Interview

Making Sure Geography Doesn't Determine Health Outcomes

Alan Morgan, MPA is the CEO for the National Rural Health Association

Please tell us about the mission and history of the National Rural Health Association (NRHA).

The National Rural Health Association has been advocating on behalf of rural America for nearly five decades. Our mission is simple — to improve the health and well-being of the 60 million Americans who call rural America home.

We represent rural hospitals, clinics, providers, public health professionals, researchers, educators and community leaders from across the country. If you care about rural health, there is a home for you in the NRHA.

Throughout our history, we've worked to ensure that people living in rural areas have access to high-quality, affordable health care close to home. Whether it's shaping federal policy, providing education and training or helping rural communities share innovative solutions, our goal is to make sure geography doesn't determine health outcomes.

What are some of the most important issues affecting the provision of health care in rural communities?

Among the biggest challenges facing rural health care today are workforce shortages, financial pressures on rural providers, aging infrastructure, transportation barriers and limited access to specialty care including behavioral health.

Many rural communities struggle to recruit primary care physicians, nurses, behavioral health professionals, dentists and pharmacists. At the same time, rural hospitals often operate on extremely thin margins while serving older populations with higher rates of chronic disease.

Broadband access is another significant issue, because so much of modern health care depends on digital connectivity. When a community lacks reliable internet service, it limits telehealth, remote monitoring and access to specialists.

What are some of the most creative responses to these challenges you have seen?

One of the most encouraging trends is that rural communities are creating partnerships and solutions that fit their local needs. We've seen hospitals partner with local schools to build health career pipelines beginning in high school. When maintaining a local hospital or clinic is not feasible, we've seen mobile clinics bring primary care, dental care and behavioral health services directly to underserved areas. Telehealth has expanded access to specialists who may be hundreds of miles away. Recently of course, we’ve seen artificial intelligence assist with clinical documentation, freeing up staff time to focus on clinical care itself.

We've also seen a rise in multisector and community partnerships. Communities share resources regionally instead of each facility trying to do everything independently. That collaborative approach can be incredibly effective.

The integration of community health workers (CHWs) into primary care, remote patient monitoring (RPM), and emergency medical services (EMS) innovations have also emerged as effective strategies for extending care beyond traditional clinical settings while addressing social determinants of health. NRHA through its National Rural Age-Friendly Initiative (NRAFI) recently developed a policy brief on how integrating CHWs into primary care can advance rural age-friendly care for older adults living in rural communities.

Please tell us about the findings from the report on your recent work with the Rural Policy Research Institute (RUPRI).

Rural health care must move beyond simply preserving existing systems and instead focus on transformation. This report emphasized the importance of strengthening the workforce, modernizing facilities, expanding broadband access, integrating behavioral health services and addressing social factors that affect health such as housing, transportation and food security.

Another key takeaway from the summit is that innovation is already happening in rural communities. The challenge is scaling successful models and providing the financial and policy support needed to sustain them over the long term.

Health care workforce shortages present significant concerns to rural health. What are the best ways to solve these problems?

There certainly isn't a single solution to address rural workforce shortages. However, several approaches have proven effective in addressing the issue.

First, with more than 95% of incoming medical students coming from urban areas, we absolutely must do a better job growing our own workforce by encouraging rural students to pursue health careers and creating pathways that help them return home to practice.

Second, we need stronger loan repayment and scholarship programs that encourage providers to serve rural communities.

Third, we should expand training opportunities in rural settings because providers often choose to practice where they train.

Fourth, workforce retention programs and incentives are equally important. Greater investment is needed in retention initiatives, such as professional development opportunities and educational benefits, along with competitive incentives, including bonuses, career advancement opportunities, comprehensive health benefits, retirement plans such as 401(k) accounts, paid time off, bonuses and other employee benefits. These efforts will be critical to recruiting, retaining and sustaining a strong rural health workforce over the long term.

Finally, technology can help extend the reach of existing providers through telehealth, virtual consultations and team-based care models. This is a great opportunity to highlight the incredible innovation that is happening in rural America today. Because of the tremendous challenges facing rural health care, we see that rural communities are serving as innovation hubs — many times on the cutting edge of innovation. Advances in artificial intelligence, combined with telehealth, are expanding the workforce and serving as models for future care.

America is aging, and rural America is aging even faster.

A recent nationwide survey of rural hospitals and facilities found that 92% were in the planning process of addressing outdated facilities, however access to funding was a universal concern. What advice can you offer to help locate and coordinate funding opportunities?

The most successful organization approach typically combines multiple funding sources rather than relying on a single grant or loan program.

Federal agencies such as the Health Resources and Services Administration and the U.S. Department of Agriculture offer programs that can support facility improvements and infrastructure investments.

State offices of rural health can also be excellent partners. I would encourage rural facilities to develop a long-term capital plan, build partnerships with local governments, community organizations private organizations and non-profits and seek technical assistance early in the process. Often the biggest challenge isn't finding funding opportunities, it's coordinating them effectively.

