The Designation of Rural Areas in California

California Endowment



Case Study Sector


In July 2005, the federal Office of Rural Health Policy (ORHP)—a bureau of the Health Resources and Services Administration (HRSA) within the U.S. Department of Health and Human Services—increased the number of census tracts considered rural within the Rural-Urban Commuting Area (RUCA) classification system. From the perspective of national health policy as a whole, the RUCA redesignation is a minor event. However, the event had significance for a number of rural health care providers across the United States. In California, for example, 18 census tracts in 12 counties were redesignated as rural, making health care providers in these tracts eligible for funding under several federal programs. Also important is the fact that California organizations and their leaders had championed and pursued the change: the California State Rural Health Association (CSRHA) and the California Legislative Rural Caucus. The California Endowment had supported these two organizations and another activity that highlighted California’s rural areas, a National Health Policy Forum (NHPF) “site visit.” The RUCA redesignation process and the Endowment’s indirect role in supporting those who sought the change offers a window into both the policy process and one way that foundations may influence it.

This case study explores the different perspectives of those who were involved in the process and examines potential lessons for foundations interested in policy change.



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