The California State Rural Health Association, a unifying voice for the state's disparate rural health care providers for almost two decades, has laid off staff and closed its Sacramento office.
The 16-member board of directors hopes to keep the trade association alive and active, "but it's becoming more difficult in this environment," said Dave Jones, president of the volunteer board.
"We ran out of funding. That's pretty much it in a nutshell," Jones said. "It's not because of sequestration or changes because of health reform. Our revenues, which mostly come from private foundations, just won't support an office and staff anymore."
The association's Sacramento office has been the center of rural health advocacy in California for more than a dozen years. Its closure leaves a hole that will be hard to fill.
"We're looking for ways to keep an active voice in policy issues, and for now we're going to have to do that through regional groups like Health Alliance of Northern California and Redwood Community Health Coalition and other groups," Jones said.
Three employees were laid off when the not-for-profit organization closed its only office Feb. 15. The association, which began as an informal gathering of regional groups in the early 1990s, incorporated in 1995. It has made no public announcement. Changes are not mentioned on the CSRHA website.
"We're trying to figure out what to say," Jones said. "We'll have something on the website soon."
Jones -- no relation to state Insurance Commissioner Dave Jones -- is CEO of Mountain Valleys Health Centers in Lassen, Shasta and Siskiyou counties.
'Leaves a Void at Statewide Level'
"This definitely leaves a void at the statewide level," said Steve Barrow, who served as the association's executive director from 2010 until last month. Before that he was the association's director of policy.
"There are lots of groups representing regional rural health constituencies out there -- clinics and doctors and some social advocacy groups. But most of them are siloed, and they don't really have a lot of cross-pollination."
Carmela Castellano-Garcia -- president and CEO of the California Primary Care Association, which oversees more than 800 clinics -- said the timing is particularly bad for the closure. In addition to policy changes from the Affordable Care Act, rural health delivery is undergoing profound changes from telemedicine and other new technologies.
"This is a really important time for rural health with reform changes and managed care expansion into rural counties and everything else that's going on. It's critical that the rural constituency have a voice in Sacramento. I hope they can regroup and get something else going," Castellano-Garcia said.
"I'm pleased that we have vibrant groups like Health Alliance and others, but not having a statewide presence in Sacramento is a loss to our community," Castellano-Garcia said.
State officials who called the closure "unfortunate" said the California State Office of Rural Health will continue to work with other industry partners and to provide information directly to rural providers.
The association's "several hundred" members pay annual dues ranging from $15 for students to $1,265 for large organizations. Foundations and corporate sponsors supply the majority of the organization's revenue through grants. In addition to policy advocacy, the association organizes events and workshops around the state.
California HealthCare Foundation, which publishes California Healthline, has made grants to California State Rural Health Association but is not considered a major funder of the organization, according to foundation officials.
Requests for comments from other foundations were not immediately successful.
John Blossom, director of the California Area Health Education Centers Program and president-elect of the national AHEC organization, said he was surprised and distressed by the office’s closing.
"The issues rural people face in respect to getting health care are very different than people in suburbs and cities. There really needs to be a strong presence to make sure those differences are appreciated and considered in policymaking," said Blossom, who has been involved in rural health delivery for decades in California.
A family physician, Blossom runs California's 40-year-old AHEC program at the University of California School of Medicine's Fresno Medical Education center. He assumes presidency of the national AHEC program this spring. AHEC develops and supports population-based approaches to health professions education with special emphasis on community-based training in underserved and rural areas.
"California State Rural Health Association has a tradition of very productively engaging state and national leaders in the issues of rural health delivery, and I hope this board and foundations can come together to revive some version of that. It’s a critical need," Blossom said.
Rural Percentages Declining in California, Nation
Nationally, the percentage of people who live in rural America is declining, according to the U.S. Census Bureau. Generally considered to be about 20% for the past several decades, the estimate now is closer to 16%.
In California, it's even lower. About five million Californians live in rural areas, roughly 13% of the state's 38 million residents, according to census data.
Rural Californians are widely spread throughout the state. Under federal guidelines for health care programs, 44 of California's 58 counties are considered rural. Sixty-eight of California's 430 hospitals are considered rural.
Rural health care providers have been organizing regionally for decades in California. Groups such as the Health Alliance of Northern California form networks of community clinics, hospitals and Indian Health Centers to expand access to health care. Many regional groups also work on improving access to mental health and dental care.
"A big change happening right now in rural areas is the change in business model from fee-for-service to managed care," said Doreen Bradshaw, executive director of HANC. "We represent eight counties and there are other groups like us around the state representing specific rural areas.
"But as far as a unified, solidified voice for rural health issues, that's going to be missing in Sacramento," Bradshaw said.