Rural Health Capital Resources Council Project

With support from the Federal Office of Rural Health Policy for FY22, the National Organization of State Offices of Rural Health has convened a national expert group to form the Rural Health Capital Resources Council.

NOSORH has convened over 30 national organizations, philanthropic organizations, regional community development finance organizations, and federal agencies. They represent community development finance, housing, economic development, rural health, broadband, and the many components that comprise healthy communities. The Council met in March and May 2022 in virtual sessions and in person in Baltimore on June 13-14, 2022.

The goal of the Council is to develop a strategic and sustainable approach to helping rural hospitals, healthcare organizations, and clinics access the capital they need for infrastructure, new services, and addressing community health needs.

NOSORH can provide leadership in continuing to develop capital resource expertise and technical assistance for SORHs, and link capital resources to the work of SORHs at the state level.

Read the Build Healthy Places blog post about partnerships between SORHs and Community Development Finance Institutions.

Strategies for FY 2023

The Rural Health Capital Resource Council (RHCRC) and NOSORH will provide leadership in continuing to develop capital resource expertise and technical assistance for SORHs, capital resources organizations, and communities in FY 2023. The RHCRC Strategic Plan provides a summary of Goals, Objectives, and Strategies for the coming year.

Resources

+ How to Create a Rural Health Capital Resources Council in Your State

How to Create a Rural Health Capital Resources Council in Your State

Have you wondered how to increase access to capital for rural health in your state? Much of the expertise exists with organizations that may not typically be engaged with State Offices of Rural Health (SORH).

Creating a Rural Health Capital Resources Council (RHCRC) is a structured way to expand engagement with key stakeholders. The RHCRC aims to develop a strategic and sustainable approach to helping rural hospitals, healthcare organizations, clinics, communities, and nonprofits access the capital they need for infrastructure, new services, and addressing community health needs.

The RHCRC is structured to take a cross-sector approach, linking rural health expertise with organizations representing community development finance, housing, economic development, transportation and the many components that comprise healthy communities.

+ Community Development and Community Development Finance Institutions

Community development is the concept that communities can come together to take collective action and generate solutions to issues in their communities. It is rooted in concepts of participatory democracy and community engagement. The founding director of the Montana Office of Rural Health, Dr. Frank Newman, believed that communities could come together to identify the services they needed and find ways to support high-quality rural health. While Dr. Newman was focused on rural health services, that belief in community development can lead to the development of the social determinants or drivers of health – transportation, access to broadband, housing, early childhood education, safety, physical activity, and food access.

As communities come together to identify solutions to local problems, they also need access to capital resources. State Offices of Rural Health may be most familiar with funds that support healthcare infrastructure and services. The array of funding available for social determinants of health, or the drivers of health, may be less familiar. This section references sources of community development funding available through federal agencies, and local community development organizations called Community Development Finance Institutions.

For a great video on how Community Development Finance Institutions work in rural America, watch Uplift America Fund.

1. From the Federal Reserve

Community development finance is a broad term encompassing the varied sources of funding that support stronger and more resilient communities around the country. Community Development staff at the Federal Reserve promote new and established sources of community development finance for low- and moderate-income (LMI) communities by working closely with financial institutions, community development organizations, nonprofits, foundations, research and policy centers, and government agencies.

Financing community development investments in LMI communities often requires a creative mix of public, private, and philanthropic resources. The Federal Reserve helps community development organizations access the technical and financial resources required to complete these often-complex deals. The Federal Reserve also uses its research and convening capabilities to explore new and emerging sources of capital to support community development finance. In addition, the Federal Reserve, as a regulator of the Community Reinvestment Act (CRA), seeks to educate banks and community stakeholders about how to partner to direct CRA-eligible loans and investments in a manner that is most impactful for the local community.

Community Development Investments: https://www.federalreserve.gov/consumerscommunities/cdi.htm

Related Information

– Community Reinvestment Act (CRA): The CRA, enacted in 1977, requires the Federal Reserve and other federal banking regulators to encourage financial institutions to help meet the credit needs of the communities in which they do business, including low and moderate-income (LMI) neighborhoods.

