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Update on Rural Definitions Determining Rural Communities: Current Changes and Updated Federal Program Eligibility March 11, 2021 Steven Hirsch, [email protected] Program Analyst Federal Office of Rural Health Policy (FORHP) Who Defines Rural? • The Census Bureau • The Office of Management and Budget (OMB) • United States Department of Agriculture’s Economic Research Service (ERS) • Federal Office of Rural Health Policy (FORHP)

2 The Census Bureau

The Census Bureau identifies two types of urban areas: . Urbanized Areas (UAs) of 50,000 or more people; . Urban Clusters (UCs) of at least 2,500 and less than 50,000 people.

For the 2010 Census, an urban area will comprise a densely settled core of census tracts and/or census blocks that meet minimum population density requirements, along with adjacent territory containing non-residential urban land uses as well as territory with low population density included to link outlying densely settled territory with the densely settled core. To qualify as an urban area, the territory identified according to criteria must encompass at least 2,500 people, at least 1,500 of which reside outside institutional group quarters.

3 Urban/Rural Population

Area Population Percentage of Population 2000 2010 2000 2010

United States 281.4 million 308.7 million

Urban 222.3 million 249.2 million 79% 80.7%

Urbanized Areas 192.3 million 219.9 million 68.3% 71.2%

Urban Clusters 30 million 29.3 million 10.7% 9.5%

Rural 59 million 59.5 million 21% 19.3%

4 Rural % of US Population

0 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010

5 Rural US Population

70,000,000

60,000,000

50,000,000

40,000,000

30,000,000

20,000,000

10,000,000

0 1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000 2010

6 7 Rochester, NY Metropolitan Statistical Area

8 Rochester, NY Urbanized Area

9 Office of Management and Budget (OMB)

• OMB defines Metropolitan and Micropolitan Statistical Areas . Metro Areas contain a core urban area of 50,000 or more population . Micro Areas contains an urban core of at least 10,000 (but less than 50,000) population. • Known as Core Based Statistical Areas (CBSAs) • Each metro or micro area consists of one or more counties and includes the counties containing the core urban area, as well as any adjacent counties that have a high degree of social and economic integration (as measured by commuting to work) with the urban core.

10 Office of Management and Budget (OMB)

11 OMB County Designations

Non-Metro Metro Micro Neither (Total Neither and Micro)

1999 908 2319 OMB (28.1%) (71.9%)

Current 1250 665 1304 1969 OMB (38.8%) (20.6%) (40.5%) (61.1%)

12 OMB Counties, 2010 Census

Population (%) Population (%) (2009 OMB) (2013 OMB)

Metro 258,317,763 (83.7%) 262,452,132 (85%)

Micro 30,943,552 (10%) 27,154,213 (8.8%)

Neither 19,484,223 (6.3%) 19,139,193 (6.2%)

Total Non-metro 50,427,775 (16.3%) 46,293,406 (15%)

1313 Metro Counties in Maryland

14 The Grand Canyon

15 The Grand Canyon

16 FORHP and ERS

1. Metropolitan area core: primary flow within an Urbanized Area (UA) • Rural-Urban commuting 2. Metropolitan area high commuting: primary flow 30% or more to a UA area (RUCA) codes 3 Metropolitan area low commuting: primary flow 10% to 30% to a UA . Provides sub county 4. Micropolitan* area core: primary flow within an Urban Cluster of 10,000 alternative through 49,999 (large UC) . 5. Micropolitan* high commuting: primary flow 30% or more to a large UC Takes functional relationships, 6. Micropolitan* low commuting: primary flow 10% to 30% to a large UC population, & population density into account 7. Small town core: primary flow within an Urban Cluster of 2,500 through 9,999 . (small UC) Taxonomy is adjustable to fit 8. Small town high commuting: primary flow 30% or more to a small UC unique needs 9. Small town low commuting: primary flow 10% through 29% to a small UC . Scheme allows better targeting 10 Rural areas: primary flow to a tract outside a UA or UC (including self)

