Charleston Leader

On May 23, 2024, U.S. Senators Shelley Moore Capito (R-W.Va.) and Joe Manchin (D-W.Va.), alongside U.S. Representatives Carol Miller (R-W.Va.) and Alex Mooney (R-W.Va.), addressed a letter to Health Resources and Services Administration (HRSA) Administrator Carole Johnson. The letter advocates for the inclusion of terrain factors in HRSA's definition of rural areas, which influences eligibility for federal healthcare resources.

"West Virginia is the only state that lies completely within the Appalachian Mountain region. It also has a higher mean elevation than any state in the east," the lawmakers stated. "We appreciate HRSA’s work to better account for difficult and mountainous terrain areas in the definition of rural for purposes of Federal Office of Rural Health Policy (FORHP) grant eligibility."

The legislators emphasized that incorporating ruggedness into HRSA's criteria would ensure that West Virginia communities receive appropriate federal funding. They highlighted that many critical health providers in West Virginia are currently classified as urban due to existing definitions, rendering them ineligible for necessary FORHP grants.

Since Fiscal Year 2020, Congress has directed the United States Department of Agriculture Economic Research Service (USDA ERS) to collaborate with FORHP to identify challenging terrains for rural health grants eligibility. In August 2023, USDA ERS released a report detailing new measurements—Area Ruggedness Scale (ARS) and Road Ruggedness Scale (RRS)—to represent relative topography.

The lawmakers noted that West Virginia has a significant portion of its population living in rugged areas: "For comparison, West Virginia has the largest share of residents living in a rugged area, with 80.7% of the population living in a rugged area and 15% in a highly rugged area."

The letter proposed extending HRSA's current proposal to include census tracts with high densities of RRS 3-5 within counties located in Metropolitan Statistical Areas but with fewer than 50,000 individuals or 12 or fewer census tracts.

"We feel this critical addition to HRSA’s proposal to include terrain factors in their definition of rural to be eligible for FORHP grants is important to better capture rugged terrain areas," they wrote.

The proposed changes aim to extend eligibility to an additional 139 census tracts and approximately 543,538 people, marking an increase of less than one percent but potentially having a significant impact on regions like Appalachia.

"We urge you to take Congressional intent into account and adopt our suggestion to address high density of rugged areas," concluded the lawmakers.