Human services play an important role in ensuring that rural residents and families have resources to maintain
or improve their own health. The availability of safe and affordable housing, income supports, food assistance,
job training, childcare support, and other services help low-income rural residents take care of themselves so
they can stay healthy. When faced with health challenges, people whose basic needs are met are better able to
concentrate on recovery and take steps to avoid future problems. Some rural hospitals even employ their own
social services staff, in an effort to provide patients with needed services that may help them avoid
By implementing population health strategies and addressing the social determinants of health (SDOH) through the
provision of human services, communities may be able to reduce healthcare costs and develop a more efficient
healthcare system. Focusing on preventive care and ensuring that patients who use the healthcare system
frequently, such as those with chronic conditions, have their basic needs met may lessen the stressors that
contribute to their chronic conditions, decrease the amount of healthcare resources they require, and reduce
Rural healthcare providers and facilities can help patients find services to meet their basic needs by
recommending benefit programs, providing referrals, or coordinating services with human services providers.
Likewise, rural human services providers may find that working with healthcare providers is an effective way to
identify unaddressed needs. Connecting human services to healthcare can help make limited resources go further
and leverage the close-knit nature of rural communities.
This guide focuses on human services that affect healthcare, including:
Income supports like Temporary Assistance to Needy Families (TANF) and Earned Income Tax Credits (EITC)
Weatherization and energy assistance
Job training and placement
Child welfare programs
Home visitation programs for parents and children
Access to healthy food and transportation also impacts health. These issues are covered separately in RHIhub's
other topic guides:
How does the availability of human services affect rural residents' health?
Human services can play an important role in the lives of low-income rural residents. People who have access to
the fundamental building blocks of well-being that we all need to thrive — access to food, housing, child
care, employment, and more — are more likely to improve their well-being by reducing stress and allowing
them more time and resources to care for their own health and the health of their families. Unfortunately, many
rural communities lack access to adequate human services for their residents.
How does the need for assistance programs compare in rural America?
According to the USDA Economic Research Service's Rural Poverty
& Well-Being, the 2019 poverty rate was higher in nonmetro areas (15.4%) compared to metro areas
(11.9%) and in some regions, like the South, nonmetro poverty was as high as 19.7%. To learn more about
the impacts of poverty on the health of rural communities, see How do poverty and unemployment impact
health in rural communities? on RHIhub's Social Determinants of Health for Rural People topic guide.
According to a May 2015 U.S. Census Bureau report, Dynamics of
Economic Well-Being: Participation in Government Programs, 2009–2012: Who Gets Assistance?,
nonmetropolitan participation in six national assistance programs is higher than for the nation as a whole. The
six major means-tested programs include: Temporary Assistance for Needy Families (TANF), state general
assistance programs, Supplemental Security Income (SSI), Supplemental Nutrition Assistance Program (SNAP),
Medicaid, and housing assistance.
Is there representation for rural human services interests at the federal level?
What rural housing, energy assistance, and weatherization programs are available?
The U.S. Department of Agriculture (USDA) Rural Development's Rural Housing Service provides
direct assistance in the form of loans, grants, and loan guarantees to low-income rural homeowners and renters
who are unable to obtain financing from conventional sources. These programs can also assist with the purchase
and rehabilitation of single and multi-family homes.
USDA Rural Development single family housing programs:
Family Home Loan Guarantees – Provides loan guarantees to low- and moderate-income households
to purchase, build, rehabilitate, improve, or relocate a structure in an eligible rural area with 100%
Preservation Grants – Provides grants to organizations to help low-income rural
residents repair or rehabilitate housing they own or occupy.
Housing Direct Loans – Offers competitive financing options for multi-family rental housing
units for low-income, elderly, or disabled individuals and families in eligible rural areas.
Multifamily Housing Loan Guarantees – Seeks to increase the number of
affordable rental housing units for low- and moderate-income individuals and families living in eligible
rural areas by offering financing options to qualified private-sector lenders and qualified borrowers.
