Sarah Jane Tribble, KFF Health News and Arielle Zionts
Medication-delivering drones and telehealth at native libraries are among the many concepts state leaders revealed in November for spending their share of a $50 billion federal rural well being program.
The Trump administration, which has promised “radical transparency,” said in an FAQ that it plans to publish the “project summary” for states that win awards. Following the lead of federal regulators, many states are withholding their full purposes, and a few have refused to launch any particulars.
“Let’s be clear,” stated Alan Morgan, chief government of the National Rural Health Association. “The hospital CEOs, the clinic administrators, the community leaders: They’re going to want to know what their states are doing.” The NRHA’s members embrace struggling rural hospitals and clinics, which federal lawmakers promised would profit from the Trump administration’s Rural Health Transformation Program.
Morgan stated his members are keen on what states suggest, which of their concepts are authorised or rejected, and their funds narratives, which element how the cash could possibly be spent.
Improving rural well being care is an “insanely complicated and difficult task,” Morgan stated.
The five-year Rural Health Transformation Program was authorised by Congress in a regulation — the One Big Beautiful Bill Act — that additionally drastically cuts Medicaid spending, on which rural suppliers closely rely. It’s being watched intently as a result of it’s a much-needed inflow of funds — with a caveat from the Trump administration that the cash be spent on transformational concepts, not simply to prop up ailing rural hospitals.
The regulation says half of the $50 billion will probably be divided equally amongst all states with an authorised software. The relaxation will probably be distributed via a points-based system. Of the second half, $12.5 billion will probably be allotted primarily based 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” targets.
Health and Human Services Secretary Robert F. Kennedy Jr. has repeatedly promised to open the federal government to the American folks. His company has a webpage dedicated to “radical transparency.”
“We’re working to make this the most transparent HHS in its 70-year history,” Kennedy said in written testimony to lawmakers in September.
Lawrence Gostin, a professor of public health law at Georgetown University, said HHS is “acting in a way that utterly lacks transparency” and that the public has the right to demand “greater openness and clarity.” Without transparency, the public cannot hold HHS accountable, he said.
Centers for Medicare & Medicaid Services spokesperson Catherine Howden said the agency will follow the federal regulations governing competitive grant materials when releasing details about the agricultural well being program.
Grant purposes are “not released to the public during the merit review process,” Howden stated, including, “The purpose of this policy is to protect the integrity of evaluations, applicant confidentiality, and the competitive nature of the process.”
Democrats and lots of well being care advocates are concerned politics will affect how a lot cash states get.
“I am very concerned about retaliation,” stated Rep. Nikki Budzinski (D-Ill.). Because Democrats management her state’s politics, “our application might not be as seriously considered as other states that have Republican leadership,” she added.
Illinois’ Democratic members of the U.S. House sent a letter to CMS Administrator Mehmet Oz in November asking for “full and fair consideration” of their state software. Illinois officers haven’t but launched their state’s proposal to KFF Health News, which has a pending public information request.
Heather Howard, a professor of the follow at Princeton University, stated she is “pleasantly surprised at how transparent the states have been.”
Howard directs the college’s State Health and Value Strategies program, which is tracking the agricultural well being fund, and praised most states for publicly posting their challenge summaries.
“To me, it speaks to the intense interest in this program,” Howard stated. Her group, reviewing about two dozen state summaries, discovered themes together with growth of home-based and cellular companies, elevated use of know-how, and workforce growth initiatives like scholarships, signing bonuses, and little one care help for high-demand positions.
“I think it’s exciting,” Howard stated. “What’s great here is the experimentation we’re going to learn from.”
Telerobotics appeared in Georgia’s and Alabama’s purposes, she stated, together with a proposal to make use of robotic tools for distant ultrasounds.
Another theme that “warms my heart,” Howard stated, was the trouble amongst states to create advisory teams or committees, together with in Idaho, the place work teams are anticipated to concentrate on know-how, workforce growth, tribal collaboration, and behavioral well being.
