A look at the health care provider shortage in rural New York
Photo: Alex Proimos, Creative Commons, some rights reserved Aug 11, 2025 — Rural New York has a shortage of health care professionals. That’s no secret. A new report from state Comptroller Tom DiNapoli’s office puts some numbers on the problem. It shows there are big shortfalls in the amount of providers in 16 rural counties,…
Photo: Alex Proimos, Creative Commons, some rights reserved
Rural New York has a shortage of health care professionals. That’s no secret.
A new report from state Comptroller Tom DiNapoli’s office puts some numbers on the problem. It shows there are big shortfalls in the amount of providers in 16 rural counties, including Essex, Franklin, Hamilton, Lewis and Washington counties in the North Country.
The report comes in the wake of Republicans’ massive tax and spending bill, which is expected to cut more than $1 trillion for health care programs like Medicaid over the next decade. Those changes could hit rural areas especially hard, making health care access even more challenging.
DiNapoli, a Democrat, spoke with Champlain Valley reporter Cara Chapman about the report.Their conversation has been lightly edited for clarity.
TOM DiNAPOLI: It’s really a snapshot, a picture in time, saying, ‘Hey, you still have some issues as far as access to primary care physicians and OB/GYN, pediatric, mental health services, dentists.’ It varies depending on which county you look at, but overall for the North Country—for rural counties—there are real challenges out there that we have to address.
CARA CHAPMAN: Were there any findings that came out of the report that were surprising or shocking that stood out to you?
DiNAPOLI: The severity of the lack of mental health professionals was one thing that jumped out to me. National studies have shown that suicide rates are higher in rural communities. I’m not 100% sure of the reason for that, perhaps isolation in general and economic challenges, but it’s exacerbated by the lack of access to mental health professionals. There are some counties that don’t have any physicians providing obstetrics and gynecology. Hamilton County has no dentist. So, some of the county differences stood out.
I think the other piece that I would mention is that of the six hospitals in our state that have the highest percentage of Medicaid reimbursement in terms of patient mix, three are in the North Country.So when you look at the Medicaid cuts coming out of Washington, the impact on our rural hospitals—some of which are already on a very tight margin—could be very severe. Could we see downsizings? Could we see closures?
CHAPMAN: Can you talk a bit more about that? What does the report tell us about how vulnerable rural areas in New York are to these Medicaid changes coming up?
DiNAPOLI: I think very vulnerable. I think families are vulnerable. Again, the numbers vary county to county, but about 30%—we’ll take it as an average—of the population of the 16 counties is on Medicaid. The Essential Plan has really helped to expand health care coverage in New York. We’re one of the states that has been very good about Medicaid expansion and leveraging federal dollars with the Essential Plan, building off of Obamacare and so on. If you go back a number of years ago, we had about 10% of our population without health care coverage. We’re now down to less than 5% without health care coverage. With these federal cutbacks, especially in our rural communities, you’re going to see those numbers going in the other direction. It doesn’t mean people aren’t going to get health care, but what’s going to happen is that if they don’t have the coverage, they’re going to end up using a hospital as their emergency room when they’re sick, or it’s going to cost more, the charity pools will have to pay for it, or we’ll get them to pay for it anyway. I think many of these cuts are shortsighted and are really going to hurt people. And again, because in rural New York the access is already limited, it’s only going to make a tough situation worse.
CHAPMAN: What can counties and the state do to address these provider shortages in rural areas? And does the current federal landscape make that even more difficult?
DiNAPOLI: The federal landscape makes it a little difficult, but I think there already have been some initiatives underway that we could build on. I think in terms of access to health care, we need to continue to look for options like more opportunities for telemedicine, which gets back to the broadband question, which again has been a challenge in rural areas. We’ve made progress, but we need to refocus on that.
We need to look for opportunities to provide more in terms of transportation. Our rural communities have limited public transit. You have an older population needing more health care. Paratransit has filled some of that void. We could have more investment in paratransit.
We need to find more opportunities to bring health care services to where people are, with things like mobile clinics and school-based health care centers. And then build on programs that we already have to incentivize medical professionals to locate their practices in rural communities. Some of these are models that have worked in other places. Some of these are models we’ve already started to do in New York.
I do hope part of the benefit coming out of our report is the reconsideration of some of what we know could work, and let’s just build on it. Our rural counties may not be the population centers for the state, but still, every New Yorker should be entitled to access to quality health care. The reason we’ve been doing this series of reports and analysis on rural issues is to make sure our rural communities are not being left out.
