What Are Rural Health Clinics, and How Much Do Services Cost?
Key takeaways:
Rural health clinics (RHCs) provide primary care, lab services, and hospice care in designated rural areas.
Anyone can go to an RHC — even if you don’t have health insurance. They don’t provide free healthcare, but some patients may not have to spend out of pocket for services.
Some RHCs provide outpatient dental, mental health, and behavioral health services.
The rural U.S. faces unique healthcare challenges. About 20% of Americans live in rural areas, but only 11% of all doctors practice in them.
Since the rural health clinic (RHC) program started in the late 1970s, RHCs have tried to fill the need for primary and preventive healthcare for people living far from resource-rich city centers. There are now about 4,700 RHCs across the nation.
Below, we break down what rural clinics offer, how they’re different from other kinds of health centers, and what you can expect to pay for their services.
How do rural health clinics work?
RHCs differ from federally qualified health centers (FQHCs) such as community health centers (CHCs). They don’t have to use a sliding-fee scale for payment, offer emergency services, or have minimum hours of operation.
RHCs must be staffed at least 50% of the time with a non-physician provider such as a:
Nurse practitioner (NP)
Physician assistant (PA)
Certified nurse midwife (CNM)
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Medical visits can take place at:
The clinic
A patient’s home
An assisted living facility
A skilled nursing facility
An accident scene
A rural clinic can be a public, nonprofit, or for-profit healthcare facility. These are called independent clinics. Some RHCs are owned by hospital systems, known as provider-based clinics.
RHCs must provide primary and preventive care and basic lab services. Some include specialties such as pediatric or OB/GYN facilities. Anyone can go to a clinic regardless of insurance or immigration status.
Many RHCs provide outpatient mental health, behavioral health, and hospice services. Some offer visiting nursing services for homebound people. They are required to have medication and biologicals on site to treat patients.
They don’t provide free healthcare, but many offer sliding-scale discounts.
About two-thirds of RHCs offer language interpretation services. A 2019 survey of RHC patients found more than half of them lived within 10 miles of a clinic.
Funding rural clinics
RHCs receive funding from the federal government and grants, but the clinics face ongoing funding shortfalls.
“With an aging rural population and lower reimbursement from Medicare and Medicaid, the financial model is difficult,” Michelle Mills, chief executive officer of the Colorado Rural Health Center, wrote in an email to GoodRx Health.
Paying for care at an RHC
RHCs accept coverage such as private insurance, Medicare, Medicaid, and Children’s Health Insurance Program (CHIP). But you don’t need insurance to get care at an RHC.
The average fee per visit can run from $130 to $600 before discounts or insurance, Mills said. In 2014, patients at 1,555 independent RHCs paid a mean out-of-pocket cost of about $36 per visit. Currently, RHCs are reimbursed from Medicare at $113 per patient encounter.
The importance of Medicaid in rural areas
Medicaid is important to expanding care in rural areas, where many people are uninsured. Medicaid coverage in rural areas went up since the Affordable Care Act passed, rising from about 12% in 2010 to 17% in 2019.
As of March 2022, 12 states hadn’t expanded their Medicaid programs. In rural areas of those states, coverage barely changed, going from 20% in 2013 to 21% in 2015. By contrast, Medicaid in rural areas of states that did expand saw coverage grow from 21% to 26% between 2013 and 2015, the Kaiser Family Foundation reported.
Adults under age 65 in rural states that didn’t expand Medicaid were twice as likely to be uninsured than those in states that expanded Medicaid. More than 440,000 uninsured adults in rural areas would be eligible for coverage if Medicaid expanded in the remaining states, according to a U.S. Department of Health and Human Services (HHS) report.
Who can receive care at a rural health clinic?
Anyone can receive care at an RHC, whether they have insurance or not.
People without housing can go to RHCs. Veterans may be able to use their VA benefits at RHCs if they meet certain criteria.
RHCs may not be as flexible as traditional medical centers in urban areas, but they do offer some flexibility. More than half of RHCs have night and/or weekend hours. About 87% accepted walk-ins.
Here’s a sample of the types of health insurance people had in rural areas:
From 2013 to 2017, about 15% of people under age 65 in nonmetropolitan areas were uninsured, about 58% had private insurance, and about 27% had public insurance (Medicare, Medicaid or VA benefits).
About 1 in 4 people under age 65 used Medicaid at RHCs.
What healthcare services are offered at rural health clinics?
RHCs must provide preventive and primary care services. This includes:
Yearly checkups
Cancer screenings
Basic laboratory testing (bloodwork and urine tests)
Some RHCs only provide specialized care like prenatal or pediatric services. Other RHCs offer dental care, behavioral health services, or mental health services. They don’t have to provide urgent care or pharmacies but must have medications and biologicals to treat in-office needs.
If your issue can’t be treated at the rural clinic, the RHC will refer you out for care. They must have a partnership with one or more nearby hospitals to provide a medically necessary service that’s not available at the clinic.
The role of telehealth at rural clinics
In recent years, efforts continue to add behavioral and mental health services to more RHCs. Internet connectivity in rural areas remains a challenge.
Telehealth changed mental and behavioral healthcare at RHCs. A 2019 survey found that 43% of RHCs used telehealth prior to the pandemic. At that time, RHCs could only bill Medicare for telehealth services if the patient went to a clinic for a phone or video visit with a remote provider, explained Karen Davis, a spokesperson with the Rural Health Information Hub, via email.
The Coronavirus Aid, Relief, and Economic Security (CARES) Act expanded care. Through the end of the official public health emergency, RHCs can receive Medicare reimbursement for telehealth visits at the same rates they are paid for in-person health services.
“RHCs will continue to offer some level of telehealth moving forward, but much depends on Congress passing a bill that allows the RHCs to continue [offering expanded telehealth],” Mills noted.
