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Rural Health Information Hub
Rural Health Information Hub

Rural Health Policy

How do we ensure access to affordable, high quality healthcare for rural residents? How can Medicare and Medicaid reimbursement methods allow rural healthcare facilities to keep their doors open? How can we attract healthcare providers to rural communities? Questions like these, along with countless others, are the basis of rural health policy.

Rural health policymaking takes place at the federal, state, and local levels of government. The process includes defining a problem, collecting data, researching solutions, choosing a course of action, implementing the plan, and evaluating the results. During each step, policymakers must weigh economic, political, social, legal, ethical, and administrative factors. Formulating rural health policy involves many people and organizations, including:

  • Lawmakers and elected officials
  • Government agencies
  • Membership associations
  • Rural health researchers
  • Rural healthcare providers
  • Rural patients
  • Rural individuals, community-based organizations, businesses, and other stakeholders

These groups work individually and collectively to identify improvements to the provision of healthcare services in rural communities.

Frequently Asked Questions

What types of issues does rural health policy address?

Rural health policy addresses many of the same issues as the broader realm of health policy, such as access to care, quality improvement, cost containment, and healthcare system redesign. However, rural health policy focuses specifically on how policy choices affect rural communities, populations, and healthcare facilities. Health policy issues of interest for rural stakeholders include:

It is important to remember, however, that policy issues change over time. As one problem is addressed through policy channels, other problems persist and new issues emerge. Priorities may shift when there is a change in the political leadership. Changes in public sentiment also play a role in determining which issues receive attention.

What role does the federal government play in the rural health policy process?

At the federal level, the Executive, Legislative, and Judicial Branches of government conduct the formal policymaking process.

  • Executive Branch
    Headed by the President of the United States, the Executive Branch plays a strong leadership role in the policymaking process. The Executive Branch is charged with executing and enforcing the laws as passed by Congress. Executive departments and agencies assist the President in carrying out the daily administrative tasks of the federal government. Through the annual executive budget process, the President is able to set national spending priorities. How the President chooses to allocate resources during his/her tenure can have a major impact on rural healthcare. Another important role of the executive branch is the rulemaking process, which allows federal agencies to determine how laws and policies are interpreted and implemented after receiving public input on proposed rules.
  • Legislative Branch
    The Legislative Branch of government, or Congress, is composed of two chambers: The U.S. House of Representatives and the U.S. Senate. Elected representatives within each chamber carry out the formal legislative process at the federal level. All federal legislative powers are granted solely to Congress. Congress also holds the “power of the purse,” controlling federal government spending through the appropriations process. At least 11 committees between the House and Senate have some influence over various aspects of rural health policy. The informally organized, bipartisan Senate Rural Health Caucus and House Rural Health Care Coalition help focus legislative attention and provide a forum for addressing rural healthcare issues. Several agencies within the Legislative Branch, such as the Congressional Budget Office (CBO) and Library of Congress (LOC), provide support and information services to members of Congress.
  • Judicial Branch
    Composed of the Supreme Court of the United States and other federal courts, the Judicial Branch interprets the meaning of laws, applies laws to specific cases, and determines the constitutionality of legislation and regulations. Decisions issued by federal courts sometimes affect health policy and rural healthcare in substantial ways.

What is the role of the Federal Office of Rural Health Policy (FORHP)?

Operating within the Health Resources and Services Administration (HRSA), the Federal Office of Rural Health Policy (FORHP) was created by Section 711 of the Social Security Act in 1987, and is charged with the following tasks:

  • Inform and advise the Secretary of the U.S. Department of Health and Human Services (HHS) on matters affecting rural healthcare and hospitals.
  • Coordinate activities within HHS that relate to rural healthcare.
  • Establish and maintain a rural health information clearinghouse.
  • Administer grants, cooperative agreements, and contracts to provide technical assistance and other activities that support healthcare in rural areas.

In this unique capacity, FORHP serves as a voice for rural communities in federal actions related to health and healthcare. Another primary function of FORHP is providing management and support services for the National Advisory Committee on Rural Health and Human Services (NACRHHS). NACRHHS is a 21-member panel of rural experts that provides recommendations to the Secretary of HHS on issues related to rural health and human services.

Which federal agencies participate in the rural health policy process?

Along with the Federal Office of Rural Health Policy (FORHP), the following agencies work to address rural health policy issues:

U.S. Department of Health and Human Services Agencies

Other Executive Branch Departments and Offices

Independent Congressional Agencies

How does the rural health policymaking process work?

An issue or idea related to rural health may emerge through research findings or concerns expressed by groups or individuals. Oftentimes, because of their advocacy function, membership organizations raise awareness of issues in the public arena. There are countless ways in which an issue may come to the forefront, and rarely do two policies follow the exact same path.

