising campaigns can be an effective way of raising funds with the proper strategy and a dedicated committee. Approaching organizations and individuals within the community can be helpful to achieving a successful fundraising goal. Consider involving:
- Local businesses and business organizations
- Local locations of larger companies
- Major employers
- Schools, school boards, and post-secondary institutions
- Chamber of Commerce
- Economic development organizations
- Local human resources groups
- Local banks or lending institutions
- Elected officials and city staff
Fundraising letters to individuals and businesses, special events, and planned giving are several strategies to achieving a fundraising goal. Local government agencies may also be able to award grants or loans, or assist in implementing a dedicated tax levy.
Can for-profit healthcare facilities apply for grant funds, or are only nonprofit organizations eligible?
There are several low-interest loan programs available to for-profit entities but, with very few exceptions, grant funds are only extended to nonprofit healthcare facilities, government entities, or tribal entities. Funders view grants as an investment in social good. Giving grant money to for-profit businesses is unlikely because that would be an investment in one particular individual or set of individuals who stand to monetarily gain from the ultimate success of a venture.
In rare cases, funders may consider a for-profit applicant if it has a strong social mission and is seen as a force for public good. It is important to read through all eligibility requirements prior to applying for funding.
What is a loan guarantee and how can it help fund a capital project in a rural hospital or a clinic?
A loan guarantee, or mortgage insurance, provides reassurance to a lending institution that if the borrower defaults, a third party (usually a government agency) will agree to pay some or all of the debt owed.
Rural healthcare organizations are more prone to face financial hardships than their urban counterparts, and are therefore generally considered higher risks to lenders. Loan guarantees essentially boost the credit rating of a borrowing healthcare facility because they provide security to the lending institution. Many federal and state agencies will provide loan guarantees, enabling healthcare organizations to have access to needed capital.
Federal programs that provide loan guarantees for rural healthcare facilities include:
- 7a Loan Program, Small Business Administration
- Section 242 Hospital Mortgage Insurance Program, U.S. Department of Housing and Urban Development
- Business and Industry Guaranteed Loans, USDA Rural Development
- Community Facilities Loan and Grant Program, USDA Rural Development
Are there funding programs that specifically support electronic health record implementation or telehealth projects in rural healthcare facilities?
In addition to the grant program listed above, there are a number of funding programs that offer grants specifically for electronic health records, health information technology, and telehealth projects, including:
- Healthcare Connect Fund – Universal Services Administrative Company (USAC) program which provides funding to healthcare providers for telecommunications and internet access services, as well as network equipment at a discounted rate.
- Distance Learning and Telemedicine Grant Program – USDA Rural Development program which provides funding to purchase and install equipment for telemedicine and distance learning programs.
- Small Hospital Improvement Grant Program (SHIP) – Federal Office of Rural Health Policy (FORHP) program which provides grants to State Offices of Rural Health on behalf of small rural hospitals in each state. Among other things, these funds may be used to purchase health information technology (HIT) equipment. For program information and application, contact your State Office of Rural Health.
There may be other types of funding offered at your state or local level — see RHIhub's Funding and Opportunities by Topic: Capital Funding. RHIhub also offers free customized funding searches – email firstname.lastname@example.org for assistance.
What are some strategies to running a successful fundraising campaign for capital projects?
According to the National Rural Health Resource Center's manual, Raising Funds for Rural Health Care, it is important to:
- Plan well by conducting a feasibility study, creating a budget, determining leadership for the campaign, and engaging a consultant.
- Gain local support by forming steering committees, executing a marketing strategy, preparing a case statement, and soliciting donations from local donors.
- Have a kick-off event in which you announce funding goals and advanced gifts, begin to solicit larger funding sources, and talk about how the project will impact the community.
What is an Essential Community Facility and how can it help rural healthcare facilities access capital?
Essential Community Facilities is a term used by USDA Community Facilities programs to describe the types of facilities it will fund. Essential Community Facilities must provide an essential public service to the local community which meets all of the following criteria:
- Be a service that is typically provided by a local unit of government
- Be needed for the orderly development of the rural community and considered a public improvement
- Does not include private, commercial or business undertakings
- Must include significant community support
This source of capital can be useful to rural healthcare facilities because USDA considers Essential Community Facilities to include medical clinics, hospitals, assisted living facilities, police stations, fire and rescue stations, community centers, public buildings, transportation, schools, libraries, and childcare centers - facilities that are essential to the quality of life in rural communities.
What is a Community Development Financial Institution and how do they help rural healthcare facilities?
Community Development Financial Institutions or CDFIs are financial institutions that have community development as their primary mission and that develop a range of strategies to address that mission. CDFIs provide comprehensive credit, investment, banking, and development services. Some are chartered banks, others are credit unions, and many operate as self-regulating, non-profit institutions that gather private capital from a range of investors for community development or lending. CDFIs make loans and investments and provide basic services to people and institutions that, for various reasons, are unable to get these services from conventional financial institutions.
CDFIs serve economically disadvantaged people and communities throughout the United States, such as affordable housing developers, small business owners, community groups, and other non-profits or social service providers.
CDFIs administer the The New Markets Tax Credit Program which provides options for the capital needs of rural healthcare organizations. The program provides tax incentives for investments for projects in distressed rural or urban counties that will spur economic growth, including capital investments in healthcare facilities. Investors give to Community Development Entities which then offer low-interest financing to businesses and nonprofit organizations. New Markets Tax Credit deals are complex; facilities will want to work with an experienced consultant.
The Opportunity Finance Network (OFN) is national network of CDFIs that works to provide high-impact investments in distressed communities. OFN maintains a CDFI Locator tool that allows you to search for CDFIs with service areas that match your location.
What are State Health Facilities Finance Authorities and how can they help with capital funding?
Many states have State Health Facilities Finance Authorities, which issue tax-exempt bonds and pool loans as well as other programs, such as capital planning assistance. Having a solid financial status improves a healthcare facility's bond rating.
For further information, contact your state health facilities finance authorities program. The National Association of Health and Educational Facilities Finance Authorities (NAHEFFA) provides a state-by-state listing of its member authorities. In most cases, an organization will need to hire a municipal advisor to work through a bond deal. For additional information, consult the Municipal Securities Rulemaking Board website.
Last Reviewed: 1/30/2017