State Office of Rural Health: For rural, by Rural

The State Office of Rural Health (SORH) program helps to ensure access to quality health care for our rural residents. The SORH concept was an innovation created by rural states. In 1973, North Carolina started the first State Office of Rural Health, with other states following during the 70’s and 80’s, including Oregon, Wisconsin, Nevada, North Dakota, Arizona, and Georgia. In the late 80’s, existing SORHs worked with the Federal Office of Rural Health Policy to develop a State Office of Rural Health grant program that was authorized and funded in 1991. Today, every state has a SORH working to strengthen rural health care delivery systems.

SORHs play a vital role in improving health care access and outcomes for rural populations. In creating the SORH grant program, the federal government implemented a 3:1 state to federal match, resulting in a substantial return on investment and commitment from the states. With significant state contributions in SORHs, each state is able to determine the best structure to fit their rural health environment. While their exact structure can vary by state, they follow a similar framework under guidance from the Federal Office of Rural Health Policy. This variability has provided SORHs with the flexibility to address ongoing rural health care challenges in their respective states and serve as a key resource of federal and state-level rural health programs that address the unique challenges faced by rural communities.

Nationally, there are three SORH models:

State Government-based SORH – The most common SORH structure, offices can reside in the state’s Department of Health & Human Services, public health agencies and even the Department of Agriculture (Texas). There are currently 34 SORHs located within the state government structure. 

University-based SORH - Often located in a medical school or school of public health, there are currently 13 University-based SORHs. 

Stand-alone SORH - Currently 3 SORHs are operating under this non-profit organization structure. 

Regardless of the SORH program model in each state, they all have a shared mission to be anchors of information and to provide technical assistance and support for rural health facilities, providers and their communities, serving as the backbone of rural health coordination within their respective states. SORHs are the foundational structures that enable rural facilities to access important programs like the Medicare Rural Hospital Flexibility Program (Flex), which supports rural hospital financial and operational stability, quality improvement, EMS and veteran health. Further, SORHs support programs that focus on workforce development, access to primary care, and education. 

All SORH programs must conduct activities in three focus areas:

Information collection and dissemination: Rural providers are often short-staffed with limited resources and capacity to keep up with important information from various state and federal regulatory bodies, payer organizations, public health agencies, and other important stakeholders. By analyzing and disseminating pertinent information, SORHs help ensure rural providers and facilities stay current on important information and in compliance with rules and regulations.

Rural health care coordination: There are often numerous organizations working to address important issues in rural communities, such as chronic disease, maternal health, and substance use disorder. The SORHs assist in identifying independent programs and initiatives aimed at the same goals and help to bring them into alignment and coordination to increase efficiency and reduce duplication of services. 

Technical assistance: SORHs provide a vast array of technical assistance to rural providers and facilities, tailored to meet the needs of their unique communities. Technical assistance can include training for rural hospitals, clinics, and other rural providers in a variety of areas, including establishing new rural health clinics, implementing and optimizing telehealth, and managing effective practices. SORHs may also provide grant support, assist in preparing for site surveys, or help ensure that the state maintains a coordinated approach to rural health emergency planning and response. 

The network of SORHs collaborate not only in their state, but also regionally and nationally. The National Organization of State Offices of Rural Health (NOSORH) was established in 1995 to enhance the capacity of SORHs in their efforts to improve access to and quality of health care. NOSORH supports the development of state and community rural health leaders, advocacy, education, and partnership among rural health constituents. NOSORH has facilitated networking and collaboration through regional conferences and meetings in recognition that health needs vary not only state by state, but also regionally.

Through a combination of grants, training opportunities, policy guidance, and strategic technical assistance, SORHs provide indispensable support for America’s rural health system. Continued support for the SORH program is essential to supporting our rural communities.

For more information on the SORH program, visit NRHA's Farm Bill advocacy priority area and the NOSORH website.