– Community Development Financial Institutions: Community Development Financial Institutions (CDFIs) are certified by the Treasury Department’s CDFI Fund and support a wide range of community development projects in LMI communities across the country.

– Financial Innovations Roundtable: Created in 2000, the Financial Innovations Roundtable creates cross-sector partnerships among conventional and non-traditional lenders, investors, and markets to provide low-income communities with increased access to capital and financial services.

– Impact Investing: Impact investing is a broad term that encompasses a number of financial strategies investors can employ to receive a social return along with a financial return. Some of these strategies have the potential to bring significant new capital into community development finance, as explored in “Pay for Success Financing” (PDF).

2. Community Development Finance Institutions

From the Opportunity Finance Network:

Community Development Financial Institutions (CDFIs) provide opportunity for all: CDFIs are lenders with a mission to provide fair, responsible financing to rural, urban, Native, and other communities that mainstream finance doesn’t traditionally reach. Where others see risk, we see opportunity.

Unlike traditional banks, we specialize in lending to individuals, organizations, and businesses in under-resourced communities, offering clients financial education, business coaching, and low-interest rate loans that increase economic potential and help build wealth.

CDFI lending leads to small businesses and homeownership, creates living wage jobs, supports the development of schools, grocery stores, and health care centers, finances climate change solutions, and so much more.

3. From the US Department of the Treasury

To connect with a CDFI in your state or community, the Treasury Department helps you access CDFIs in your state and community at this site: https://www.cdfifund.gov/faq

What does the CDFI fund do? The Community Development Financial Institutions Fund (CDFI Fund) plays an important role in generating economic growth and opportunity in some of our nation’s most distressed communities. By offering tailored resources and innovative programs that invest federal dollars alongside private sector capital, the CDFI Fund serves mission-driven financial institutions that take a market-based approach to supporting economically disadvantaged communities. These mission-driven organizations are encouraged to apply for CDFI Certification and participate in CDFI Fund programs that inject new sources of capital into neighborhoods that lack access to financing.

Each business financed, each job created, and each home built represents a critical step in the transformation of a life, a family, and a community. This is real change. This is the CDFI Fund. Discover More >

– What are CDFIs?

– Did you know the CDFI Fund is an important part of your community?

– Which CDFI Fund program is right for your organization?

– Looking for training or technical assistance opportunities?

Are you an individual or business seeking a loan? Click here to learn how to find CDFIs and CDEs that are providing services in your community.

Are you seeking Opportunity Zones information? Click here to find information and resources about Opportunity Zones.

Are you keeping safe from scams? Scammers have been contacting individuals claiming to be from the CDFI Fund. Click here to learn more.

4. From the US Department of Housing and Urban Development

COMMUNITY DEVELOPMENT – Housing and Urban Development (HUD)

Overview: Community development activities build stronger and more resilient communities. To support community development, activities are identified through an ongoing process. Activities may address needs such as infrastructure, economic development projects, public facilities installation, community centers, housing rehabilitation, public services, clearance/acquisition, microenterprise assistance, code enforcement, homeowner assistance, etc. Federal support encourages systematic and sustained action by state and local governments.

Community Development Block Grant (CDBG) Programs

– CDBG Colonias Set-Aside: requires the border states of Arizona, California, New Mexico and Texas to set-aside a percentage of their annual state CDBG allocations. The set-aside is used in the Colonia to help provide Colonias residents with potable water, adequate sewer systems, or decent, safe, and sanitary housing.

– CDBG Disaster Recovery Program: provides flexible grants to help cities, counties, and states recover from Presidentially-declared disasters. The grants focus on low-income areas, subject to availability of supplemental appropriations.

– CDBG Entitlement Program: provides annual grants on a formula basis to entitled cities and counties. The grants develop viable urban communities by providing decent housing, a suitable living environment, and expand economic opportunities for low- and moderate-income persons.