17 RUCA codes in Coconino County, AZ

8 10 8

10 7

10 2

18 FORHP’s Definition

• All Non-Metro Counties • All RUCA Tracts 4-10 in Metro Counties • Certain RUCA Tracts (over 400 sq. miles, fewer than 35 people per sq. mile and RUCA 2-3) in Metro Counties • Around 57 million people • Around 85% of the area of the USA

19 FORHP Rural Areas

20 Metro and Nonmetro Counties are Very Different

Density Per Land Area County Pop. Urban Pop. Urban % UA Pop. % UA UC Pop. % UC Rural Pop. % Rural Sq. Mile in Sq. Miles

Metro 224,809 197,393 88% 188,132 84% 9,262 4% 27,416 12% 276 813

Metro Central 331,742 300,832 91% 291,341 88% 9,491 3% 30,910 9% 367 929

Metro 47,077 25,468 54% 16,588 35% 8,880 19% 21,609 46% 76 621 Outlying

Nonmetro 23,341 9,468 40.6% 125 0.5% 9,344 40.0% 13,872 59% 23 1,034

Micro 42,004 21,576 51.4% 350 0.8% 21,226 50.5% 20,428 48% 39 1,074

Neither 14,255 3,486 24.5% 12 0.1% 3,474 24.4% 10,769 75.5% 14 1,013

21 Metro Outlying and Micro Counties

Density Per Land Area County Pop. Urban Pop. Urban % UA Pop. % UA UC Pop. % UC Rural Pop. % Rural Sq. Mile in Sq. Miles

Metro 224,809 197,393 88% 188,132 84% 9,262 4% 27,416 12% 276 813

Metro Central 331,742 300,832 91% 291,341 88% 9,491 3% 30,910 9% 367 929

Metro 47,077 25,468 54% 16,588 35% 8,880 19% 21,609 46% 76 621 Outlying

Metro Outlying 23,185 6,969 46% 0 0 6,969 46% 16,216 54% 36 650 No Urbanized Area

Nonmetro 23,341 9,468 40.6% 125 0.5% 9,344 40.0% 13,872 59% 23 1,034

Micro 42,004 21,576 51.4% 350 0.8% 21,226 50.5% 20,428 48% 39 1,074

Neither 14,255 3,486 24.5% 12 0.1% 3,474 24.4% 10,769 75.5% 14 1,013

22 Rural Definitions (Census 2010)

Urban/Metro Rural/Nonmetro Census 249.2 million (80.7%) 59.5 million (19.3%)

OMB 262.6 million (85%) 46.1 million (15%)

Current FORHP 251.8 million (82%) 56.9 million (18%)

FORHP (add 295 counties) 247.0 million (80.3%) 60.85 million (19.7%)

• Pros: • Adds Counties with Zero Urbanized Area Population • Cons: • Includes Some Counties with Large Urban Cluster Population • Still Leaves Out Counties with Very Low Urbanized Area Population

23 FORHP Federal Register Notice

• Current Definition: . All Non-Metro Counties . All Census Tracts with RUCA code 4-10 in Metro Counties . Certain Census Tracts (over 400 sq. miles, fewer than 35 people per sq. mile and RUCA 2-3) in Metro Counties . Around 57 million people . Around 84% of the area of the U.S. • Expansion: . All Outlying Metro Counties with no Urbanized Area Population  Low Density, Low Population Counties  Around 60.8 million people total (around 3.8 million added)  295 counties based on OMB 2020 county delineations

24 FRN Comments

• FORHP received 67 responses to the FRN . Positive about the proposal: 51 . Negative about the proposal: 11 . Noncommittal about the proposal: 5 • Many commenters suggested other changes to rural definition . Include a Mountainous/Difficult Terrain exception: 26 . Include Hub Sites in Metro areas that serve rural: 25 . Include a specific county or counties: 25 . Allow State Designated Rural Areas: 6 . Make all providers, CAHs, RHCs, Health Centers, rural: 6 . Remove Prison Populations from Urban Core: 5 . Remove College Populations from Urban Core: 5 . Include Legacy Providers (Grandfathering): 4