Another significant challenge is the limited availability of experienced grant writers and the capacity to sustain funding over time. Rural organizations can address this by investing in grant-writing training for existing staff, collaborating with experienced grant writers through local and regional partnerships or consultants and, when feasible, sharing grant-development resources and grant opportunities across organizations. Building internal grant-writing capacity and developing a long-term sustainability plan from the onset can improve competitiveness for funding and help ensure that successful projects continue beyond the initial grant period.

What are your thoughts on the state of the federal government’s Rural Health Transformation Program?

This is a once in a lifetime historic opportunity to develop an innovative, sustainable future for rural health care. The program represents an important recognition that rural health care requires solutions tailored to rural realities. That only occurs, however, if the program is implemented correctly, with the funds going to rural providers and communities.

What excites me most is the emphasis on innovation and flexibility. Rural communities differ tremendously from one another, so allowing local leaders to design solutions that meet their unique needs is critical. At the same time, strengthening multi-state collaborations, community partnerships and dissemination of successful state models are also key to success and sustainability. The lessons and best practices emerging from these efforts can help inform and strengthen rural health policy nationally.

Moving forward, success will depend on sustained investment, strong accountability measures, clearly defined performance measures and ensuring that communities of all sizes have the capacity to participate

What are some innovative programs that individual states and legislatures have enacted to address the challenges facing rural health?

States have become laboratories for innovation. Many states have expanded loan repayment programs for rural providers. Others have supported rural residency programs to train physicians locally. Some have invested heavily in broadband expansion to support telehealth.

We've also seen innovative approaches to behavioral health integration, community paramedicine programs and regional partnerships that allow multiple rural facilities to share resources and expertise. There has also been significant growth in rural age-friendly initiatives including, remote patient monitoring, telehealth, dementia and memory care, direct care workforce development, PACE site expansion and Area Agency on Aging (AAA) partnerships to extend care coordination reach into rural communities. 

The common thread is that successful programs recognize that rural communities often need flexibility rather than one-size-fits-all solutions.

Can you project the affects slated changes to Medicaid redetermination in 2027 will have on rural access to care?

While it will vary across states, this is going to have a substantial adverse impact to rural health nationally. Rural populations simply have a higher percentage of individuals with high health needs, and the inability to pay for that care. Any significant changes to Medicaid eligibility or enrollment processes can have major consequences for rural communities because Medicaid is such an important source of coverage in many rural areas.

If eligible individuals lose coverage due to administrative barriers or confusion about the renewal process, we could see increases in uncompensated care, delays in treatment and additional financial strain on rural hospitals and clinics. At the end of the day, rural facilities will close as a result of Medicaid funding reductions.

One of your recent projects is the National Rural Age-Friendly Initiative. What can you share with us about this?

America is aging, and rural America is aging even faster.

Our National Rural Age-Friendly Initiative focuses on helping rural communities become better places to grow older. That means looking beyond health care alone and considering transportation, housing, social connections, caregiver support and community services.

The goal of our initiative is to help rural communities create environments where older adults can remain healthy, engaged and independent for as long as possible.

The initiative, supported by the John A. Hartford Foundation, is helping integrate Age-Friendly Health Systems' (AFHS) 4Ms Framework (What Matters, Medication, Mentation and Mobility) into rural health care to improve the quality of care for rural older adults. Through this AFHS work, the initiative is strengthening the rural workforce by training CHWs to deliver rural age-friendly care and connect older adults with essential community resources.

The initiative extends its activities beyond the AFHS work by partnering with organizations across the age-friendly ecosystem to advance multisector collaboration and coordinated systems-level programs/initiatives/approaches to healthy rural aging.

his work benefits everyone because age-friendly communities tend to be stronger communities overall.

Another project is your Rural Oral Health Initiative. What is the impetus behind that collaboration?

Oral health is often overlooked, but it is a critical part of overall health. While I understand oral health impacts both urban and rural residents, the impact is most acutely felt in rural communities.

Many rural communities face shortages of dental professionals and limited access to preventive dental care. Poor oral health can contribute to other health problems, including heart disease, diabetes complications and adverse pregnancy outcomes.

The Rural Oral Health Initiative brings together partners from across the health care system to identify practical solutions that improve access, expand workforce capacity and integrate oral health more effectively into primary care.

What advice do you have for all of those who are working in rural health care?

First and foremost, I am greatly appreciative of all who work in rural health. Rural health professionals are some of the most dedicated people you'll ever meet. They wear many hats, solve problems creatively and often serve communities where everyone knows them by name.

My advice is to continue building partnerships, embrace innovation while keeping patients at the center of every decision and remember that your work matters. Rural health care isn't just about treating illness — it's about sustaining communities.

The challenges are real, but so is the resilience of rural America. Every day, I see people finding new ways to improve care and strengthen the communities they serve. That gives me tremendous optimism about the future of rural health.

Alan Morgan, MPA is the CEO for the National Rural Health Association.