How States Are Integrating Child Care Into Rural Health Transformation

In Kansas and across much of the country, where families live profoundly shapes their access to child care, education, health care, employment and other basic needs. An extensive body of research documents disparities in access to services between rural and urban areas.

Most efforts to address these challenges focus on a single sector at a time. Increasingly, however, communities are exploring coordinated, cross-sector approaches that address multiple needs simultaneously. One emerging example is the Rural Health Transformation Program, a landmark $50 billion federal initiative administered by the Centers for Medicare & Medicaid Services (CMS) to support state-driven efforts to transform rural health care. All 50 states are receiving CMS funding, creating 50 potential "laboratories for innovation," according to Kate Sapra, deputy director of the CMS Office of Rural Health Transformation, who spoke at the recent National Rural Health Association Annual Conference. Sapra noted that several states proposed strengthening rural health care through multisector approaches and said she was "particularly intrigued" by efforts to improve access to child care as part of broader strategies to stabilize and strengthen rural health care systems.

Staff at the Center for Public Partnerships and Research (CPPR) recognized that no systematic summary existed of how states planned to use Rural Health Transformation Program funding, including efforts to strengthen child care infrastructure. Given CPPR's work across sectors to help communities build capacity to support children and families, staff conducted a systematic review of state Rural Health Transformation Program proposals to identify which states incorporated child care strategies and what interventions they proposed.

Associate Researcher Senior Chris Tilden said, "We found that about 10 states proposed addressing child care in some way through their Rural Health Transformation Program-funded efforts."

Most states frame child care as a workforce recruitment and retention strategy, recognizing that attracting rural health care professionals can be difficult when adequate child care is unavailable. Most proposed interventions focus on financial incentives, such as child care stipends, to support recruitment and retention. A smaller number of states propose capital investments in child care facilities or partnerships with existing child care providers. None of the proposals reviewed appear to align rural health care transformation efforts with existing early childhood systems-building initiatives, including those supported by the Administration for Children and Families through the Preschool Development Grant Birth Through Five program.

Read the full CPPR analysis.