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North Carolina's rural communities still face health care gaps despite community-launched programs that have created some solutions.

As state lawmakers continue negotiations over Medicaid expansion, advocates say decades of funding community-based initiatives have helped create solutions and chipped away at the health care gap.

Adam Linker, vice president for programs at the Kate B. Reynolds Charitable Trust, said work has been done to build the decision-making capacity of community groups during the rollouts of different state initiatives and programs aimed at improving the health of residents.

“The most important aspect of improving health and reducing disparities, racial and ethnic disparities, is really making sure that these rural communities have a voice in the programs and policies that are most impacting them,” Linker said.

Three million North Carolinians live in a rural county lacking quality health care infrastructure, and are more likely to die of heart disease, diabetes, lung disease and suicide. North Carolina is one of a handful of states which have chosen not to expand Medicaid since the Affordable Care Act offered states the chance to loosen eligibility requirements more than a decade ago.

Brandy Bynum Dawson, senior director of policy research and innovation for the North Carolina Rural Center, pointed out in addition to a lack of primary-care physicians, specialists are also hard to come by in rural regions. She believes Medicaid expansion could help reduce the shortage.

“That runs the gamut from doctors to psychiatrists and other mental-health providers and dentists and pediatricians and OB-GYNs,” Bynum Dawson said.

Laura Gerald, president of the Kate B. Reynolds Charitable Trust, said her organization has been working to provide incentives for doctors, nurses and other medical professionals, to practice and live in rural areas. She pointed to the Jerry M. Wallace School of Osteopathic Medicine at Campbell University outside Raleigh, which used a $2 million grant to help increase enrollment of rural students.

“We’ve supported the community practitioners program through the medical society over the years,” Gerald said. “And I’ve also supported institutions like Campbell University that are training providers to work in these areas.”

At a virtual town hall held by the North Carolina Healthcare Association, rural hospital leaders said they are facing an uptick in emergency room visits for behavioral-health issues.

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