Housing Rental Assistance Program – Provides payments to owners of USDA-financed rural rental
housing or farm labor housing programs on behalf of tenants. This program is also available for low-income
The U.S. Department of Housing and Urban Development (HUD) offers several
programs intended to help individuals and rural communities access affordable and safe housing that are
generally accessed through state, local, and community partners, including:
The Housing Assistance Council (HAC) is a national organization that
helps local groups build affordable homes for low-income residents in rural communities. HAC offers low-interest
loans and technical assistance, training, and programs for veterans and other vulnerable populations in rural
The Low Income Home
Energy Assistance Program (LIHEAP), offered through the U.S. Department of Health and Human Services,
primarily focuses on providing federal financial assistance to qualifying individuals and families with low
incomes pay their energy bills. LIHEAP can also help with home weatherization and minor energy-related home
repairs to reduce energy consumption.
The Weatherization Assistance
Program from the U.S. Department of Energy helps low-income families permanently reduce their energy
bills by making homes more energy efficient through repairs and weatherproofing.
HUD's Healthy Homes Program works to protect
the health of children and families by addressing home environmental health concerns including mold, lead,
allergens, asthma, carbon monoxide, pesticides, and radon. Healthy Homes grants are available to organizations,
state and local governments, federally-recognized Indian tribes, and colleges and universities. These grants can
be used to develop effective hazard intervention methods and provide public education to decrease
housing-related environmental safety problems.
In some states, rural utility cooperatives may offer utility-funded bill assistance programs. Other low- and
moderate-income energy efficiency programs, financed by states or utility providers to assist with
weatherization, may also be available.
How do income assistance programs help rural low-income residents and families?
The Earned Income Tax
Credit (EITC) provides a refundable tax credit for many low- to moderate-income working individuals and
families. The benefit amount depends on the recipient's income, number of children, number of dependents, and
other criteria. The article Earned
Income Tax Credit Plays Outsized Role in Rural reports that a higher percentage of noncore rural
taxpayers (23.4%) received EITC payments compared with metropolitan taxpayers (19.8%).
For the 2021 tax year, the Child Tax Credit
was expanded to offer $3,600 for children 5 and under and $3,000 for children 6 to 17 for those who meet the
income qualifications. The benefit makes advanced monthly payments starting in July 2021 through December 2021,
with the remaining half of the credit to be claimed on the 2021 income tax return.
Temporary Assistance to Needy Families (TANF) and Tribal Temporary Assistance for Needy Families (Tribal TANF)
are another type of federal income assistance that provides time-limited financial assistance and employment and
training services to low-income families. TANF benefits are funded through block grants to states and federally
recognized Indian tribes and administered locally through county human services agencies. States and tribes have
some flexibility in how they implement the program. The Carsey School of Public Policy report, TANF
in Rural America: Informing Re-Authorization, compares differences in TANF participation rates in rural
and urban areas, and found that, in 2009, over 11% of rural low-income families received TANF benefits compared
with almost 14% of urban low-income families. The smaller percentage of low-income rural families using TANF
could be due to barriers accessing human services and stigma connected with receiving government assistance in
The U.S. Department of Labor provides oversight for the unemployment
insurance programs that operate in all 50 states and some territories. Unemployment insurance provides
benefits to eligible workers who find themselves unemployed by no fault of their own and meet specific
eligibility requirements. Some states may have additional criteria determined by state law.
Healthcare providers can help patients access assistance programs by directing them to local human services
agencies or other online resources such as the EveryONE Project:
Neighborhood Navigator tool from the American Academy of Family Physicians. Benefits.gov also provides information and links to federal and state
benefit programs, including TANF, Tribal TANF, state general assistance programs, Supplemental Security Income
(SSI), Social Security Disability Insurance (SSDI), unemployment benefits, and other programs that can help
rural low-income families.
What job training programs are available in rural communities?
Job training programs can help workers develop and improve their skills and abilities to obtain and keep steady
Development Boards are a network of federal, state, and local offices that support workers and
employers. Local Workforce Development Boards support regional planning efforts to address local workforce needs
and oversee the American
Job Centers, one-stop shops offering services and assistance for jobseekers, with funding from the U.S.
