Turn Trusted Institutions into Points of Care and Opportunity

The Problem

For many rural families, the problem is no longer simply whether broadband exists somewhere nearby. The problem is whether they have a place where they can actually use it for something important.

Approximately 99 million Americans live in federally designated primary care Health Professional Shortage Areas (HRSA HPSA data, 2024). A 2023 GAO report found that rural hospital closures leave affected residents traveling 20–30 additional miles on average to reach comparable specialty care (GAO-23-105765). 

Yet many of those same communities still have a school, library, health facility, workforce center, tribal facility, or other institution with reliable connectivity. Those institutions were not designed for private digital appointments. Open rooms, shared computers, noise, limited equipment, and lack of technical support can make a strong broadband connection effectively unusable for a confidential or high-stakes session.

The stakes are documented. The first operational Medicaid work requirement program — Arkansas in 2018 — lost 18,164 beneficiaries in six months. A study published in the New England Journal of Medicine found that coverage losses were driven primarily by failure to navigate compliance documentation systems, not failure to actually perform qualifying work activities (Sommers et al., NEJM 381(11), 2019). 96.5% of affected beneficiaries were already working, already exempt, or faced documentation barriers they could not overcome. 

Access to a service is not meaningful if the process for reaching it is itself a barrier.

The Context

States have spent years connecting community institutions. They are also confronting growing pressure to improve rural healthcare access, strengthen workforce pipelines, help residents navigate government services, and show what public infrastructure investments actually deliver.

Those efforts do not have to happen separately. The same trusted institution can support multiple services if people have a private, connected place to access them. A Portal in a library might support a telehealth visit in the morning and a job interview in the afternoon. A Portal in a CareerTech, school, health facility, or tribal community center can serve the same role for a different population.

The common denominator is access infrastructure: use institutions that already exist, add the private space and technology people need, and connect those locations into a network that can support many services over time.

Why This Matters Now

The evidence points to the same problem from several directions: connectivity matters, but connectivity alone is not enough.

First, A 2023 peer-reviewed study published in the National Library of Medicine found that counties with the highest broadband availability had 47% higher telehealth utilization than those with the lowest but a separate JAMA Network Open study of 172,387 Wisconsin Medicaid beneficiaries found that telehealth disparities persisted even among patients with high-speed internet at home. 

The connection is part of the answer. People also need the right place, equipment, privacy, and support to use it. A connected anchor institution can provide that foundation, but only if it is equipped for the service.

Second, the HRSA shortage data quantifies the population with no alternative. HRSA identifies 99 million Americans in federally designated primary care Health Professional Shortage Areas. In many of these communities, rebuilding a hospital, opening a new workforce center, or placing a specialist nearby is unrealistic. But the community may already have a connected institution capable of becoming a local access point.

Third,The One Big Beautiful Bill Act, signed July 4, 2025, mandates Medicaid work requirements for adults in the ACA expansion group beginning January 1, 2027.Whatever systems states build for compliance, residents will still need practical ways to access them. A statewide network of trusted access points gives states another way to help residents complete training, reach navigators, and use digital services without assuming everyone has the equipment, privacy, or connectivity to do so from home.

Ready Portals are private, connected rooms designed to deploy inside existing community institutions. States can place them wherever the need, connectivity, space, and local partnership make sense: libraries, schools, CareerTechs, health facilities, community colleges, tribal facilities, senior centers, community organizations, and other trusted institutions.

The network should include accessible configurations so people using wheelchairs and companions can use the Portal comfortably. Site selection should account for physical accessibility from the beginning rather than treating it as a later accommodation.

Inside, the Portal provides the video, audio, privacy, connectivity, and interface required for high-quality remote interaction. Depending on the program, Portals can also support peripherals and other equipment required for specific healthcare or service use cases.

Each site needs sufficient connectivity, power, floor space, and an accessible path to the Portal. Those requirements should be confirmed during site assessment before deployment.

Portals are designed as flexible access infrastructure rather than single-purpose telehealth booths. A state can use the same network to support telehealth, behavioral health, workforce programs, education, remote job interviews, benefits assistance, government services, and other services delivered remotely.

BOSS gives the organization managing the network one place to see Portal status, utilization, maintenance needs, and other operating information across the fleet. That makes a distributed network of access points manageable as infrastructure rather than a collection of standalone rooms.