Sarah Jane Tribble, KFF Health News and Arielle Zionts
RAPID CITY, S.D. — Echo Kopplin desires South Dakota’s leaders to know that cash from a brand new $50 billion federal rural well being fund ought to assist residents with restricted transportation choices.
Kopplin, a doctor assistant who works with seniors, low-income individuals, and psychological well being sufferers within the rural Black Hills, shared her ideas at a gathering hosted by state officers.
South Dakota’s leaders did a “good job of diving in” and asking inquiries to get “deeper at the root of the problem,” she stated.
Kopplin later informed KFF Health News how considered one of her rural sufferers just lately missed two appointments due to a broken-down automotive and no entry to public transportation.
Nationwide, well being care staff like Kopplin and hundreds of others — from affected person advocates to expertise executives — flocked to city halls or on-line portals throughout the seven weeks state leaders needed to craft and submit their purposes for the Rural Health Transformation Program to the federal Centers for Medicare & Medicaid Services. That deadline was Nov. 5.
“We will give $50 billion away by the end of the year,” CMS Administrator Mehmet Oz stated Nov. 6 at a Milken Institute occasion in Washington. He stated all 50 states had submitted purposes.
The program will “allow us to right-size the health care system,” Oz stated, including that improvements from the agricultural work “will spill over to suburban and urban America as well.”
Among purposes and summaries publicly shared by states, themes embrace workforce growth, telehealth, and entry to wholesome meals. In Kansas, leaders wish to construct a “Food is Medicine” program. Wyoming officers suggest a brand new program referred to as “BearCare,” a state-sponsored medical insurance plan that sufferers might use solely after medical emergencies.
But many well being coverage specialists and Democrats are elevating alarms that the Republican-backed program will turn into a “slush fund.” Critics fear it’s going to fail to achieve the small-town sufferers they are saying want it most, particularly as states face almost a trillion {dollars} in Medicaid spending reductions over the subsequent decade. Medicaid, a joint federal-state program, serves almost 1 in 4 rural Americans.
“The status quo is tremendous distress in rural communities,” stated Heather Howard, a professor of the apply at Princeton University and director of the college’s State Health and Value Strategies program, which is monitoring the agricultural well being fund. The new funding received’t be sufficient to offset the Medicaid losses, she stated.
Congressional Republicans added the five-year, $50 billion Rural Health Transformation Program as a last-minute sweetener to President Donald Trump’s large tax-and-spending laws. The transfer helped win help for the One Big Beautiful Bill Act from conservative holdouts who apprehensive that the Medicaid cuts within the invoice would hurt rural hospitals of their states.
In Montana, which hosted a web-based public discussion board earlier than submitting its utility, a nonprofit director pitched youth peer help as a method of battling excessive suicide charges. A registered nurse requested state leaders to “think maybe even bigger” and think about statewide common well being care.
And in Georgia, a technology-focused chain of main care clinics that serves seniors proposed increasing its operations into that state in its on-line public remark. A rural grant author requested for “safe and stable housing.”
The regulation says half of the $50 billion will likely be divided equally amongst all states with an authorized utility. The relaxation will likely be doled out in accordance with a points-based system. Of the second half, $12.5 billion will likely be allotted based mostly on every state’s rurality. The remaining $12.5 billion will go to states that score well on initiatives and insurance policies that, partially, mirror the Trump administration’s “Make America Healthy Again” aims.
Top Senate Democrats have raised alarms in regards to the rural well being program. They embrace Ron Wyden of Oregon and Tina Smith of Minnesota, who called on a federal watchdog company to analyze the equity and implementation of the fund. Taylor Harvey, a Wyden aide, stated the Government Accountability Office has confirmed it’s going to examine.
According to the federal statute, no less than a quarter of states with an approved application may share the second half of the funding each fiscal year, CMS spokesperson Catherine Howden said. The agency plans to publish summaries of approved state projects, according to CMS guidance.
A handful of conservative-leaning states — together with Texas, Arkansas, Louisiana, and Oklahoma — have already instituted regulatory and legislative initiatives, similar to prohibiting “non-nutritious” meals in profit applications, that garner additional points in this system utility course of.
Michael Chameides, a county supervisor in rural New York, stated he fears the cash might “be used in ways that would hurt certain states or reward certain states.” Chameides can be the communications and coverage director with the Rural Democracy Initiative, a nationwide advocacy group that launched a rural action report final month.
Edwin Park, a analysis professor at Georgetown University’s Center for Children and Families, stated federal lawmakers gave Oz and his company “really excessive discretion” when awarding the cash.
Federal directors have added guidelines that aren’t inside the statute that created this system, Park stated. For instance, its utility tips say states can’t use greater than 15% of their funding to pay suppliers for affected person care — funds which might be anticipated to take a success because of the Medicaid cuts.
Georgetown’s well being coverage specialists and Democrats aren’t the one ones with issues. Some Republicans and small hospitals in Ohio fear the cash will go to massive well being techniques as an alternative of smaller, impartial hospitals that serve individuals inside their rural communities.
CMS’ Oz repeated the thought of getting “big hospitals to adopt smaller institutions” on the Washington gathering after purposes had been filed. He used comparable language at a rural well being summit hosted by South Dakota-based Sanford Health. “How do we get big hospitals to adopt smaller hospitals? Not to take them over, but to keep them viable by giving them good telehealth services, specialty support, radiology support,” he stated on the October occasion.
Sanford owns or manages dozens of hospitals and a whole bunch of clinics and long-term care facilities, in addition to a medical insurance firm. The system reported about $81 million in working revenue throughout the first six months of fiscal yr 2025, in accordance with a recent bond rating report.
Last yr, Sanford opened a “command center” for its systemwide telehealth initiative. It launched a telehealth growth in 2021 and affords digital take care of 78 medical specialties, Sanford President and CEO Bill Gassen stated.
“We’ve tried to imagine, what if that number doubles?” Gassen stated. The startup prices for telehealth are excessive, he stated, and the agricultural fund could possibly be a singular alternative “for us to make virtual care available to more patients, to more communities, to more hospitals and health systems across the country.”
Gassen, who is about to chair the American Hospital Association in 2027, stated Sanford leaders have met with state and federal officers, together with Oz, whom he’s identified for years, and Chris Klomp, a high deputy at CMS and a senior adviser to Health and Human Services Secretary Robert F. Kennedy Jr.
The phrase “telehealth” seems 36 instances within the rural well being program’s 124-page utility tips. But Don Robbins Jr., chief govt of a small hospital on the Illinois-Kentucky border, chuckled on the thought of utilizing the funding for that goal.
Robbins, whose 25-bed Massac Memorial Hospital averages 5 to seven sufferers in its beds every day, stated his hospital doesn’t frequently supply telehealth. Even if it did, he stated, sufferers dwelling greater than a mile outdoors of city couldn’t use it as a result of they don’t have a great web connection.
The small hospital reported a $31,314 loss in September, Robbins stated. “I think if we get anything out of it,” Robbins stated of the agricultural well being program, “we’ll be lucky.”
Kopplin, the doctor assistant who attended the South Dakota assembly, is cautiously optimistic in regards to the rural well being fund. She views it as an exquisite probability for states to check out concepts and study from what works and what doesn’t.
But “in a lot of ways this bill is going to be a band-aid approach” for rural well being, she stated. “It’s not really going to fix the problem.”