Department of Labor and oversight from the state workforce agency.
A few examples of resources and services for rural jobseekers include:
The Northern Rural Training and Employment Consortium (NoRTEC) in
Northern California is an example of a workforce program that provides job training and employment services
to build a strong rural workforce and support the rural economic prosperity.
The National Farmworker Jobs Program (NFJP) helps migrant
and seasonal farmworkers and their families access education, job training, housing, and child care. The
federal program partners with state and community organizations to help workers enter the workforce and
obtain employment that suits their skill set.
Native Employment Works Program (NEW) provides
funds to federally-recognized Indian Tribes and Alaska Native organizations to offer education and training
to support job readiness, placement, and retention for tribal populations and service areas.
There are other initiatives that support rural residents in search of work, such as the Rural Workforce Innovation Network (RWIN). RWIN seeks to build
partnerships and collaboration to improve workforce opportunities for rural jobseekers.
Other programs that can provide support and services to help rural residents finding employment and job training
recipients can also receive support for basic education, job training, job placement, technical
training, and other services related to child care and transportation as it relates to finding and obtaining
Rural Childcare Supports
Rural jobseekers with families often face their own challenges related to finding childcare accommodations. An
October 2020 Bipartisan Policy Center report, Child
Care in 25 States: What We Know and Don't Know, analyzed the supply and demand of child care in 25
states to identify trends and gaps in care based on geographic and socioeconomic factors prior to the start of
the COVID-19 pandemic. The analysis found that 17 of the 25 states had a larger childcare gap in rural areas
compared to urban areas. The study also found that only 38% of families living in rural areas reported that
finding quality child care within their budget was easy, while over 50% of families living urban areas reported
The Child Care and Development Fund (CCDF), authorized by the
2014 Child Care and Development Block Grant Act (CCDBG), is a partnership between the federal government and
states to provide financial assistance to help families with low income access quality child care so they can
work, attend school, or obtain job training. CCDF is administered by states and tribes with support from the
Administration for Children & Families (ACF) Office of Child Care. A 2017 report from the Center for Law and
Social Policy (CLASP) and the National Women's Law Center (NWLC), Implementing the Child Care and Development Block
Grant Reauthorization: A Guide for States, analyzes the CCDBG and offers implementation considerations
for states aimed at increasing the availability and quality of childcare providers for targeted populations,
including those living in rural areas.
The U.S. Child Care Deserts Mapping Tool, from the Center for
American Progress, is an interactive map illustrating the demand and supply for child care as well as the
locations of childcare deserts. Due to the difficulty of finding quality child care that is also affordable,
many residents rely on informal arrangements with family, friends, or other caregivers, who might or might not
be licensed childcare providers. Childcare.gov offers
information and considerations when searching for quality child care. Head Start and Early Head Start are
federally-funded programs that promote early childhood education and development for children 5 and younger from
families with low income, including those located in rural areas.
How are the challenges of addressing child welfare different in rural communities?
Child Abuse and Maltreatment
A January 2021 Children and Youth Service Review journal article, Rural Differences in Child
Maltreatment Reports, Reporters, and Service Responses, examines urban and rural differences in child
maltreatment reporting by both professional and nonprofessional reporters from 2003 to 2007 and 2013 to 2017.
The study found reporting rates highest in rural areas for both professional and nonprofessional reporters and
that rural areas were more likely to have re-reports of child maltreatment compared to urban areas.
Child Maltreatment Report Rates per 1,000 Children
The National Center on Substance Abuse and Child Welfare's (NCSACW) Plans of Safe Care
Learning Modules offers guidance and information for states, tribes, communities, and other stakeholders
to develop or improve their systems of care and services available for infants with prenatal substance exposures
and their families.
