Leveraging Community Health Workers and Pharmacists to Drive Rural Health

Rural Americans are nearly 1.5 times as likely to live without a nearby physician, with just 39.8 doctors per 100,000 people compared with 53.3 in urban areas. That gap, combined with higher rates of chronic disease, has left rural health systems under mounting strain, compounded by recent Medicaid cuts and coverage losses. The $50 billion Rural Health Transformation Program (RHTP) stands out as dedicated funding for innovation and an opportunity to see the creative ways states are addressing these challenges. Many states are turning to two trusted, community-based resources: community health workers (CHWs) and pharmacists.

Milken Institute Public Health explored how states are incorporating CHWs and pharmacists into their strategies to improve access, strengthen care coordination, and advance chronic disease prevention. Drawing on an analysis of all 50 state RHTP narratives, the report finds that 46 states specified roles for CHWs and 48 highlighted pharmacy-based services, demonstrating widespread recognition of their value in rural care delivery. States are investing in workforce development, integrated care teams, tech-enabled care, data systems, and sustainability to expand the impact of these roles.

The report highlights innovative state approaches that position CHWs as care navigators and community connectors, while empowering pharmacists to provide chronic disease management, preventive services, and expanded clinical care. Finally, the report offers actionable recommendations for policymakers, health systems, pharmacies, and payers to ensure these promising innovations continue beyond the lifespan of federal funding and become lasting components of rural health infrastructure.