Georgia's Application: Rural Health Needs and Target Population

Rural Health Needs and Target Population

Georgia is proud to introduce the Georgia Rural Enhancement And Transformation of Health (GREAT Health) program. GREAT Health will create stabilizing conditions for long-term success as the state transitions to value-based care across payers and delivery systems via the Achieving Healthcare Efficiency through Accountable Design (AHEAD) model. This significant shift in the delivery of rural health services will foster financial durability for rural health providers and meaningfully improve health outcomes for rural patients. The GREAT Health Program will weave systems reforms, one-time investments, and a shift to valuing health into the fabric of rural communities. GREAT Health impacts will be felt statewide; however, Georgia’s impact is focused on 126 counties and rural portions of counties, as listed in the state map (Attachment C) and county list (Attachment D), as described by the Health Resources and Services Administration (HRSA).

Rural Demographics

Rural communities in Georgia are uniquely positioned to embrace opportunities to improve their health and healthcare delivery systems. Compared to urban counterparts and to the nation as a whole, rural areas have higher rates of poverty (including higher numbers of children living in poverty) (Farrigan, 2016), lower educational attainment, (U.S. Department of Agriculture, 2017), and lower rates of employer-sponsored health insurance (NewKirk, 2014). These factors impact healthcare delivery and rural Georgians’ access to care. Specifically, the state has a rural population of 2.4 million and a rural population density of 55 residents per square mile (590 nonrural) (National Institute on Minority Health and Health Disparities, 2025); the poverty rate in rural communities is 19% (13% nonrural and 14% statewide), and 16% of Georgia’s rural residents have not graduated from high school (10% nonrural) (U.S. Department of Agriculture, 2025). Rural areas in Georgia have a higher proportion of uninsured residents compared to nonrural areas (14% of rural residents are uninsured versus 12% nonrural) (National Institute on Minority Health and Health Disparities, 2025). Rural Georgians experience additional economic disadvantages that affect their ability to maintain health and wellbeing. Despite a rural unemployment rate of 3.3% in 2023 (3.2% for non-rural areas), per capita income was lower in rural areas ($45,276 for rural versus $62,787 for nonrural) (United States Department of Agriculture, 2025). The service industry employs more people than any other sector in rural Georgia, collectively employing five times more people than the next highest sectors of manufacturing, healthcare, retail, and food services/hospitality (Georgia Department of Labor, 2025).

Health Outcomes

The fragile systems of care and provider shortages in rural Georgia have directly impacted the lifespan of rural Georgians. There are no obstetrician-gynecologists in 82 of Georgia’s 159 counties and 63 counties had no pediatricians in 2024 (Georgia Board of Health Care Workforce, 2024). There are no birthing facilities in 108 of Georgia’s 126 HRSA-designated rural counties/portions of counties (Georgia Department of Public Health, 2025). As rural residents grow into adulthood, they are more likely to die from heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke than their urban counterparts (Garcia, 2017). Georgia’s all-cause mortality (2019-2023) was 1,048 per 100,000 people in rural areas compared to 854 per 100,000 in nonrural areas (National Institute on Minority Health and Health Disparities, 2025). The same trend was seen for health conditions:

  • Major cardiovascular diseases: 12,200 per 100,000 population in rural versus 8,300 nonrural (Institute of Public and Preventive Health, 2025)
  • Cancers: 481 per 100,000 population in rural versus 469 statewide (Georgia Rural Health Innovation Center, 2025a)
  • Suicide: 19 per 100,000 population in rural versus 15 nonrural (Georgia Rural Health Innovation Center, 2025a)

For older adults in rural communities, 188,300 individuals over 65 are living with Alzheimer’s or another type of dementia. Older adults in rural areas face serious gaps in care, with dementia diagnoses often delayed and services fragmented—driving avoidable hospitalizations (1,573 ED visits per 1,000 people with dementia in 2018), avoidable hospital readmission rates (22.5% for dementia patients in 2018), and higher Medicaid costs (Alzheimer’s Association, 2025). The AHEAD model presents an opportunity to develop a cohesive plan to combat the growing incidence of chronic conditions and population needs for more integrated and coordinated care.

Healthcare Access

Fifty-three rural Georgia counties do not have a hospital, creating significant time and distance barriers to accessing care (Georgia Rural Health Innovation Center, 2025b).

Georgia currently has 93 rural hospitals—defined as located in a rural county or meeting rural-specific Centers for Medicare & Medicaid Services (CMS) definitions—including 30 Critical Access Hospitals, 36 rural Inpatient Prospective Payment System hospitals, and one rural emergency hospital. In addition to hospitals, rural residents rely heavily on Federally Qualified Health Centers (FQHCs), rural health centers, and Rural Health Clinics (RHCs) for clinical care. There are 21 FQHCs that operate one or more clinics per organization, providing healthcare services in 100 rural counties, and 98 RHCs provide services in 58 of 126 rural counties (Georgia Primary Care Association, 2024). These examples represent opportunities to expand general and specialty care that rural Georgians need for meaningful healthcare integration.

A clear example of limited access to care for many rural communities is evident in the central and southwestern areas of the state where several rural counties rely heavily on a limited number of FQHCs and local emergency medical services (EMS) to provide routine and urgent medical care. Primary care providers are also limited in Georgia, with 41 rural counties having no internal medicine physicians and 19 counties with no family medicine physicians in 2024 (Georgia Board of Health Care Workforce 2024).

Rural Facility Financial Health

Over the last twenty years, rural healthcare entities have faced financial uncertainty leading to facility closures or reduced bed counts. Overall, total rural set up and staffed beds decreased from 4,972 in 2001 to 3,236 in 2024— a net reduction of 1,736 beds or roughly 35%. Georgia rural hospitals see 35 emergency department visits per 100,000 people compared to 26 per 100,000 people for nonrural areas. Inpatient admissions from emergency departments are also higher for rural communities (38% versus 21% for nonrural) (National Institute on Minority Health and Health Disparities, 2025).

Conclusion

With this context in mind, the proposed GREAT Health Program was developed to address the five overarching Rural Health Transformation Program (RHT Program) strategic goals and the GREAT Health Program’s vision of transforming health for rural populations, in rural places, for rural progress. These strategies work in concert with the future shift to the AHEAD model requirements and improved health outcomes tied to risk. Georgia will use this funding opportunity to improve the health of its residents in the 126 HRSA-designated rural areas, making rural communities more conducive to improved collective wellbeing. The implementation of the RHT Program has been carefully planned in response to the realities of rural Georgians’ health needs and the infrastructure, workforce, and service gaps. Stakeholders across Georgia are ready to embark on the mission to uplift rural areas of the state to meet their potential and make Georgia a leading example of rural health innovation and transformation.