– CDBG HUD Administered Non-Entitled Counties in Hawaii Program: provides annual grants on a formula basis to Hawaii, Kauai, and Maui counties. The grants provide decent housing, a suitable living environment, and expand economic opportunities for low- and moderate-income persons.

– CDBG Insular Areas Program: provides grants to four designated insular areas: American Samoa, Guam, Northern Mariana Islands, and the U.S. Virgin Islands. The grants provide decent housing, a suitable living environment, and expand economic opportunities for low- and moderate-income persons.

– Neighborhood Stabilization Program: provided grants to communities that suffered from foreclosures and abandonment. The grants purchase and redevelop foreclosed and abandoned homes and residential properties. Authorized by Congress 2008 to 2011. No new funding is available.

– Recovery Housing Program: allows states and the District of Columbia to provide stable, transitional housing for individuals in recovery from a substance-use disorder.

– Section 108 Loan Guarantee Program: is the loan guarantee provision of the CDBG Program. It provides communities a source of financing for economic development, housing rehabilitation, public facilities, and large-scale physical development projects.

– State CDBG Program: allows states to award grants to smaller units of general local government. The grants develop and preserve decent affordable housing by providing services to the most vulnerable in our communities and creating and retaining jobs.

CDBG Resources

– Explore

– Find Grantees

– HUD Exchange

– Accomplishment Reports

– Activity Expenditure Reports

– Performance Profiles

5. State Community Development Organizations

States house their community development programs in many configurations – Departments of Community Development, Economic Development, Housing and many combinations. National organizations of state community development agencies include the Council of State Community Development Agencies and the National Alliance of Community Economic Development Associations.

6. Regional Development Organizations (National Association of Development Organizations)

The National Association of Development Organizations (NADO) is a 501c4 membership association that represents the interests of regional community and economic development practitioners. Established in 1967, NADO advocates for federal policies and programs that promote equitable community development, economic competitiveness, rural development, economic mobility, and quality of place. NADO represents a national network of more than 500 Regional Development Organizations (RDOs) across the country.

RDOs are multi-jurisdictional, quasi-governmental organizations that provide regional planning and local community and economic development services.

These organizations collectively assist thousands of cities and counties with community development, economic development, workforce training, transportation planning, public infrastructure, affordable housing, disaster prevention, rural capacity-building, public health, regional planning, and the provision of other community services.

Many RDOs help provide needed services and resources within underserved and rural communities. RDOs also administer a variety of federal, state, and local funds.

RDOs are also sometimes known as “Councils of Government” (COGs), Planning and Development Districts (PDDs), Regional Planning Councils (RPCs), Area Development Districts (ADDs), “Local Development Districts” (LDDs), and others.

Many of these organizations also serve as federally-designated Economic Development Districts (EDDs), a designation given by the U.S. Department of Commerce. Some RDOs also have federal designations given by other federal agencies, including designation by the U.S. Department of Transportation as Metropolitan Planning Organizations (MPOs) or as Regional/Rural Transportation Planning Organizations (RTPOs) that play important roles in regional transportation planning.

Although the work portfolio that an RDO conducts varies from one organization to another, in general, all RDOs facilitate a variety of community services and initiatives designed to bolster economic competitiveness and quality of life.

7. USDA Rural Development and Community Facilities

USDA Rural Development: https://www.rd.usda.gov/about-rd

USDA Rural Development operates over fifty financial assistance programs for a variety of rural applications. You can search from programs at https://www.rd.usda.gov/programs-services

USDA offers loans, grants and loan guarantees to help create jobs and support economic development and essential services such as housing; health care; first responder services and equipment; and water, electric and communications infrastructure.

USDA promotes economic development by supporting loans to businesses through banks, credit unions and community-managed lending pools. They offer technical assistance and information to help agricultural producers and cooperatives get started and improve the effectiveness of their operations.

USDA provides technical assistance to help communities undertake community empowerment programs, and helps rural residents buy or rent safe, affordable housing and make health and safety repairs to their homes.