25 26 Rural Eligibility Analyzer

27 Rural Grant Opportunities From the Federal Office of Rural Health Policy Program FY 2021 FY 2022 FY 2023 Notice of Funding Opportunity (NOFO) Rural Health Care Services Outreach To Be Awarded Summer Rural Health Network Development NOFO Available Summer 2022 Rural Health Network Development Planning NOFO Available Summer 2020 NOFO Available Summer 2021 NOFO Available Summer 2022

Small Health Care Provider Quality NOFO Available Winter 2022 Improvement Delta States Network NOFO Available Summer 2022 Rural Communities Opioid Response Program - NOFO Out Implementation Rural Communities Opioid Response Program – NOFO Out Psychostimulant Support Rural Maternal Obstetrics Management Late Spring/Early Summer Strategies Program

Northern Borders Region Planning Grants Late Spring, Early Summer

http://www.hrsa.gov/ruralhealth/

28 Connect with HRSA

Learn more about our agency at: www.HRSA.gov

29 Proposed OMB Redefinition of Metropolitan Statistical Areas

Webinar Presentation March 11, 2021 Census - Urban Area Definitions

• The Census Bureau identifies Urban Areas - densely settled cores of census blocks or census tracts that meet minimum population density requirements.

• The Census Bureau has defined two types of Urban Areas: • Urbanized Areas (UAs): densely settled areas with 50,000 or more people, and • Urban Clusters: densely settled areas of at least 2,500 and less than 50,000 people.

• Areas outside these Urban Areas are considered rural.

31 New Mexico Urban Areas

32 Core-Based Statistical Areas (CBSAs)

• The Office of Management and Budget (OMB) has built upon Census definitions and created two Core-Based Statistical Area (CBSA) definitions of regions including and surrounding Urban Areas. • Metropolitan Statistical Areas (MSAs): areas with at least one urbanized area of 50,000 or more population plus adjacent territory that has a high degree of social and economic integration with the core as measured by commuting ties. • Micropolitan Statistical Areas (MiSAs): areas with at least one urban cluster of at least 10,000 but less than 50,000 population, plus adjacent territory that has a high degree of social and economic integration with the core as measured by commuting ties. • Both these CBSAs are county or multi-county based. They rely on commuting data to determine the connection of outlying counties to the central urban county. • The list of CBSAs are updated with each decennial census and with the subsequent 5-year American Community Survey estimates for the mid- decennial.

