Rural schools and hospitals are trying to staff up even as they face a number of other significant challenges, government officials and policy groups told members of a House Appropriations Committee panel on Wednesday.

Schools serving remote populations are short-staffed but have trouble recruiting and retaining teachers, Education Department official Ruth Ryder told lawmakers. Students also face barriers such as inadequate internet service, and absenteeism has doubled over the past year.

At the same time, more than 147 rural hospitals facing low patient volume and high fixed costs have closed since 2010, leaving some rural residents with challenges accessing nearby care, Department of Health and Human Services official Thomas Morris said.

The hearing before the departments of Labor, Health and Human Services, Education, and Related Agencies Subcommittee covered a range of issues facing rural areas, including access to healthcare, education and employment in remote and low-population areas.

Ryder, the deputy assistant secretary for policy programs at the Education Department’s Office of Elementary and Secondary Education, said most schools reported starting the school year short-staffed, especially when it comes to special education personnel. She told lawmakers that the nation had 130,000 fewer teachers after the pandemic than it did before, building on already existing deficits.

“We know there were shortages before the pandemic and our schools still have a long way to go before they’re fully staffed,” Ryder said.

Special education teachers are in especially short supply, according to Brittany Hott, an associate professor at the University of Oklahoma. Hott cited data from the National Coalition on Personnel Shortages showing that 98% of school districts in the U.S. lack a full complement of special education teachers, which she said makes it difficult for schools to provide early intervention services. 

“I have districts that do not have a special education teacher, no counselor, no school psychologist and no social worker,” she said. “There are waiting lists of children to be evaluated for special education of over a hundred students.”

Hott suggested that the committee increase funding for both the state grant and personnel preparation programs offered through the Individuals with Disabilities Improvement Act. 

Morris, who serves as the associate administrator in the HHS Office of Rural Health Policy, said rural residents account for just 19% of the nation’s total population while spanning 86% of its landmass. In addition, rural areas have higher proportions of uninsured patients than urban areas, and many rural residents are “heavily dependent” on Medicare and Medicaid. 

The Biden Administration’s 2024 budget request does include $30 million for supporting rural hospital facilities, Morris said. Approximately $10 million of these funds are going to help rural hospitals at imminent risk of closure, while $20 million is for startup funding to help rural hospitals expand to provide additional services like pulmonary rehab, cardiac rehab and cancer services, he said.

Morris also said the budget includes $145 million for its Rural Community Opioids Response Program, which provides rural communities with funds for opioid addiction prevention, treatment and recovery. 

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Carrie Cochran-McClain, the chief policy officer for the National Rural Health Association, urged Congress to continue to provide $73 million for the Health Resources and Services Administration’s Rural Hospital Flexibility Grants for struggling hospitals. She also asked them to support the Biden administration’s $30 million budget request for rural hospital facilities. 

Rural hospitals also face workforce shortages, Morris said. According to the Health Resources and Services Administration, rural areas account for 66% of the primary care health professional shortage. 

Morris said his department was hoping to help bolster rural physician numbers by using Rural Residency Planning and Development Grants, which have created rural residencies in 32 states. 

“Research shows shows that if we can expose students to rural training during their practice, they are more likely to practice there,” Morris said. “That’s certainly true for family medicine.”

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