October 2025

Policymakers can explore various opportunities to promote care across the care continuum — such as home-based care, chronic disease management, and caregiver support — while addressing persistent rural resource barriers like workforce shortages, lack of transportation, and limited specialty care access. Key areas to consider include:

• Expand home- and community-based care models. States can strengthen rural health infrastructure by investing in innovative care models such as PACE, community paramedicine, and palliative care — particularly those that require upfront capital. Federal funding opportunities, including the Rural Health Transformation (RHT) Program established by the 2025 budget reconciliation bill, can help support these efforts. With $50 billion allocated over five years, RHT funds may be used to launch or expand home- and community-based care models that improve access and outcomes in rural communities. States can also work within their delivery system landscapes to identify opportunities, for example partnering with Medicaid managed care organizations or larger health systems in the state to support expansion of innovative models in rural areas.
• Strengthen rural health workforce to utilize skills of trained and non-traditional providers. Providers highlighted in these models, including paramedics, primary care providers, and nurses, serve as key connections to this population that experiences social isolation. Non-licensed providers, such as community health workers, can also be included in the multidisciplinary teams that are a key feature of these care models.
• Formalize cross-system collaboration with engaged care partners. Rural communities often face resource constraints, including limited funding and personnel. The models in this Collection highlight collaboration between primary care, emergency medical services, community-based organizations, and other care providers that have traditionally operated in silos. Policymakers can formalize these partnerships through local Multisector Plans for Aging or other agreements focused on older adult care.
• Encourage outcomes measurement and evaluation to build rural care evidence base. Many resources in this Collection highlight the lack of rigorous evidence for older adult care models in rural settings. This gap presents an opportunity for states to adapt care models to fit local needs while prioritizing measurement of short- and long-term health outcomes — such as utilization of high-cost care, management of chronic conditions, and cost savings for payers and programs.