COVID cases and deaths are declining across the US, leading more states to open back up. But experts fear that COVID clusters, like those in North Carolina and Hawaii will occur, especially in rural counties where vaccination rates are lower (38.9%) than in urban areas (45.7%), and vaccine hesitancy/resistance is higher (CDC MMWR, May 18, 2021). The Health Resources and Services Administration (HRSA) is hoping to change that by providing more funding to rural areas to conduct testing and promote vaccinations.
Nearly 20% of the US Population Lives in Rural Areas
Around 60 million people live in rural communities across the US (MMWR). Older Americans account for 23% of the rural population, while African Americans, Latinx, and Native Americans make up 22% (ISDA Issue Brief).
The Northeast has the largest rural population, while the West has the smallest. According to Stacker, the 5 states with the highest and lowest percentage of rural residents are:
|States with the Largest Rural Populations||States with the Smallest Rural Populations|
|1. Vermont||50. California|
|2. Maine||49. New Jersey|
|3. West Virginia||48. Nevada|
|4. Mississippi||47. Massachusetts|
|5. Montana||46. Hawaii|
According to the MMWR, rural communities typically have a higher percentage of residents who:
- Do not have health insurance
- Have health comorbidities
- Are disabled
- Are 65 years of age or older
They also have less access to healthcare, often having to make long drives to get specialty and more intensive care. All these factors put them at greater risk for more severe cases of COVID, as does their hesitancy to get the vaccine.
Vaccination Rates in Rural America are Lower than in Urban Areas
Rural counties lagged behind their urban counterparts in getting the vaccine. The following table shows MMWR county-level vaccine administration data for adults in 49 states and the District of Columbia who are over the age of 18 and who received at least their first dose of the Pfizer or Moderna vaccines or the single dose Johnson & Johnson vaccine between December 14, 2020-April 10, 2021.
|Demographics||Rural Residents||Urban Residents|
|Total number of adults who received a vaccine||38.9%||45.7%|
|Vaccinated adults over age 65||67.6%||37.7%|
|Vaccinated adults between the ages of 18-64||29.1%||37.7%|
|Females who were vaccinated||41.7%||48.4%|
|Males who were vaccinated||35.3%||41.9%|
Several factors are impacting the vaccination rate among rural Americans. Older, rural adults are more likely to live alone and in poverty, and often do not have access to a computer or the internet. This makes it difficult to schedule online appointments or get to an appointment. Vaccine availability is a problem in some areas: 14.6% of rural residents said they had to travel to non-adjacent counties to receive the vaccine (MMWR). Other barriers include vaccine resistance and confusion about vaccine eligibility.
Vaccine Resistance Among Rural Residents
The MMWR included results of a Kaiser Family Foundation poll conducted in March where unvaccinated rural residents were asked if they would get the COVID-19 vaccine:
- 21% of residents said they would definitely not get a vaccine
- 45% of those respondents were adults aged 18-64
- 8% were adults aged 60-69
Confusion about the Vaccine Eligibility
The Kaiser poll found that rural residents were confused about whether or not they were eligible to get a COVID-19 vaccine in their states. Of the 30% who said they didn’t know if they were eligible:
- 45% were Hispanic adults
- 39% were adults under age 30
- 35% did not have a college degree
HRSA Funding Can Help Address Vaccine Access and Educational Issues
On May 4, 2021, the Department of Health and Human Services committed $1 billion to increase COVID testing, vaccine availability, and educational efforts in rural America. HRSA will administer the funding, which is available to 4,600 Medicare-certified rural health centers (RHCs) and includes:
- $460 million for the COVID-19 Testing and Mitigation Program:
- Up to $100,000 per RHC to expand testing for rural residents to strengthen community-specific programs to prevent the spread of the virus.
- $398 million to existing grantees of the Small Rural Hospital Improvement Program (SHIP) for expanding testing and mitigation programs through the nation’s 1,730 small rural hospitals (fewer than 50 beds) and Critical Access Hospitals.
- Each hospital will receive up to $230,000.
To get vaccines into rural communities, RHCs are invited to join the newly created Rural Health Clinic COVID-19 Vaccine Distribution (RHCVD) Program, which will send additional vaccines directly to enrolled clinics. The vaccine allocation will be separate from the jurisdiction’s weekly allocation, getting more vaccines directly into the hands of rural clinics. The program also guarantees funding for all eligible clinics that apply for the nearly $100 million in grants to aid in their fight to reduce health equity.
Targeting Migrant and Seasonal Workers
Another HRSA effort announced on May 18 aims to increase vaccination rates among migratory and seasonal agricultural workers, including workers in the food sector. Many of these workers are at increased risk for COVID because they live in congregate housing, use shared transportation, and work in close proximity to each other. The funding targets health centers that support a large number of migrant, seasonal, and food service workers. States with the largest concentration of these workers include California, Florida, North Carolina, Washington, and New York.
Rural Health’s Role in Fighting the Pandemic
Rural health clinics have been playing important roles in fighting the pandemic. According to the National Association of Rural Health Clinics:
- 90% of RHCs are educating patients about COVID vaccinations
- 55% are administering vaccines.
Whether you are an RHC or a community health organization, you are presented with a great opportunity to address the total healthcare needs of your underserved community members during your outreach and vaccination efforts. For example, patients must wait 15 minutes after getting the vaccine to make sure they don’t experience any adverse reactions. A staff member could use that time to talk to patients about the availability of free or low-cost health plans available through the marketplace if they enroll by August 15. Securing insurance coverage can improve their overall health and ensure you are getting reimbursed for the medically necessary care you provide.
American Exchange is Here to Help
Whether it’s making sure your vulnerable community members get the comprehensive insurance coverage they need or clearing your billing backlogs, American Exchange can help so you can focus your attention on patient care.
Enrollment and Billing Services
When your organization enrolls clients in Affordable Care Act (ACA) plans, you’re not only improving their overall health and quality of life, you’re creating a steady revenue stream that allows you to expand services and reach more community members. American Exchange can help you achieve both goals. We have successfully put more than 60,000 unique individuals and families on the road to good health by enrolling them in ACA health plans. We’ve also helped numerous public health agencies like yours bill Medicare, Medicaid, TRICARE, COBRA, and commercial insurers, so you get reimbursed for the health services you provide.
HIV Subsidy Programs
We specialize in enrollment and billing services for HIV subsidy programs across the nation. We’ve worked with Ryan White programs in Florida, Georgia, Illinois, Kansas, Mississippi, Missouri, New Hampshire, South Carolina, and Tennessee. We’ve connected more than 20,000 people living with HIV/AIDS to health plans that address all their medical needs, enabling them to adhere to medication regimens and live longer healthier lives.
COVID Administrative Service
American Exchange is helping state and local health departments across the country become mass immunizers. We are a leading provider of COVID administrative support services, helping state and local health departments and community organizations like yours. We can assist you in becoming a mass immunizer and can bill for vaccine administrative services. Vaccination numbers should increase again as children aged 12-18 are now able to get the Pfizer vaccine.