Rural clinics’ role in hospice care
RHCs can be a source for end-of-life care, too. Starting in 2022, RHCs can receive payment for hospice attending physician services provided by an RHC physician, NP, or PA. Services can take place at:
Freestanding Medicare-certified hospice facilities
Hospitals
Skilled nursing facilities
Accident scenes
The patient’s home
Is it free to go to a rural health clinic?
RHCs do not provide free healthcare; the services have set fees. Some people may get a discount if the clinic has a sliding scale. Others may have all service fees covered, depending on their health insurance.
Many RHCs have a discount program or sliding-scale payment structure. This means you pay an amount based on your income and family size. RHCs are not required to have a sliding-scale program.
The government funded COVID-19 testing at RHC locations. In 2021, the HHS announced they would fund free at-home tests at RHCs.
Can you receive dental care at a rural health clinic?
Some RHCs offer dental care, but they are not required to do so. If they don’t offer it, RHCs likely can connect you to resources for low-cost dental care.
Rural health dental clinics provide services such as:
Routine cleanings
X-rays
Fillings
Dentures
Tooth extraction
In some cases, dentists or dental students may donate their services.
How can you find a rural health clinic near you?
Use the Health Resources and Services Administration’s (HRSA) online tool to find a rural health clinic. Search “all HRSA facilities” and then check off a box for “rural health clinic.” Or check out your state association.
If you live in a rural area and need inpatient care, what are your options?
If you go to an RHC first, and they determine you need inpatient care, they can refer you to a specialist or local hospital. They may refer you to a designated rural hospital.
The bottom line
Rural health clinics operate in designated rural areas. You can receive primary care services and lab services, including hospice care, at RHCs. Some rural clinics offer dental, mental health, and behavioral health services. They take health insurance, but you don’t need coverage to go to an RHC. They don’t provide free healthcare, but some may offer a sliding-fee scale for people who are uninsured. Those with Medicaid for health insurance may not have any out-of-pocket costs, depending on their local program.
Why trust our experts?
References
Assistant Secretary for Planning and Evaluation. (2021). Access to affordable care in rural America: Current trends and key challenges.
Centers for Medicare & Medicaid Services. (2021). Calendar year (CY) 2022 Medicare physician fee schedule final rule.
Centers for Medicare & Medicaid Services. (2021). CMS manual system.
Centers for Medicare & Medicaid Services. (2021). Update to rural health clinic (RHC) payment limits.
Centers for Medicare & Medicaid Services. (2021). Virtual communication services in rural health clinics (RHCs) and federally qualified health centers (FQHCs): Frequently asked questions.
Centers for Medicare & Medicaid Services. (2021). Medicare benefit policy manual chapter 13 - Rural health clinic (RHC) and federally qualified health center (FQHC) services.
Centers for Medicare & Medicaid Services. (2022). New & expanded flexibilities for RHCs & FQHCs during the COVID-19 PHE.
Centers for Medicare & Medicaid Services. (2022). Rural health clinic.
Colorado Rural Health Center. (n.d.). Home.
Day, J. C. (2019). Rates of uninsured fall in rural counties, remain higher than urban counties. U.S. Census Bureau.
Foutz, J., et al. (2017). The role of Medicaid in rural America. Kaiser Family Foundation.
Gale, J., et al. (2010). The provision of mental health services by rural health clinics. Maine Rural Health Research Center.
Health Resources and Service Administration. (n.d.). HPSA find.
Health Resources and Service Administration. (2004). Starting a rural health clinic - A how-to manual.
Health Resources and Service Administration. (2006). Comparison of the Rural Health Clinic and Federally Qualified Health Center Programs.
Health Resources and Service Administration. (2022). Rural health clinics and federal office of rural health policy (FORHP) rural health areas.
HHS.gov. (2021). HHS provides $424.7 million to rural health clinics for COVID-19 testing and mitigation in rural communities.
Hinkle, L. E., et al. (2017). Behavioral health issues for rural health clinics. Kentucky Office of Rural Health and UK Center of Excellence in Rural Health.
Kaiser Family Foundation. (n.d.) Number of Medicare certified rural health clinics.
Kunz, S., et al. (2019). Immigrant health policy paper. National Rural Health Association.
Lahr, M., et al. (2019). Access and capacity to care for Medicare beneficiaries in rural health clinics. University of Minnesota Rural Health Research Center.
Li, L., et al. (2021). Sources of insurance coverage in nonmetropolitan areas: The role of public and private insurance since 2009. RUPRI Center for Rural Health Policy Analysis.
National Association of Rural Health Clinics. (n.d.). Home.
National Association for Rural Health Clinics. (2021). American Rescue Plan provides $9 billion for rural providers.
National Association of Rural Health Clinics. (2021). Biden administration announces plans to distribute free at-home COVID testing kits through RHCs.
National Conference of State Legislators. (n.d.). Meeting the primary care needs of rural America: Examining the role of non-physician providers.
National Rural Health Association. (2014). Rural health clinics.
Rural Health Information Hub. (n.d.) Dental clinic model.
Rural Health Information Hub. (n.d.). People experiencing homelessness.
Rural Health Information Hub. (2022). Rural hospitals.
Rural Health Information Hub. (2021). Rural veterans and access to healthcare.
Rural Health Information Hub. (2022) Rural health clinics (RHCs) – Funding & opportunities.
Rural Health Information Hub. (2022). Rural hospitals.
Schulte, A. R. (2019). Cost-sharing as a barrier to accessing care at FQHCs and RHCs for rural Medicare beneficiaries. North Carolina Rural Health Research and Policy Analysis Center.
U.S. Department of Veteran Affairs. (2019). Veteran community care.