33 New Mexico Core-Based Statistical Areas

34 2010 Census 2010 Census 2010 Census 2010 Census County Total Urban Rural MSA Percent Rural Population Population Population Catron County, New Mexico 3,725 0 3,725 100.0 De Baca County, New Mexico 2,022 0 2,022 100.0 Harding County, New Mexico 695 0 695 100.0 Hidalgo County, New Mexico 4,894 0 4,894 100.0 Mora County, New Mexico 4,881 0 4,881 100.0 Union County, New Mexico 4,549 0 4,549 100.0 Torrance County, New Mexico 16,383 199 16,184 98.8 M Taos County, New Mexico 32,937 13,686 19,251 58.4 McKinley County, New Mexico 71,492 30,471 41,021 57.4 Cibola County, New Mexico 27,213 12,152 15,061 55.3 Lincoln County, New Mexico 20,497 9,596 10,901 53.2 Rural/Urban Colfax County, New Mexico 13,750 6,551 7,199 52.4 Rio Arriba County, New Mexico 40,246 20,218 20,028 49.8 Populations Socorro County, New Mexico 17,866 8,991 8,875 49.7 San Miguel County, New Mexico 29,393 15,609 13,784 46.9 -- NM Counties Guadalupe County, New Mexico 4,687 2,621 2,066 44.1 Grant County, New Mexico 29,514 17,014 12,500 42.4 Quay County, New Mexico 9,041 5,283 3,758 41.6 Luna County, New Mexico 25,095 14,903 10,192 40.6 Roosevelt County, New Mexico 19,846 12,610 7,236 36.5 Sierra County, New Mexico 11,988 7,918 4,070 34.0 San Juan County, New Mexico 130,044 86,266 43,778 33.7 M Otero County, New Mexico 63,799 44,917 18,880 29.6 Santa Fe County, New Mexico 144,170 107,896 36,274 25.2 M Chaves County, New Mexico 65,645 49,727 15,918 24.2 Lea County, New Mexico 64,727 51,114 13,613 21.0 Eddy County, New Mexico 53,829 42,603 11,226 20.9 Doña Ana County, New Mexico 209,233 168,871 40,362 19.3 M Sandoval County, New Mexico 131,561 109,119 22,442 17.1 M Valencia County, New Mexico 76,569 63,758 12,811 16.7 M Curry County, New Mexico 48,376 41,570 6,806 14.1 Los Alamos County, New Mexico 17,950 15,932 2,018 11.2 Bernalillo County, New Mexico 662,564 634,766 27,798 4.2 M 35 OMB MSA/MiSA Redefinition Proposal

• OMB is proposing to redefine the MSA definition, changing the minimum Urban Area population to qualify as an MSA from 50,000 to 100,000 people. • The maximum Urban Cluster population to qualify as an MiSA will also change from 50,000 to 100,000 people. • No Census Bureau Urban Area definitions will be affected. Commuting data will continue to be used as a basis for measuring connectivity to outlying counties. • It is estimated that 144 current MSAs will be reclassified as MiSAs under the proposal. • CBSAs will now have a minor re-evaluation annually, with a more comprehensive review at the fifth year mid-decennial.

36 Programs Relying on MSA Definition

• Multiple programs rely directly on MSA definitions, Including: • Centers for Medicare and Medicaid Services (CMS): • Medicare Hospital Wage Index • Medicare Ambulance Fee Schedule • CMS GME • Rural Referral Center Designation • Stark Law • USDA-ERS Rural Definitions • RUCA • Urban Influence Codes • NCHS Rural-Urban Definitions • CDC Wonder • Healthy People • Other programs rely indirectly on MSAs through RUCA or other definitions. FORHP program eligibility is partially reliant. • Many programs rely on Urban Area definitions, bypassing MSA status.

37 Rationale for MSA/MiSA Redefinition

• OMB notes that the minimum population required for an urban area to qualify a metropolitan statistical area had not kept pace with population growth of the United States. • OMB observes that the population of the United States has more than doubled since the 1950 census (the population in 2019 is about 2.2 times larger than in 1950), while the standards have maintained the same minimum population. • OMB recommends doubling the minimum required population of an urban area to qualify a metropolitan statistical area from 50,000 to 100,000. This would parallel overall population growth in the nation. • Areas with a core of 50,000 to 99,999 population would become micropolitan statistical areas.

38 Considerations

• What constitutes an urban core? • Is a settlement of 50,000 no longer ‘big enough’ to provide services and economic activity to qualify? • Is there a bigger population number which assures that a settlement is ‘big enough’? • Is there a consensus threshold population that most people would agree with – one that isn’t an arbitrary boundary? • Was the process of establishing the new minimum population transparent and open for public review? • Is the decision to change the minimum population threshold simply a ‘statistical’ concern, or is it really demographic and socioeconomic policy. • Should the OMB proceed without consideration of the program impact of the redefinition? Should agencies be allowed a transition period before implementation to permit program policy changes?