All 50 states submitted purposes to federal regulators by the Nov. 5 deadline and awards will probably be introduced by the top of the 12 months, in line with CMS.
As of late November, practically 40 states had launched their challenge narrative, the principle a part of the applying, which describes proposed initiatives, in line with KFF Health News monitoring. More than a dozen states have additionally launched their funds narratives.
A handful of states — Idaho, Iowa, Kansas, Minnesota, New Mexico, North Dakota, South Carolina, and Wyoming — launched all elements of the applying.
KFF Health News filed public information requests for states’ full purposes. Some states have refused to launch any of their software supplies.
Nebraska, for instance, rejected a public information request, saying its software supplies are “proprietary or commercial information” that “would give advantage to business competitors.”
Kentucky shared its software abstract however stated the rest of the applying is a “preliminary draft” not topic to launch beneath state legal guidelines.
Erika Engle, a spokesperson for Hawaii Gov. Josh Green, stated the governor “is committed to transparency” however declined to share any of the state’s proposal.
Hawaii and different states are nonetheless processing formal public information requests.
The rural well being program is a part of the July regulation projected to scale back federal Medicaid spending in rural areas by $137 billion over 10 years.
Those cuts are anticipated to have an effect on rural well being services’ backside traces, threatening their capacity to remain open. A current Commonwealth Fund report discovered that rural areas proceed to lack access to main care. But the rules for the agricultural well being program say states can use solely 15% of their new funding to pay suppliers for affected person care.
Between the Medicaid cuts and funding increase from the brand new program, “there’s real opportunity for national policy to impact rural, both in the negative and the positive potentially,” stated Celli Horstman, a senior analysis affiliate on the New York-based coverage suppose tank who co-authored the report.
Among the publicly out there rural well being transformation proposals, Democratic-leaning states present assist, or are prepared to undertake, a few of the administration’s objectives however will lose out on factors from eschewing others.
For instance, New Mexico stated it will introduce laws requiring college students to take the Presidential Fitness Test and physicians to finish persevering with training programs on diet. But it gained’t stop folks from utilizing their Supplemental Nutrition Assistance Program advantages to purchase “non-nutritious” meals similar to soda and sweet.
Many states wish to put money into know-how, together with telehealth, cybersecurity, and distant affected person monitoring tools. Other themes embrace rising entry to wholesome meals, bettering emergency companies, stopping and managing persistent sicknesses, and enlisting group well being employees and paramedics for residence visits.
Specific proposals embrace:
Arkansas desires to spend $5 million via its “FAITH” program — Faith-based Access, Interventions, Transportation, & Health — to enlist rural non secular establishments to host training and preventive screening occasions. Congregations might additionally set up strolling circuits and health tools.
Alaska, which traditionally relied on dogsled groups to convey treatment to distant areas, is trying to check the usage of “unmanned aerial systems” to hurry up pharmacy deliveries to such communities.
Tennessee desires to extend entry to wholesome actions by spending cash on parks, trails, and farmers markets.
Maryland desires to start out cellular markets and set up fridges and freezers to enhance entry to recent, wholesome meals that usually spoils in rural areas with few grocery shops.
State Sen. Stephen Meredith, a Republican who represents a part of western Kentucky, stated he nonetheless expects rural hospitals to shut regardless of his state’s rural well being transformation program.
“I think we’re treating symptoms without curing the disease,” he stated after listening to a presentation on Kentucky’s proposal at a state committee meeting.
Morgan, whose group represents rural hospitals prone to shut, stated the state’s concepts might sound good.
“You can craft a narrative that sounds wonderful,” he stated. “But then translating the aspirational goals to a functioning program? That’s difficult.”
KFF Health News staffers Phil Galewitz, Katheryn Houghton, Tony Leys, Jazmin Orozco Rodriguez, Maia Rosenfeld, Bram Sable-Smith, and Lauren Sausser contributed to this report.