Foster Care and Adoption
The Rural Monitor article Finding
Homes for Rural Foster Children discusses difficulties finding foster homes in rural areas, with the
result that many foster children must leave their community for care. All foster parents must be licensed by the
state, which requires background checks, tuberculosis testing, home inspections, and training about the child
welfare system. Religious organizations, community groups, and county offices can help foster families by
providing financial support for background checks and home modifications. Rural Adoptions: A Different Kind
of Rural Trust, another Rural Monitor article, shares examples of successful adoption
initiatives in rural communities.
How is the provision of human services different in rural areas?
In many rural communities, residents must travel significant distances to access support programs or may
experience other barriers impacting their ability to seek services. Local agencies and community-based
organizations may find that in order to publicize their services, they will need to invest time and effort on
Rural residents may hesitate to ask for help because of a strong tradition of self-reliance. However,
integrating human services with the healthcare system in rural communities may benefit from the strength of
relationships between local stakeholders and service providers. Providers in small, rural communities may need
to offer several different types of services that are available evenings or weekends to meet the needs of
the communities they serve. In this situation they can develop a better understanding of people's needs and
problems, and position themselves better to meet those needs. The RUPRI Human Services
Panel report, Rethinking Rural
Human Service Delivery in Challenging Times: The Case for Service Integration, describes this aspect of
“The creativity and resilience of rural people, and the informal networks so prevalent in rural areas
would further complement and enhance an integrated services approach… A rural service integration system
would allow the flexibility to combine processes that take advantage of these creative local networks, while
addressing the unique needs of a changing rural demographic, particularly with the expanded growth of
immigrant and aging populations.”
The COVID-19 pandemic largely caused a shift from in-person to a virtual model for the delivery of human
services. It is anticipated that some human services will continue to be offered virtually after the pandemic.
The Office of the Assistant Secretary for Planning and Evaluation (ASPE) published a series of
briefs focused on virtual human services delivery that share implementation information and models,
lessons learned, and best practices related to virtual human services delivery. The briefs also identify
possible barriers and highlight considerations for human services providers working with underserved and rural
populations such as access to technology, broadband, and other platforms for service delivery.
What are benefits to the rural healthcare system of helping address the social determinants of health through
the provision of human services?
People with chronic health conditions that require extensive healthcare services can experience other challenges
that can have a significant impact on their health and may exacerbate their illnesses such as poverty, hunger or
a lack of access to healthy food, housing issues, environmental concerns, and more. A healthcare system that
coordinates and collaborates with human services programs and community service providers has a greater
opportunity to address social determinants of health (SDOH), that would be more likely to reduce the need for
and overutilization of healthcare services, reduce burdens on healthcare providers, and avoid value-based
Access to quality education for children and adults
Timely access to quality healthcare services
Improving health and safety in neighborhoods and other built environments
Building social and community relationships and support mechanisms
In 2008, the Institute for Healthcare Improvement (IHI) advocated the Triple Aim concept of
improving patient experience, improving population health, and reducing per capita costs of healthcare to
improve the overall healthcare system in the U.S. Several provisions of the 2010 Affordable Care Act (ACA)
focused on healthcare delivery and how providers are paid by federal programs, shifting the traditional payment
for healthcare from volume- to value-based care. An example of this shift to value-based care and payment is the
rise of Accountable Care Organizations (ACOs). ACOs emphasize sharing accountability between providers and
healthcare organizations to achieve the goals of the Triple Aim. ACOs and other value-based programs provide an
incentive for members to work together with human services agencies to expand traditional services, improve the
patient experience, improve population health, and reduce the cost of care.
A related shift is occurring, from focusing on providing healthcare when people are sick to a more comprehensive
population health approach that focuses on the health of communities, preventive care, and the SDOH. To
facilitate this approach, the federal government requires nonprofit hospitals to conduct a community health
needs assessment (CHNA) every 3 years to retain their tax status. Rural hospitals can benefit from this
requirement by identifying the areas of greatest need in their communities and the sources of highest healthcare
costs. Hospitals and their communities then must create an implementation strategy which can coordinate with
human services to address identified social needs and reduce healthcare costs, while at the same time improving
population health. Additional information and resources related to conducting community health needs assessments
are available in RHIhub's Conducting Rural Health
Research, Needs Assessment, and Program Evaluation topic guide.
