Related Guides on this Topic
You may also want to see this guide on a related topic: What
is Rural?
Introduction
Frontier areas are the most rural settled places along the rural-urban
continuum, with residents far from health care, schools, grocery
stores, and other necessities. Frontier is often thought of in
terms of population density and distance in minutes and miles to
population centers and other resources, such as hospitals. Many
frontier counties are located in the West, a part of the country
where individual counties tend to cover a large geographic area.
Even counties that have a town with a hospital, grocery store,
and other services may also encompass areas that are much more
rural and isolated, making them frontier counties. Frontier areas
face challenges in providing access to health and human services
that are even greater than the challenges faced by less isolated
rural communities.
Frequently Asked Questions
Tools
American FactFinder
Database
A source of data/information on United States population, housing, economy and geography.
Frontier Designation Matrix
Web site
A matrix that can be used to determine if an area is frontier, based on population density, distance to services, and travel time.
List of Frontier Counties from 2000 U.S. Census
Web site
List of frontier counties, by state, with county population and population density information. Includes total state population and state percent of population in frontier for each state.
Rural Definitions
Web site
Provides tables, maps and methods to help the user identify and define rural.
Rural Health Grants Eligibility Advisor
Web site
A Web search page that determines if a community is rural according to the Office of Rural Health Policy’s (ORHP) definition.
Rural Health Research: Frontier health
Web site
Provides summaries of current and completed rural health research projects and related publications addressing the topic of frontier health, produced by the Office of Rural Health Policy's funded rural health research centers.
Rural-Urban Commuting Area (RUCA) Codes (Version 2.0)
Web site
Describes the Rural-Urban Commuting Area Codes (RUCAs), a method of defining rural areas. Includes an overview of RUCAs and downloadable RUCA data, as well as information on the history of this definition.
Rural-Urban Commuting Area (RUCA) Codes
Web site
An updated list of rural-urban commuting area (RUCA) codes. RUCA codes classify U.S. census tracts using measures of population density, urbanization, and daily commuting. The most recent RUCA codes are based on data from the 2000 decennial census.
Rural-Urban Commuting Area (RUCA) Codes: ZIP Code Version 2.0
Web site
A zip-code based list of rural-urban commuting area (RUCA) codes, based on 2004 ZIP codes and 2000 Census commuting data.
State and County Quick Facts
Web site
Facts and data about the people, business and geography of each state and county.
Funding
Inactive Funding
Inactive Funding Opportunities -
Lists additional funding programs for this topic that are not currently accepting applications. Programs that are inactive may be offered again in the future.
Maps & Map Collections
Frontier Counties
Geographic coverage: United States
Printable map that shows the location of frontier counties nationwide. Data source: U.S. Census Bureau, 2000.
Date: 2000
Frontier Counties, 2004
Geographic coverage: United States
Identifies counties with fewer than seven people per
square mile.
Date: 2004
National Center for Frontier Communities: Maps
Geographic coverage: United States
Maps on topics of interest to frontier. Includes maps showing frontier counties, federal lands, mining dependent areas and farming dependent areas.
RUCA Maps
Geographic coverage: United States
State and regional maps that use Rural Urban Commuting Area (RUCA) data to show levels of rurality.
Regulations, Forms & Other Useful Documents
Addressing the Nursing Shortage: Impacts and Innovations in Frontier America
Sponsoring organization: National Center for Frontier Communities
Discusses the nursing shortage and how it affects rural and frontier communities. Includes strategies to address the shortage and maps of hospital nurse shortage areas.
Date: 12 / 2004
Consensus Definition: 2007 Update
Sponsoring organization: National Center for Frontier Communities
Update on a definition of frontier developed in 1997 that uses a weighted matrix to determine which areas are considered frontier. Discusses the use of the matrix in cooperation with the states.
Date: 2007
Defining the Term "Frontier Area" for Programs Implemented through the Office for the Advancement of Telehealth
Sponsoring organization: University of North Dakota Center for Rural Health
An expert panel report to the Office for the Advancement of Telehealth, Health Resources and Services Administration, U.S. Department of Health and Human Services. Provides an overview of current frontier definitions and describes the process used to develop a new frontier area definition that could be applied to telehealth programs.
Date: 05 / 2006
Emergency Medical Services in Frontier Areas: Volunteer Community Organizations
Sponsoring organization: National Center for Frontier Communities
Provides information on paid and volunteer Emergency Medical Services (EMS) workers in frontier and rural areas. Discusses challenges facing volunteer EMS systems and provides examples of different types of programs from several states.
Date: 04 / 2006
Frontier: A New Definition
Sponsoring organization: National Center for Frontier Communities
Discusses the definition of frontier, based on population density, distance to the closest market for services, and travel time. Also describes the process by which this definition was developed. Includes a matrix that can be used to determine frontier status.
Date: 04 / 1998
Impact of Seasonal Population Variations on Frontier Communities: Maintenance of the Healthcare Infrastructure
Sponsoring organization: National Center for Frontier Communities
Provides findings from three case studies of frontier communities with seasonal population variations: Skagway, Alaska; Quartzsite, Arizona; and Lake City/Hinsdale County, Colorado. Discusses the experiences of these communities in meeting the health care needs of the permanent local population and seasonal residents and visitors.
