Objective 5: Rural Health Resource Plan
Assessment of the availability of health resources in rural areas, unmet needs, adequacy of the rural health workforce, and transportation barriers to accessing care.
RCW 43.370.030(3)(e) requires the State Health Plan and Resource Strategy to include a rural health resource plan that assesses the availability of health resources in rural areas, evaluates unmet needs, examines the adequacy of the rural health workforce, and considers transportation barriers to accessing care. Federal and state reimbursement policies will also be evaluated to determine whether modifications could more efficiently and effectively meet health care needs of rural communities.
More than 85% of Washington’s land is rural, with about 1.1 million residents living in these areas, according to Washington’s Rural Health Transformation Program application. Understanding how geographic and system factors affect access to care in these regions is essential to statewide health planning. Rural areas face unique challenges related to geography, workforce availability, and the sustainability of health care services.
Key Research Areas
- Health needs of rural communities
- Availability of rural health resources
- Rural health workforce capacity
- Transportation and geographic access
- Unmet health care needs
- Financial policies affecting rural health care
Together, these analyses will help identify where rural communities face barriers to care and where policy or system changes may improve access to services.
Objective 5 Highlights
Explore topics below or view the Full Draft of Objective 5 [PDF]. After reviewing, we invite you to identify any additional questions or topics you believe should be included for a comprehensive assessment.
Email comments to ofmshp@ofm.wa.gov before April 17, 2026 to ensure inclusion in the State Health Plan and Resource Strategy. Comments received after that deadline will be evaluated but may not be included in the final report.
Rural communities often experience demographic, geographic, and socioeconomic conditions that influence health care needs and service delivery. This component will leverage findings from Objective #1 to examine characteristics of rural populations that affect health care demand.
The analysis will consider how geographic isolation, limited local services, and cultural or community characteristics influence the types of health services needed in rural areas.
Key indicators include:
- Population aging trends
- Income levels, employment patterns, and major industry sectors
- Health insurance coverage
- Prevalence of chronic conditions, behavioral health needs, and injuries
The second component will assess the availability and distribution of health care resources in rural Washington. Using the health care facilities and services inventory under Objective 2, this analysis will identify facilities and providers serving rural populations. Attention will be given to the role of critical access hospitals, rural hospitals, community clinics, tribal owned clinics, federally qualified health centers (FQHCs), behavioral health providers, and other essential components of rural health systems.
The analysis will also examine trends in service availability, including changes in facility locations, ownership, service lines, and the role of telehealth in expanding access to care.
Below are examples of key indicators that will be used.
Key indicators include:
- Geographic distribution of facilities and providers
- Provider-to-population ratios
- Availability of key service lines and changes over time (e.g., acute or emergency care, obstetrics)
- Use of telehealth services in rural communities
- Housing availability and new home construction
The third component examines whether rural communities have an adequate health care workforce. This analysis will evaluate the supply and distribution of health care professionals in rural areas, including primary care providers, specialists, behavioral health professionals, and tribal community providers. This analysis will also consider broader community factors affecting workforce recruitment and retention, such as housing availability, community infrastructure, and opportunities for professional collaboration.
Key indicators include:
- Workforce shortages across provider types
- Effects of workforce shortages on access to services
- Barriers to recruitment and retention, including housing constraints
The fourth component will assess physical access barriers including geographic distance and transportation limitations which can significantly affect access to health care in rural communities. These challenges may be exacerbated by regional referral patterns that require patients to travel outside their communities for specific specialized care, or for care from providers in their network. Understanding these barriers will help identify where geographic access constraints contribute to unmet health care needs.
Key indicators include:
- Travel distance to primary and specialty care
- Average travel times for common health services
- Availability of transportation options such as non-emergency medical transportation
- Effects of transportation barriers on appointment access, urgent or emergency care, and specialty care
The fifth component will examine the extent to which available health care resources meet the health needs of rural communities. This analysis will draw on projected service needs and estimated gaps identified in Objective #2.
This analysis will focus on barriers rural residents face in accessing primary care, specialty care, behavioral health services, and other essential services. Comparing rural health status indicators with statewide and regional trends will help identify conditions or populations where health needs may be greater or services more limited.
Key indicators include:
- Utilization patterns of health care services (e.g., emergency department use)
- Travel time and distance to care
- Appointment availability
- Wait times for services
The sixth and final component will evaluate how federal and state financial policies influence the availability and sustainability of health care services in rural areas. Many rural health providers serve smaller populations and operate with limited financial margins, making reimbursement policies a critical factor in whether services can be maintained locally.
The analysis will examine reimbursement structures affecting key rural providers, including critical access hospitals, rural hospitals, rural health clinics, federally qualified health centers, and behavioral health providers. Financial indicators for rural hospitals and clinics will be reviewed, including trends in uncompensated care and reductions in service lines that may be associated with payment structures.
Key indicators include:
- Effects of recent Medicare and Medicaid reimbursement changes on rural providers
- Potential reimbursement policy changes that could improve rural health care delivery
- Policy changes that have increased financial pressures on rural providers
- Workforce programs or other initiatives supporting rural provider sustainability
Outcome of Rural Health Resource Plan
These analyses will provide a comprehensive assessment of health care resources in rural areas of Washington. The analysis will identify where rural communities experience challenges related to service availability, workforce capacity, geographic access, or financial sustainability of health care providers and facilities.
Findings from this objective will help identify areas where rural communities face barriers to accessing care and where changes in health care delivery models, workforce strategies, infrastructure, or reimbursement policies may improve the efficiency and effectiveness of services.
This section will also monitor implementation of the Rural Health Transformation Project and the Medicaid Transformation Project and link those outcomes with the analyses conducted under this objective.