How can rural healthcare providers help their patients access needed social supports? What programs have been
designed to do this?
One way healthcare providers can help patients find social supports is by co-locating healthcare services with
social services. Another option is to add a social worker or case manager to the clinic staff to help
coordinate and facilitate care to meet patients' needs. Examples of co-locating services in rural areas
In rural Humboldt County, California, a Federally Qualified Health Center (FQHC) is located in the same
building as a Family Resource Center. The RUPRI Human Services Panel report, Humboldt County, California: A
Promising Model for Rural Human Services Integration for Transformation, describes how the Family
Resource Center provides community services such as case management, food distribution, child care, and
benefits application assistance to community members in need. The co-located FQHC and Family Resource Center
share a front-desk and administrative staff to help ease the transition from medical services to social
Vermont's Blueprint for Health program includes
social workers as part of multi-disciplinary community health teams that operate in a medical home framework
along with community-led strategies to improve population health. The Blueprint provides for additional
administrative payments to support the community health teams. This program works to connect patients with
needed services such as benefit applications, housing needs, weatherization and energy assistance, and
offers support in cases of domestic and child abuse. The program also helps physicians stay informed about
service options available to their patients.
Efforts to better coordinate care are creating a more formalized process to involve social services in the
provision of healthcare. Current programs in rural settings include:
The Northwest Oregon Network (NEON) Pathways
Community Hub is a pay-for-outcome model that uses community health workers (CHWs) to connect
patients with the appropriate resources to address their health needs. CHWs identify high-risk patients,
determine the best pathway for improved health, and educate them about the health and social services
available in their community. They also help patients find needed resources. Once the pathway is
successfully completed, payment is made to the employing organization.
NCCARE360 is a statewide network of healthcare and human services
organizations and providers that operate on a shared technology platform to better coordinate and
collaborate on improving the health of residents in North Carolina.
The Maine Rural Health Research Center's working paper, Integrated
Care Management in Rural Communities, provides examples and strategies for implementing integrated care
for long-term care services, many of which are funded under Medicaid, and involve coordination or integration
with acute care providers under Medicare.
How can rural human service providers work with the healthcare system to address patients' basic needs?
Family or Community
Resource Centers are particularly effective in rural communities. These resource centers provide human
services to families with low-income in inviting and accommodating settings, and may also offer basic healthcare
services such as health screenings, preventive care, immunizations, and more. Family or Community Resource
Centers provide health and human services to an entire community, thus reducing stigma associated with receiving
safety net services for a single individual. As mentioned in a 2015 RUPRI publication, Accountable
Care Communities in Rural: Laying the Groundwork in Humboldt County, California, in rural California:
“The decentralized Family Resource Centers are community sites for a number of activities that promote
healthy people and healthy communities, including parent education, food and clothing, social services, local
health and behavioral health and community meetings. These centers provide a variety of cross-sector services
driven by the needs of the community in an approachable manner.”
Another program to address patients' basic needs is the Full-Service
Community Schools Program (FSCS). FSCS is a grant program, funded by the Office of Elementary and
Secondary Education, that seeks to coordinate, improve, and integrate health and social services to support
community development, children, and families, including children at high-poverty rural schools. FSCS supports
the development of partnerships between schools and nonprofits, community-based organizations, and other groups
with an interest in providing quality education. Additional resources outlining the Full-Service Community
Schools Program, how to start a community school, and what local communities and states are doing to support the
model is available from the Coalition for Community Schools.
RHIhub's Rural Services Integration Toolkit provides rural-specific
resources that include successful, evidence-based program models, and implementation considerations for rural
communities seeking to develop a health and human services integration program. Also, the Human
Services Value Curve is a toolkit developed by the American Public Human Services Association
(APHSA) that may be useful as a reference document for rural agencies and community organizations working to
better integrate health and human service systems.
What types of funding are available for coordinating with human services and providing human services benefit
enrollment in a healthcare setting?