Date: 04 / 2006
Modeling the Frontier Extended Stay Clinic Conditions of Participation and Reimbursement Methodologies
Sponsoring organization: Office of Rural Health Policy
Discusses the financial feasibility of the Frontier Extended Stay Clinic (FESC), a proposed new provider type to expand services in remote and isolated primary care clinics. Compares Medicare reimbursement for FESC status with Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC), and Critical Access Hospital (CAH) reimbursement. Includes detailed examples of financial impact for seven clinics in rural Alaska, Nevada, Washington, and Wyoming.
Date: 2004
Oregon Domestic Violence Program Meets Frontier Funding Challenges
Sponsoring organization: National Center for Frontier Communities
Describes a federally-funded program in rural frontier Oregon providing coordinated support for
victims of domestic violence. Discusses the special challenges of funding a social service program in a frontier community.
Date: 08 / 2006
RUCA Data: Travel Distance and Time, Remote, Isolated, and Frontier
Sponsoring organization: WWAMI Rural Health Research Center
Discusses how Rural Urban Commuting Area (RUCA) codes, travel times and distances can be used together to create needed definitions of remote and isolated areas.
Rural and Frontier Mental and Behavioral Health Care: Barriers, Effective Policy Strategies, Best Practices
Author(s): Donald Sawyer, John Gale, David Lambert
Sponsoring organization: National Association for Rural Mental Health
Reports on the mental and behavioral health needs of Americans living in rural and frontier areas with a focus on barriers, policy strategies, and best practices.
Date: 2006
Seasonal Population Fluctuations in Rural and Frontier Areas: Phase One: The View from State Offices of Rural Health
Sponsoring organization: National Center for Frontier Communities
Describes the impact that seasonal population changes have on the provision of health services in rural and frontier areas.
Date: 06 / 2003
Training Community Health Workers: Using Technology and Distance Education
Sponsoring organization: Office of Rural Health Policy
Overview of programs and issues related to the use of technology and distance education to train community health workers (CHWs) in frontier areas. Includes examples of successful programs.
Date: 04 / 2006
Update: Frontier Extended Stay Clinic (FESC)
Sponsoring organization: National Center for Frontier Communities
Update on the status of the Frontier Extended Stay Clinic (FESC) demonstration program. Includes information on the history of the program, legislation, contacts and websites for additional information.
Date: 2006
Journals
Frontier Area Report
Published once per year. Provides information to frontier communities on research, education, and policy development.
Organizations
Frontier Mental Health Services Resource Network
National organization
Provides an extensive collection of publications on the problems with access to mental health services in rural areas. Defines "frontier" and displays through maps counties designated as frontier areas. Offers technical assistance to rural agencies and advocates mental health/substance abuse topics as they impact upon or exist within rural areas.
National Center for Frontier Communities
National organization
Serves as a national clearinghouse, conducts research, and provides education on issues of importance to frontier communities.
National Rural/Frontier Women's Health Coordinating Centers (RFCC)
Federal government
Identifies and coordinates a network of existing resources to provide a full range of appropriate health services to women and their families in rural and frontier communities.
Terms & Acronyms
Frontier Isolated rural area, sometimes defined as having a population density of six or fewer people per square mile. Other commonly used definitions may also consider distance to services and travel time.
Frontier Extended Stay Clinic (FESC) A provider designation that allows a primary care clinic located in a remote area to provide and be reimbursed for monitoring and observation of patients for a limited period of time, in cases where patients cannot or should not be transferred. Currently a demonstration project.
Health Professional Shortage Area (HPSA) Geographic regions that have shortages of professionals working in primary medical care, dental or mental health care. HPSAs may be urban or rural areas, population groups or medical or other public facilities. Geographically, HPSAs can be cities or towns, counties or groups of counties. HPSA designations are reviewed and revised annually by the Secretary of Health and Human Services based on criteria set forth in the Public Health Service Act.
Health Professional Shortage Area - Primary Care (HPSA - Primary Care) HPSA designation for a shortage of primary care health professionals that meets three requirements. First, the area must be a rational area for delivery of primary medical care services. Second, the ratio of population to existing providers must meet or exceed 3,500 people to every single provider or meet or exceed a ratio of 3,000 to 1 and have an unusually high level of need. Lastly, the area under consideration must have primary medical care professionals in continuous (nearby/adjoining) areas that are over utilized, excessively distant or inaccessible.
Medically Underserved Area (MUA) Medically Underserved Areas (MUAs) are federal designations derived from the Index of Medical Underservice (IMU). This index ranges from 0 to 100 and is based on four criteria: 1) ratio of primary medical care physicians per 1,000 people, 2) infant mortality rate, 3) percent of the population with incomes below the poverty level and 4) the percent of the population age 65 or older. An IMU of 62.0 or less qualifies an area to be designated a MUA. Geographic areas designated as MUAs can be a whole county or a group of contiguous (adjoining) counties, minor civil divisions (MCD), census county divisions (CCD) or census tracts.
Rural-Urban Commuting Areas (RUCAs) A Census tract-based classification scheme (and a ZIP code-based alternative version) that utilizes the standard Census Bureau's urban area and place definition in combination with work commuting information to characterize all of the nation's Census tracts regarding their rural and urban status and functional relationships. Under the RUCA definition, types of rural and urban are defined by their city/town type and the portion of the populations that work commute from rural to urban areas.
Urban Influence Codes (UICs) A set of 12 county-level urban influence categories developed by the Economic Research Service based on population and commuting data from the 2000 Census of Population that captures some differences in economic opportunities.
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