Each state has a USDA Rural Development Director: https://www.rd.usda.gov/browse-state

USDA Community Facilities Programs

From the USDA website: https://www.rd.usda.gov/programs-services/community-facilities/community-facilities-direct-loan-grant-program

Essential community infrastructure is key in ensuring that rural areas enjoy the same basic quality of life and services enjoyed by those in urban areas. Community Facilities Programs offer direct loans, loan guarantees and grants to develop or improve essential public services and facilities in communities across rural America. These amenities help increase the competitiveness of rural communities in attracting and retaining businesses that provide employment and services for their residents.

Public bodies, non-profit organizations and federally recognized American Indian Tribes can use the funds to construct, expand or improve facilities that provide health care, education, public safety, and public services. Projects include fire and rescue stations, village and town halls, health care clinics, hospitals, adult and child care centers, assisted living facilities, rehabilitation centers, public buildings, schools, libraries, and many other community-based initiatives. Financing may also cover the costs for land acquisition, professional fees, and purchase of equipment. These facilities not only improve the basic quality of life but assist in the development and sustainability of rural America.

USDA Community Facilities Programs

USDA Rural Development Business Programs

+ Rural Health Information Hub (Capital Funding for Rural Health Care)

RHIhub is an excellent resource for all types of rural health information needs.

RHIhub has created a topic section on Capital Funding for Rural Healthcare that gives a comprehensive overview of resources available for rural health: https://www.ruralhealthinfo.org/topics/capital-funding#cdfi

+ Rural Prosperity and Rural Health (Current Publications and Research)

Investing in Rural Prosperity – Federal Reserve Bank, St. Louis

“We believe rural communities are more likely to achieve these and other common community and economic development goals if, instead of focusing on scarcity or on only what they need to bring in from the outside, they build from the inside on the assets they already have. We also believe that rural communities will achieve longer-term, more durable success if they focus not just on the aggregate picture, but on how their development efforts reflect and consider the needs and opportunities of all segments of the community. Because of these beliefs, we think that an asset-based, equitable approach to rural development not only is necessary but will set communities on a course to create broad-based economic prosperity. Our proposed approach is tailored to the specific goals, assets, and organizational infrastructure of the community; designed to be resilient to changing circumstances; intentionally inclusive about who is at the decision-making table and who benefits from local development; and created and carried out through a collaborative process. We call this type of approach the “TRIC” to fostering shared economic prosperity in rural communities.”

Thrive Rural: Connecting Rural Development, Health and Opportunity

Community Strategies Group of the Aspen Institute, University of Wisconsin Population Health Institute, with funding from the Robert Wood Johnson Foundation.

“Two lines of attack are required:

The first is to advocate for flexible, integrated funding streams that encourage and support projects with multiple objectives across economic development and health and connect these funding streams to outcomes outlined in newer frameworks.
The second is to encourage local and regional collaborations across jurisdictions, organizations and functions to share ideas, pool resources, and plan together.”

Build Healthy Places Network: A Playbook for New Rural Healthcare Partnership and Models of Investment:

“This playbook is an action-oriented guide designed for healthcare organizations wanting to pursue partnerships with local community and economic development and other sectors in rural areas and small towns to create the community conditions that support improved community health. After interviewing dozens of experts, we share case studies highlighting core strategies used by rural healthcare entities as example for future multisector partnerships to follow.”

The playbook out lines four broad strategies that the healthcare sector can use to collaborate with cross-sector partners for rural health and prosperity and provides practical steps for implementation, along with case studies.