39 Links and Contacts

• OMB Notice: Recommendations From the Metropolitan and Micropolitan Statistical Area Standards Review Committee to the Office of Management and Budget Concerning Changes to the 2010 Standards for Delineating Metropolitan and Micropolitan Statistical Areas • 86 FR 5263 • https://www.federalregister.gov/documents/2021/01/19/2021- 00988/recommendations-from-the-metropolitan-and-micropolitan-statistical-area- standards-review-committee • Reports: Recommendations From the Metropolitan and Micropolitan Statistical Area Standards Review Committee • https://www.regulations.gov/docket/OMB-2021-0001/document • Harvey Licht, Senior Associate, Varela Consulting Group • [email protected] Bureau of the Census – Proposed Redefinition of Urban Areas

Webinar Presentation March 11, 2021 Introduction

• On February 19, 2021 the Bureau of the Census published Proposed Criteria for the Definition of Urban Areas in the 2020 Census. In this notice the Census Bureau is proposed changes to: • The methodology for identifying population concentrations – settlements - considered urban in nature. • The categories of urban population settlements currently being used.

• Urban Areas are Census defined categories for areas of concentrated population. • They are different from Incorporated Places – cities, towns and villages. • They are also different from unincorporated Census Designated Places (CDPs). • Settlements are continuous areas of higher population density that can include an incorporated town and the settled area immediately outside its boundaries.

42 Current Approach to Defining Urban Areas

• Categories of Urban Areas • Urbanized Areas (UAs): densely settled areas with 50,000 or more total population. • Urban Clusters: densely settled areas of at least 2,500 and less than 50,000 population.

• Definition Methodology • Basic Unit: Census Tract. • Unit Density Criterion: Population Density of 1,000 persons per square mile. • Area Criterion: Contiguous sets of census tracts meeting the density criterion with a total population of at least 2,500. • Adjustments: May be made for empty/low density areas within tracts and between tracts along corridors.

43 Proposed Approach to Defining Urban Areas

• Categories of Urban Areas: • Elimination of subcategories [Urbanized Areas and Urban Clusters]. • All areas will be referred to as Urban Areas.

• Definition Methodology: • Basic Unit: Census Block [smaller than Census Tract]. • Unit Density Criterion: Housing unit density of at least XXX per square mile. Population density no longer the criterion. Housing units may be occupied or vacant. • Area Criterion: Contiguous sets of Census Blocks meeting the density criterion with a total population of at least 10,000 or with a total number of housing units of at least 4,000. Population total is no longer the only criterion. Smaller settlements of 2,500 to 9,999 will no longer be considered ‘Urban’. • Adjustments: Changes are proposed to how ‘jumps’ along corridors will be handled.

44 Impact of Proposed Changes

• Settlements of 2,500 to 9,900 people will no longer be categorized as ‘Urban Areas’. • Data for these smaller settlements will no longer be included in the roll-up category for Urban Areas at State and National levels. • Data for these smaller settlements will no longer be compiled in Census reports. • Note: Some data for populations within the limits of incorporated towns and villages may continue to be available, but data for populations of contiguous areas outside those boundaries will not.

• Urban Areas will no longer be broken into two categories – Urbanized Areas and Urban Clusters for Census data compilation. • Small population settlements and large population settlements will be in the same data category for data compilation.

45 Considerations

• What categories of population settlement are useful for policy and program purposes? • Do ‘Urbanized Area’ and ‘Urban Cluster’ have meaning for these purposes? • What categories are useful for understanding different types of population settlements in rural areas? • Will the proposed definition changes affect any program eligibility of any population settlement currently considered ‘Urban’? • Will the changes of definitions and elimination of reporting categories hamper the ability to do necessary rural data analysis, including longitudinal analysis? • Is housing unit density an accurate substitute for population density in delineating categories of densely settled areas?

46 Links and Contacts

• Bureau of the Census Notice: Urban Areas for the 2020 Census- Proposed Criteria • 86 FR 10237 • https://www.federalregister.gov/documents/2021/02/19/2021-03412/urban-areas- for-the-2020-census-proposed-criteria

• Harvey Licht, Senior Associate, Varela Consulting Group • [email protected]