The T.L.L. Temple Foundation continues to accept proposals for education, economic opportunity, health, human services, and arts and culture. Our highest priorities in health are Provider Availability and Affordable Health Options.

To view our complete strategic plan, please click here.


The supply of primary care providers, dentists, and other high need health occupations in East Texas is increased.

There is a shortage of healthcare providers across the country, but rural areas are especially impacted. The federal government projects a shortage of more than 20,000 primary care physicians in rural areas by 2025.1 The Health Resources and Services Administration (HRSA) estimates that approximately 10,000 additional dental practitioners are needed to meet the current need for dental care in 6,300 mostly rural communities.2 This inadequate supply of primary care providers, dentists, and other provider types has plagued East Texas for decades. According to HRSA, all Texas counties in the foundation’s service area are health professional shortage areas (HPSAs) for primary care, 19 counties are HPSAs for dental care, and all counties with the exception of Harris are HPSAs for mental health care.3 Provider-to-patient ratios for primary care are three times the U.S. average and 19 of the foundation’s rural counties have worse ratios than the state average.4 One reason rural areas lack primary care physicians is that physicians usually choose to live in the area where they complete their residencies. With 99 percent of residencies located in urban or suburban areas, it is no surprise that rural areas are faced with physician shortages.5 When people do not have consistent access to a primary care provider, conditions such as depression, and early signs of cancer or chronic disease may go undetected and untreated potentially leading to premature death. Patients routinely seen by a primary care provider have a 19 percent lower chance of premature death than those who only see specialists for their care.6 A lack of dental care can also lead to poor health outcomes such as cardiovascular disease, dementia, respiratory infections, and diabetic complications.7 There is no doubt that without adequate access to health care, rural East Texans will struggle with their health, have less opportunities, and contribute less to building thriving communities.

Although the lack of primary care providers is disheartening, there are reasons for optimism in a few areas. Sam Houston State University (SHSU) launched a College of Osteopathic Medicine in 2020 with a focus on addressing the shortage of primary care physicians in rural East Texas. Osteopathic physicians tend to choose primary care tracts and are more likely to practice in rural locations.8 In early 2020, the University of Texas System announced it would establish a medical school in Tyler to increase access to care in the East Texas region. Additionally, for new physicians and dentists who are not interested in starting an independent practice, rural East Texas has a number of Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) which are regularly looking to hire primary care physicians and dentists. Physicians and dentists who work in a clinic have the advantages of an established patient base, reduced administrative responsibilities, and no up-front investment in starting their own practice.

The foundation seeks to increase the number of primary care providers, dentists, and other providers in rural East Texas by working with partners such as medical schools, dental schools, hospitals, and clinics to establish rural residency programs and provide incentives to practice in our most underserved areas. These incentives include medical education student loan repayment programs, hiring incentives, and support to begin a practice within a clinic setting in an HPSA.
  • Rural Residency Programs: Establish and fund rural residency programs in health professional shortage areas.
    • Fund feasibility studies to determine if a GME program is possible at selected locations
    • Fund planning grants and trainings for hospitals/clinics to prepare for residency programs
    • Fund residency programs
    • Fund infrastructure within hospitals and clinics to support residency programs
  • Hiring Incentives: Create and fund incentive programs for clinics to recruit primary care providers, dentists and other providers.
    • Establish and fund incentive programs
  •  Support to Enter Practice: Support efforts to recruit new physicians and dentists to rural East Texas.
    • Create, fund, and promote loan repayment programs with medical schools and dental schools
    • Fund clinic on-boarding costs such as credentialing, Drug Enforcement Administration (DEA) registration, Medicaid and Medicare certification for providers to ensure transition into practice in rural East Texas


To determine the success of our strategies and efforts we will:

  • Monitor the number of primary care providers, dentists, and other providers practicing within our service area each year
  • Monitor the number of applicants for rural residency, those transitioning into practice in our service area, and those retained
  • Review the rankings of the foundation’s counties in the County Health Rankings and Roadmaps
  • Review HPSA status within our service area.


East Texans obtain affordable health insurance

Health insurance is crucial to a family’s well-being and financial security. Health insurance offers protection from high, unexpected medical expenses which could push struggling families into poverty. Additionally, health insurance provides access to primary and preventive care leading to better health outcomes. Uninsured people receive less medical care and less timely care leading to worse health outcomes.1 Financial challenges have been magnified by the pandemic. According to one study, the average charge per COVID-19 patient requiring a hospital stay is $73,300 without insurance.2 A medical debt this large could cause financial ruin for many families. Unfortunately, Texas leads all 50 states in the number of uninsured individuals. One of only 12 states which have not expanded Medicaid, Texas has more than 20 percent of adults and 11 percent of children who are uninsured.3 Within the foundation’s service area, some counties have more than 30 percent of adults and 15 percent of children who are uninsured.4 The County Health Rankings and Roadmaps ranks 16 of our 23 Texas counties in the bottom quartile of the state for health outcomes, and 19 of all 23 counties rank in the lower half.

Many individuals are eligible for low-cost or free health insurance. For instance, most currently uninsured adults and young adults have incomes that could make them eligible for marketplace subsidies or Medicaid.5 Many of the children who lack health insurance coverage are eligible for CHIP and Medicaid, but their families are either not aware of that, or do not know how to enroll. Fortunately, many organizations work diligently to expand coverage for children, protect and invest in children’s health in the state budget, and improve outreach and enrollment systems for children and families. Likewise, other organizations work and advocate on behalf of adults to expand public coverage options and ensure that all adults are covered by health insurance regardless of income status.

The foundation’s strategy to increase the number of children and families that have access to affordable health insurance includes convening cross-system partners, catalyzing new initiatives, and commissioning and/or making use of research to make the case for increased coverage. Additionally, the foundation supports organizations that advocate for affordable health insurance options for all.

  • Children’s Health Insurance: Increase the number of children and families that have access to affordable health insurance
    • Make grants to organizations that enroll children in CHIP and Medicaid
    • Fund studies/convenings to identify barriers to enrollment for those eligible
    • Fund organizations to proactively move into identified communities to increase enrollment
  • Public Coverage Options: Support efforts that help people access affordable health insurance options
    • Support advocacy for expanded public coverage options
    • Make grants to organizations advocating for expanding Medicaid or alternate plans
    • Make grants to organizations that advocate through public awareness campaigns
    • Promote the advantages of Medicaid expansion


To determine the success of our strategies and efforts we will:

  • Monitor the number and percentage of children and adults with health insurance
  • Monitor the number and percentage of new enrollees in CHIP and Medicaid
  • Review the rankings of foundation counties in the County Health Rankings and Roadmaps
  • Monitor access to health care based on the number of visits to providers