Preparing rural health leaders for immigration policy shifts

For rural health leaders, every policy change has an outsized impact. In communities where the local clinic or hospital may be the only health care provider for miles, federal changes to immigration-related eligibility for public health benefits can quickly cascade into operational, financial, and community trust challenges.

The U.S. Department of Health and Human Services recently announced upcoming restrictions on access to certain federal public health benefits for individuals with an Unsatisfactory Immigration Status designation. While the policy targets specific populations, the ripple effects go well beyond.

Many patients, especially agricultural and manufacturing workers, may delay or avoid care due to confusion or fear about eligibility. For example, among low-income immigrants in California, approximately 14 percent reported avoiding public programs in the past year due to concerns about harming their immigration status,[1] and those individuals had more than twice the odds of delaying needed medical care or prescription refills. On the provider side, rural hospitals and clinics face growing uncompensated care burdens when uninsured patients present in crisis and may suffer staffing shortages if immigrant health care workers lose eligibility for certain benefits.

Programs potentially affected by these policy changes

• Facilities designated as Certified Community Behavioral Health Clinics, often the only behavioral health resource in rural counties
• The Community Mental Health Services Block Grant program
• Facilities designated as Community Health Centers, which are essential for migrant and seasonal farmworkers
• Health workforce programs, a key pipeline for rural providers
• Services administered by the Substance Abuse and Mental Health Services Administration
• Title X family planning
  
  

Leadership actions for rural executives

• Conduct a rapid impact assessment with your leadership team to identify operational and financial risks related to UIS policy changes.
• Coordinate with legal advisors to identify necessary updates to patient screening or data collection.
• Develop an internal communication brief and FAQs to provide frontline staff with consistent messaging.
• Engage your board and key stakeholders early to maintain transparency and build trust.
• Collaborate with state hospital associations or peer organizations to advocate for clarity and equitable policy implementation.
  
  

Strategic communications in rural communities

• Educate local partners such as churches, agricultural co-ops, and school districts.
• Engage trusted messengers like local doctors, hospital CEOs, or community board members.
• Speak plainly by avoiding jargon when discussing eligibility changes.
• Prepare your team. Rural staff often wear multiple hats and need clear guidance.
• Lead with clarity and consistency while balancing compliance, care delivery, and community engagement.
  
  

For rural health systems, leadership goes beyond managing operations to building and maintaining trust. Proactive communication combined with strategic planning helps organizations navigate policy changes without compromising patient care or community confidence.

Helping rural health systems thrive

America has a long history of welcoming immigrants into rural communities, especially in health care, where physicians and nurses from around the world have long histories of working in, living in, and becoming pillars of small towns.

Every problem faced by urban health care administrators and clinicians is mirrored in rural communities and often amplified. Workforce issues top the list, as reliance on travel nursing stretches already limited rural hospital budgets. According to the Advisory Board, demand for travel nursing was up 284 percent in 2023. The average pay for nurses in rural hospitals was around $1,200 per week, while travel nursing agencies advertised rates up to $5,000 and in some cases $9,562 per week. Hospitals must pay multiples of these rates.

Meanwhile, supply chain issues are worsening because of tariffs and rising transportation costs for delivering supplies, pharmaceuticals, and equipment to hospitals. Regarding transportation, rural patients encounter significant barriers, as they have fewer public transportation options than those in urban areas.

Welcoming immigrants and developing strong training programs in rural health care facilities can help address workforce shortages and stabilize families. Immigrant workers play a vital role in addressing these challenges, helping to control health care costs by filling critical roles that would otherwise require costly temporary staff, keeping supply chains moving through work in local manufacturing and food service, and sustaining transportation networks that patients and providers rely on.

Economic stability, supported in part by revitalizing our rural tradition of welcoming new immigrants, is crucial for sustaining the rural health care infrastructure.

What can rural health care executives do today?

• Coordinate with state officials, faith-based organizations, and local educational institutions like community colleges and residency programs to create job training and re-licensure pathways for newly arriving immigrants.
• Highlight the contributions of immigrant communities and the richness of a diverse health care workforce.
• Identify a community leader or partner such as a mayor, commissioner, or business owner to champion efforts that integrate immigrants into the local health care ecosystem as patients, staff, and trainees.

Rural health leaders have always known how to innovate under pressure. By investing in people through trust, inclusion, and strategic partnerships, we can transform moments of uncertainty into long-term resilience.

NRHA adapted the above piece from Health Management Associates, a trusted NRHA partner, for publication within the Association’s Rural Health Voices blog.
 

About the author: As managing director of delivery systems at Health Management Associates, Warren Brodine leads major project development, oversees large-scale contracts, and advises teams on efficacy and quality. With nearly 30 years of experience with safety-net health care, Warren Brodine partners with governments, communities, federally qualified health centers, hospitals, and payors to improve financial performance, patient care, and community health—driving innovation while ensuring long-term sustainability.

Sources

[1] National Library of Medicine - Association of California Immigrants' Avoidance of Public Programs Due to Immigration Concerns With Delayed Access to Health Care: https://pmc.ncbi.nlm.nih.gov/articles/PMC9856315/