At the federal level, once a problem and potential policy solution are identified, policymakers in the U.S. Senate and U.S. House of Representatives may craft legislation intended to address the issue. This legislation development process often includes input from a variety of experts and interested parties, including through Senate or House committee hearings, where witnesses invited for their expertise or viewpoint provide testimony and answer questions. If the legislation is passed, signed by the President, and becomes law, then federal agencies with jurisdiction over the related policy or program will be called upon to administer regulations and enforce the law. To increase the likelihood of getting passed, rural health legislation commonly becomes part of a larger bill such as an appropriation bill.

Occasionally, the President may issue executive actions to implement policy. On the federal level, executive orders are often instructions directing federal agencies to conduct certain policy actions and are published along with regulations in the Federal Register.

State-level policymaking involves many players. Policies become law once approved by the state's legislative body and signed by the state's governor. Regulation and enforcement of state-level policies becomes the responsibility of state agencies, similar to the process at the federal level. However, due to a level of state sovereignty as defined by U.S. law, variation amongst enforcement methods exists between states. Table 4.5 in the Council of State Governments' The Book of the States provides a state-by-state overview of the powers of governors to issue executive orders.

At both the state and federal levels, the process of identifying and addressing issues through policy is iterative. Each time a change is made, policymakers, researchers, and interested parties examine the results, look for ways to improve the solutions, and begin the process again. Evaluation and data reporting requirements for federally-funded programs and rural health research help support this process.

How do researchers support rural health policy?

Rural health researchers focus their efforts on identifying, understanding, and solving problems related to the provision of healthcare in rural communities, as rural areas face many unique healthcare challenges. Research findings help inform policymakers and stakeholders about disparities or other prevalent issues that should be addressed. Additionally, research related to rural populations and rural healthcare facilities helps forecast the effects of policy on rural healthcare access, and predicts potential unintended consequences of proposed policies.

Researchers may also be tasked with evaluating program performance. In this role, researchers identify which programs and methods are effective, and which are not. The evaluation process helps facilitate best practices and ensures resources are being used in the most effective manner.

Through the Federal Office of Rural Health Policy, the federal government funds a number of rural health research centers and analysis initiatives across the U.S. For information about current rural health research projects, please see the Rural Health Research Gateway. For additional information about rural health research, see the Conducting Rural Health Research, Needs Assessment, and Program Evaluation topic guide.

What role do membership organizations play in advocating for rural health issues?

Membership organizations work with policymakers to inform them on issues and challenges affecting the rural health community. These organizations often communicate important messages by producing documents, sponsoring or attending conferences, maintaining an online presence, and communicating directly with lawmakers and regulators. Membership organizations also keep their members informed by tracking pending legislation and regulations. When new laws pass and regulations are issued, membership organizations relay important provisions to ensure their members are aware of the policy change.

As part of their advocacy function, membership organizations help mobilize members and connect them with state and federal legislators. State associations play an important role in educating and advocating for state action and help inform national associations about the implications of national policies at the state and community level. Oftentimes, as a way to focus efforts and set priorities, groups of individuals with similar interests assemble within the organization to form an interest group or committee. This model allows diverse interests to voice their opinions, while working towards common goals within the framework of the larger organization. Other major functions of membership organizations include education, policy formation, research, and technical assistance.

Membership organizations with interests in rural health include:

What resources are available to stay current on evolving rural health policy?

Several government agencies, membership organizations, research centers, and nonprofit organizations at the national and state levels serve as resources to stay current on rural health policy issues. The following lists, while not exhaustive, include resources representing a variety of rural health interests:

Resources on Federal Policy

Resources on State Policy
Note: there will be variation among states.

  • State Offices of Rural Health (SORHs)
    State-level offices coordinate statewide efforts to improve healthcare delivery systems in rural communities. They are also tasked with collecting and disseminating information, and providing technical assistance to public and nonprofit entities. All 50 states currently have a SORH.
  • State Rural Health Associations (SRHAs)
    Advocacy groups that focus statewide efforts and provide forums for collaboration within each state.
  • State and Regional Primary Care Associations (PCAs)
    Organizations that offer training and technical assistance (T/TA) to safety-net providers.
  • State and Territorial Health Officials
    Oversee state/territorial health departments and implement state laws affecting them. Often lead or serve on boards and commissions related to public health issues.
  • State Long-Term Care Associations
    Trade associations that work to enhance long-term care services through advocacy, education, and collaboration.

How can I influence rural health policy?

There are many ways to engage in the rural health policy making process. Many membership organizations help their members connect with state and federal legislators and ask their members for feedback on policy proposals. Writing op-eds in a local paper or attending a public meeting hosted by lawmakers is another way to make government officials aware of current issues affecting your facility or the health of people in your community.

Federal agencies post drafts of new or revised regulations in the Federal Register and often accept comments from the public before the final rule is published. Interested stakeholders, from membership organizations to corporations to individuals, can submit letters describing their concerns of how the proposed rules will impact their interests and or voice support of these policies. Agencies also post information on public meetings and requests for nominations for advisory committees in the Federal Register. Similar opportunities to comment on proposed regulations exist at the state level as well.

Last Reviewed: 4/13/2021