The strategic areas are:

Strengthening Economic Opportunity and Workforce Support – This strategy deploys economic and workforce development strategies to create stability and increase health outcomes. It includes strengthening local career pathways, healthcare workforce housing for recruitment and retention
Supporting Local Control – Increasingly, rural healthcare is deploying strategies to support community ownership models that help close the racial wealth and health gap.
Strengthening Infrastructure to Support Healthcare Access – This strategy seeks to build and strengthen the infrastructure that supports healthcare delivery and responds to the challenges of physically connecting rural healthcare with those needing services. The work can take several forms, such as collaborating with partners to co-locate services to improve access, supporting community hubs for health, expanding reach through broadband availability, or improving transportation for individuals to access needed services

Increasing Resources – A common strategy for healthcare investment in rural development is increasing access to resources. Successful approaches can include diversifying the funding base and finding innovative resources, such as a hospital’s use of general obligation bonds and loans to fund a New Market Tax Credit allocation Another trend is to donate land to support community-based projects such as affordable or supportive housing. An increasing number of healthcare institutions are reaching out to partners in rural community development that have expertise in creatively deploying capital in support of housing, workforce development, and other issues central to rural healthcare’s impact on community health.

See also these playbooks, available at the same website:

Healthcare Playbook for Community Developers: “This resource guides community developers toward partnerships with hospitals and healthcare systems. Gain practical advice on navigating the vast healthcare ecosystem with your organizational assets in mind. Create your roadmap for partnership today!”

Community Economic Development & Healthcare Playbook: “This action-oriented playbook, developed in collaboration with The National Alliance of Community Economic Development Associations (NACEDA), offers a roadmap for community economic developers and social enterprises to partner with health institutions to create career pathways for residents in low-income neighborhoods & BIPOC communities.”

Population Health in Rural American in 2020, Proceedings of a Workshop, National Academy of Sciences, Engineering and Medicine, 2021

“Rural America is economically, socially, culturally, geographically, and demographically diverse. This multidimensional diversity presents complex challenges and unique opportunities related to delivering health care and improving health outcomes and health equity in rural communities.

To explore issues related to population health in rural America, the Roundtable on Population Health Improvement of the Board on Population Health and Public Health Practice of the National Academies of Sciences, Engineering, and Medicine convened a public virtual workshop, “Population Health in Rural America in 2020” on June 24-25, 2020. The workshop planning committee was composed of rural health experts representing public health, health care, and tribal health. Presentations and discussions focused on rural America in context, rural health vital signs, rural health care in action, assessment and implementation strategies for improving the health and health equity in rural populations, and rural health policy. This Proceedings of a Workshop summarizes the presentations and discussions from the workshop.”

Improving Community Health by Strengthening Community Investment Roles for Hospitals and Health Systems

Center for Community Investment, Initiative for Responsible Investment and RWJF:

“In many places, communities lack a systematic approach to organizing demand for capital, producing the investable opportunities that could put willing capital to work, and creating the conditions to facilitate its deployment.

Often this results from a failure to engage key stakeholders—be they public agencies, employers, or anchor institutions—whose mission is in fact aligned with community objectives.”

Hospitals Aligned for Healthy Communities – Healthcare Anchor Network

“The Hospitals Aligned for Healthy Communities toolkit series is designed to provide hospital and health system leadership and department managers with the steps to begin to harness their everyday operations to drive community health and well-being.

The toolkit series was developed with support from the Robert Wood Johnson Foundation to accelerate a new model in healthcare that builds community health into core business practices.”

Reimagining rural policy: Organizing federal assistance to maximize rural prosperity

Brookings analysis of the 2019 Catalog of Federal Domestic Assistance:

“To be successful, a national rural strategy must embrace diverse rural perspectives while breaking down urban-rural divides by incentivizing regional approaches. An analysis of the impact, constraints, and successes of the seven regional commissions and authorities previously authorized would be a start. Special attention should be paid to addressing power dynamics that have historically excluded groups, and to promoting collaboration with a wide range of partners and intermediaries.

To complement the national strategy and ensure that rural areas have fair access to the federal assistance that can help advance their priorities, we suggest a federal rural audit—a close examination of eligibility, funding formulas, and spending criteria of community and economic development programs, identifying those that disadvantage or create barriers to entry for rural areas.”

