When billions of dollars in federal funding started flowing into rural healthcare agencies as part of the American Rescue Plan, facilities turned to State Offices of Rural Health for assistance in how to use it.

Shortly after the public health emergency declaration, nearly $400 million in funding went to 1,540 rural hospitals with fewer than 50 beds through the Small Rural Hospital Improvement Program (SHIP). 

Those funds were to go toward operational improvements including hardware, software and training. Additionally, the Federal Office of Rural Health Policy developed a number of programs for Medicare-Certified Rural Health Clinics (RHCs) that provided each hospital with $49,000 (in May 2020) for Covid-19 testing, another $100,000 (in June 2021) for Covid testing and mitigation, and another $50,000 (in July 2021) for Covid vaccination confidence programs.

State Offices of Rural Health helped RHCs in their own states apply for funding and track how that funding was spent. But, since each state office is different, how the state offices responded to the crises varied.

In some states, Offices of Rural Health are a function of the state government. But many are not. Tammy Norville, CEO of the National Organization of State Offices of Rural Health (NOSORH), said in an interview with the Daily Yonder that each state is different. Three state Offices of Rural Health are non-profit organizations, while 13 are located in academic settings – either universities or community colleges. The rest, she said, are part of state government. Those located in state government, Norville said, are most often located in their state’s Department of Health and Human Services, except for one which is located in the state’s Department of Agriculture.

“We like to say, when you’ve seen one state Office of Rural Health, you’re really seen one state office of rural health,” Norville said. “They’re all set up differently. Even the ones in state government offices. They’re different in how they’re staffed, how the work is distributed. It’s all depends on the state they’re in.”

At NOSORH, the goal was to provide support to state offices of rural health as they, in turn, supported their RHCs.

In some cases, that meant taking the pulse of what was going on during the pandemic and highlighting some of the best practices that were going on among the offices.

For individual state Offices of Rural Health, the funding for Rural Health Clinics came at a critical time.

Robert Duehmig, interim director of the Oregon Office of Rural Health, said in an interview with the Daily Yonder that the money was needed, but almost overwhelming.

“The amount of money that flowed from the federal government and from the state government and different entities was huge,” he said. “And it was done at a time where even if we were fully staffed, we’re not huge offices, and neither are a lot of our clinics. We were starting to close down for a period of time. The expectations of some of those funds I think were often or somewhat unrealistic.”

The Oregon Office of Rural Health’s role in distributing that money was to make sure the hospitals were eligible and to help them identify how they were going to spend those funds. Once the hospitals had signed an agreement on how they would spend those funds, the state office would distribute them.

Some eligible hospitals chose not to take the federal funds though. Five rural hospitals in Oregon did not. Duehmig said it was not that they didn’t need it or that they weren’t eligible, but that in some cases they were having trouble finding expenses to apply those funds to. In other cases, there just wasn’t enough manpower in the hospital to monitor and record how the funds were used.

In Michigan, John Barnas, executive director of Michigan Center for Rural Health, said the relationship between the center and the state health organization was key in getting grant money to the right communities.

Working with the Michigan Department of Health and Human Services, the Michigan Center for Rural Health was able to cooperatively get funding to needy rural communities. And by looking at the data, the center was able to find populations that needed the funding the most.

“We utilized population-based data to look at age demographics, race, ethnicity demographics, poverty demographics,” Barnas said. “We also looked at data around immunization levels for flu and Covid-19.”

Norville said the money came as a blessing, but also as a curse. At a time when rural health clinics were at their busiest, she said, the federal government was throwing money at them, requiring them to spend it in certain ways, and asking them to track how they spent it. That meant more labor to monitor how the money was spent, she said.

“Just think about the effort that it took to do that in the middle of a public health emergency… but these guys did it, I mean, that’s the story, right? Regardless of what left hooks came at them, they rose to the challenge. And they did what they needed to do to take care of things.”

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