Arizona Rural Health Resource Manual
Background: What is Rural?
- Hospital Financing
- Hospital Designations
- Health Clinic Resources
- Tribal Resources
- Health Information Technology
- EMS Resources
- Emergency Preparedness Resources
- Rural Health Funding Resources
- Workforce Resources
- Development Resources for Boards of Directors and Board of Trustees
- Public-Sponsored Insurance Resources
- Advocacy Resources
- Other Resources of Interest
Background: What is Rural?
The deﬁnition of rural has tremendous ﬁscal and health service implications for rural residents of our state and country.
As populations shift and are noted in our ofﬁcial Census records, so does the deﬁnition of rural. Many towns in Arizona that were considered rural twenty years ago are no longer federally identified as rural because of population growth.
It is extremely important that health care agencies and institutions remain vigilant over the changing deﬁ nitions of “rural.” For example, modiﬁcation of a single deﬁnition can cause a health care provider to lose its federal Health Professional Shortage Area (HPSA) designation and the ﬁnancial rewards that accompany the designation.
It is also important for rural providers to make their voices known to policy-makers whenever new rural deﬁnitions are proposed. When the federal government proposes to change a deﬁnition, a notice seeking public comment is printed in the Federal Register. Currently, for example, a deﬁnition of “frontier” is being explored by the Health Resources and Services Administration (HRSA) within the U.S. Department of Health and Human Services. “Frontier” differs from “rural” in that it may apply to much more sparsely populated areas than those that ﬁt under “rural.” Many Navajo Nation members can be identiﬁed as living in “frontier” areas of the state where their homes are located in remote areas that are a one-hour drive from the nearest service center. Similarly, the Havasupai Tribe might be identiﬁed as “frontier” as there are no roads leading to the homes of the residents that live at the bottom of the Grand Canyon. To date, no formal deﬁnition of frontier has been adopted by HRSA. Until then, a few federal programs are funding pilot projects that will strengthen access to health services in areas they consider “frontier.”
Deﬁning rural is critical when applying for federal funding that is speciﬁcally directed to rural communities. For example, the Federal Ofﬁce of Rural Health Policy, the U.S. Department of Agriculture, and the Universal Services Corporation all require applicants for funding and/or telecommunications discounts to meet the deﬁnition of rural adopted by these agencies. It is highly recommended that before a rural entity applies for federal funding, eligibility based on rurality is determined.