The Federal Office of Rural Health Policy (FORHP) offers community-based grants that can be used to support and
coordinate relationships between the human services providers and the healthcare system to improve access to
care and address unique healthcare needs in rural areas. The Rural Health Network
Development Program is a grant to support rural providers who work in formal networks to integrate
administrative, clinical, technological, and financial functions. The Rural Health Care
Services Outreach Grant Program can support a wide range of non-clinical activities that improve health
and healthcare in rural communities.
The Funding & Opportunities section of this topic guide
offers a list of rural specific funding for human services projects with a healthcare component.
What are some of the barriers to integrating human services with healthcare in a rural setting?
One of the most significant challenges to integrating human services with healthcare is financial sustainability
due largely to difficulty billing for services provided by a social worker or other human service provider in a
fee-for-service healthcare payment model in a healthcare setting. Many health insurance companies will not pay
for phone consultations that social workers conduct for case management services with patients. A National
Academies of Sciences, Engineering, and Medicine 2019 report, Integrating Social Care into the Delivery of Health Care,
identified five key financial challenges impacting the integration of social services and healthcare including:
Legal definitions of healthcare, which drive what is covered by health insurers
Healthcare payment models that lack necessary incentives
Fragmented financing for dually eligible Medicare and Medicaid beneficiaries
A lack of administrative capacity for social service providers
The report also shares a framework for five activities for healthcare systems that have been used successfully
strengthen communication and coordination between the social services and healthcare sectors. These activities
include awareness, adjustment, assistance, alignment, and advocacy with activities that target both individuals
and the community to improve integration.
The Commonwealth Foundation's report, Care
Management for Medicaid Enrollees through Community Health Teams, notes that one potential
solution is to create community health teams or networks and medical homes that are financially supported
through a single payer system, such as Medicaid, or by multiple payers that could include commercial insurers,
Medicare, and Medicaid.
Another significant barrier to integrating human services with healthcare in rural areas is having human service
programs and operating staff available to coordinate with the healthcare system. Since rural human services
providers often lack adequate resources, it may be difficult for them to provide needed services in a community,
regardless of the setting. As the RUPRI Human Services Panel states in their report, Rethinking Rural Human Service
Delivery in Challenging Times: The Case for Service Integration, sometimes even services deemed
essential are unavailable or nonexistent.
Other challenges include:
Compliance with federal and state laws and regulations
Navigating privacy laws to allow data sharing without compromising confidentiality
Availability of transportation
Stigma associated with receiving services
Lack of infrastructure or technology
Community members' lack of awareness of available services and programs
Lack of local revenue to financially support services and programs
Balancing and coordinating different organizational structures
RHIhub's Rural Services Integration Toolkit offers further discussion on barriers and implementation challenges that may
occur with rural services integration and describes potential solutions to address these challenges.
Where can I find information about the different ways human services can be integrated within a rural healthcare
The human services system interacts with the healthcare system in many ways, from healthcare provider referrals
to a human services provider to creating new programs involving physicians, human services providers, and
community organizations to address unmet needs in a community such as housing, transportation, access to healthy
food, and more. A RUPRI Rural Human Service Panel
report discusses common
themes and characteristics for five case studies that showed innovative and non-conventional approaches of
integrating health and human services projects in rural areas. To learn more about the different services integrations models and how they can be
integrated see RHIhub's Rural Services Integration Toolkit.
What human services may be available to rural residents who are affected by the opioid crisis?
In October of 2017, the U.S. Department of Health and Human Services declared the opioid crisis to be a nationwide public
health emergency. This emergency declaration requires attention not only from healthcare providers and
systems, but also from organizations providing human services that have made many resources available at the
local and national level.
To learn more about initiatives targeting opioids in rural areas and resources rural communities and
organizations can use to address opioid misuse, see RHIhub's Rural Response to the
Opioid Crisis topic guide. For a more in-depth review of how substance misuse, including opioids,
impacts health in rural communities, see RHIhub's Substance Use and Misuse in
Rural Areas topic guide.