What I’m Learning About Equitable Rural/Urban Regional Development

Published on June 28, 2022, LinkedIn, Katrina Badger, MPH, MSW, Program Officer at the Robert Wood Johnson Foundation

Equitable rural/urban regional development is vital to advancing racial, economic and health equity. These are things that cannot be solved in the context of a single community—they must be solved regionally. Moreover, they require narrative change and regional infrastructure, capacity, roles, and incentives.
The problem/solution is bigger than any single entity or person, which stymies action. It is usually nobody’s job to think, convene and plan regionally. Regional development hubs play a critical role, as they are deeply committed to the place and are also able to spread the risk. More infrastructure and capacity support is needed for these key actors.
Regional economic connectivity improves economic growth and equity for rural and urban places.
Micropolitans play a critical role in regional development in significantly rural regions.
Public amenities are highly valued aspects of quality of life, which is a core driver of increased population and employment growth, and decreased poverty rates.
Regional development must proactively address both geographic and racial equity. Regional planning tends to get narrowed to things everyone can agree on. Tricky issues (like racial and geographic equity) are avoided for the sake of progress.
Narrative is a powerful force shaping what people consider possible. “Opportunity” often works; “equity” often does not.
The way forward requires a broader frame at the intersection of health, economic development, community development, and other sectors to reduce silos, diversify who’s at the table, and bring new perspectives together. Community development and economic development must come together—and an orientation around health and wellbeing outcomes enables a focus on person-centered outcomes instead of (or in addition to) traditional economic growth outcomes.
Both bottom-up and top-down change is necessary. There is a need to both build community power and get people in positions of power to be more inclusive and approach equity in more transformational ways.

Valuing Rural Minority Communities: Inclusive growth, broadband, and leadership

Brookings Institute, Makada Henry-Nickie and Regina Seo, August 2022.

From the report: “Several policy-related conclusions emerge from our analysis:

Building institutional capacity: Breaking path-dependent cycles of decline and disinvestment requires creative leaders to be invested in rural minority communities’ value and potential. Because leadership matters, it is pivotal that decision-makers across public, private, and philanthropic networks collaboratively invest and direct institutional resources toward building leadership to implement strategies and experiment with new theories of change.
Infrastructure: Reinforcing the economic environment is critical to attracting incumbent businesses willing to relocate to cheaper housing markets or those searching for places with strategic access to e-commerce distribution nodes and global trade gateways. Fostering the establishment of new firms calls for substantial local investment in broadband technology and complementary infrastructure.
Understanding local competitive advantage: These areas must identify and leverage local natural and human capital resources to enhance economic growth and development in a sustainable fashion. Examples of these assets include regional institutions, natural resources, and historical/cultural attractions.
Demographics: To thrive, it will be vital for these areas to retain young, college-educated workers and to attract prime-age working families. These objectives require job opportunities, affordable housing, and quality investments in community-centric placemaking strategies.
Federal rural development partnership: Federal partnership is essential to institutionalizing prosperity in rural America’s divested places. However, the conventional top-down approach to rural policymaking vested in a single agency is counterproductive. The needs of rural minority communities call for a new partnership model that establishes a whole-of-government rural development mandate and coordinates federal policy across agencies to support and amplify local community development efforts.

This report sheds light on regenerative strategies inspired by a diverse group of individuals committed to their local communities’ vitality. Many approaches are replicable in other contexts and can motivate new ideas or experiments. We encourage readers to critically examine the frameworks we present and to appreciate the tremendous heterogeneity shaping outcomes and trajectories, especially the many ways community leadership manifests in the success stories of rural places.”

+ RHCR 101: Introduction to Rural Health Capital Resources

In this introductory session, participants will learn about the role of organizations that can help fund rural health and community projects like housing, clinics, dental practices, and economic development. Participants will learn how to find and connect with these organizations to achieve rural health capital needs.

View: Webinar Recording

+ Rural Health Capital Resources 101

Unwrap the basics of federal, state, and private sources of capital for rural health and prosperity and learn how capital resources are used in rural settings to achieve community health improvement goals.

View: