Congress has maintained a long-standing interest in improving the health status of rural populations, particularly through increasing access to health services and health workforce training. Federal regional commissions and authorities (FRCAs) are state-federal partnerships that use congressionally-provided appropriations for economic development grants and related activities. FRCAs tend to be rural relative to the overall United States’ population. There are eleven FRCAs (see map below); as of the date of publication, six are active. FRCAs have used a range of program authorities to help economically distressed regions to address health-related concerns. For instance, FRCAs can provide grants for health care facility development, health care workforce development, substance use disorder treatment, and health care business technical assistance. In addition, some FRCAs oversee health advisory councils and J-1 visa waivers for foreign physicians who provide medical services in communities with shortages of health providers. Under P.L. 118-272, enacted in FY2025, Congress expanded FRCA authorities, including authorities for health care demonstration projects. In recent years, Congress has directed other federal agencies to partner with or provide funding to FRCAs for various health care initiatives. Regions of the Federal Regional Commissions and Authorities (FRCAs) (by county, parish, or borough) / Source: CRS analysis of authorizing commission and authorities legislation and Esri Data and Maps. Notes: There are no FRCAs in Hawaii. The Northwest Regional Commission is not included in the map above. P.L. 119-74 provided funding for this commission in Washington, Oregon, Idaho, and Montana, but did not provide further geographic information. Efforts to improve individual and community health outcomes and expand health care access may align with a region’s economic development objectives. Health care facilities and related businesses are often employers and may be a region’s largest source of jobs. They may also contribute to state and local economic development through their direct and indirect spending and may induce other jobs in their regions. Health resources and health care institutions also contribute to public health, and are amenities that workers and businesses may consider in their location and investment decisions. FRCAs use community-driven approaches, convene cross-sector partnerships, and are statutorily authorized to facilitate projects informed by state and local priorities, some of which may also address individual and community health. For instance, FRCAs may support workforce development efforts, which are often designed to enhance regional employment opportunities, and employment is generally correlated with improved individual and community health. Employment is associated with lower mortality in certain circumstances and conditions, and employment may also affect the health of the larger community because of the relationship between employment opportunities, insurance status, health care access, and the financial viability of health providers. FRCAs may also provide a regionally-oriented framework for addressing certain factors that contribute to health. Health care funding often flows to states, but individuals may access health care in ways that cross state boundaries. FRCAs, most of which have multistate regions, may be able to work on the complicated issue of health care access using their experience in administering regional, multistate projects and collaborating with multiple levels of government entities, including regional development organizations. Congress may wish to evaluate how FRCAs’ health-related programs are implemented and how they may further the FRCAs’ and FRCA members’ economic development goals. Congress may also wish to evaluate whether these programs may serve as a way to expand the reach of federal funding in different or complementary ways or if there are areas of overlapping activity. Congress may consider options to change, integrate, or otherwise coordinate FRCAs’ health-related activities with other federal funding programs. Recognizing the role of state and local decisions in health outcomes, policymakers could direct FRCAs to administer economic development programs that are tailored to specific health challenges or opportunities while continuing to integrate state and local input and priorities. Should Congress be supportive of expanded FRCA roles, Congress may wish to build on the existing state and local partnerships that are central to the FRCAs’ structural, governance, and operational framework. Finally, Congress may wish to evaluate existing FRCA health activities and their partnerships with other federal, regional, state, and local entities.
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