Drones that deliver medications to local libraries and provide telehealth are among the ideas that state leaders have just mentioned to spend their share of the $50 billion federal rural health program.
The Trump administration, which promised “radical transparency,” said in the document: Frequently Asked Questions We plan to release “project summaries” for states that have secured funding. At the direction of federal regulators, many states are hiding their entire applications, and some have refused to disclose details.
“Let me be clear,” said Alan Morgan, executive director of the National Rural Health Association (NRHA). “Whether you’re a hospital director, clinic administrator, or community leader, they’ll all want to know what their state is doing.”
NRHA members include financially challenged rural hospitals and clinics. federal congressman They have pledged to benefit from the Trump administration’s Rural Health Transformation Program.
Morgan said his members are interested in what the state proposes, which ideas are approved or rejected, what the budget justification is and how the money can be used.
Improving rural health care is “an incredibly complex and difficult task,” Morgan said.
The five-year Rural Health Transformation Program was approved by Congress in a so-called law. one big beautiful bill bill— It also significantly reduces Medicaid spending, on which rural health care providers rely heavily. The program is being closely watched because it represents a much-needed injection of funding. That’s despite conditions imposed by the Trump administration to ensure the funds are used for innovative ideas and not simply to sustain ailing rural hospitals.
Under the law, half of the $50 billion would be distributed equally to all states through approved applications. The remainder is distributed according to a points system. From the second half$12.5 billion is allocated to each state based on its level of “rurality.” The remaining $12.5 billion will be paid to states that obtain: good score In plans and policies consistent with the Trump administration’s goals, in part under the motto “Make America Healthy Again” (Make America Healthy Again).
Secretary of Health and Human Services Robert F. Kennedy Jr. has repeatedly promised to keep the government open to the American people. Your agency has webpage Committed to “radical transparency.”
“We are working to make the Department of Health and Human Services (HHS) the most transparent in its 70-year history.” Kennedy wrote. In written testimony submitted to Congress last September.
Lawrence Gostin, a public health law professor at Georgetown University, said HHS is acting “in a completely non-transparent manner” and the public has a right to demand “greater openness and clarity.” He added that without transparency, the public cannot assess the accountability of the institution.
Catherine Howden, a spokeswoman for the Centers for Medicare and Medicaid Services (CMS), said the agency will follow federal regulations: Competitive Grant Resources By posting information about rural health programs.
Howden said grant applications “are not disclosed during the valuation process,” adding, “The purpose of this policy is to protect the integrity of the valuation, applicant confidentiality and the competitive nature of the process.”
Democrats and some health care advocates fear that decisions about distributing funds are being driven by political motivations.
“I’m concerned about political retaliation,” said Rep. Nikki Budzinski, D-Ill. He added that because Democrats control politics in our state, “our requests may not be taken as seriously as in other Republican-led states.”
In November, Illinois Democrats sent the following letter to the House of Representatives: letter It asks CMS Administrator Mehmet Oz to conduct a “fair and comprehensive evaluation” of the state’s applications. Illinois state officials have not yet forwarded their proposal to KFF Health News, which submitted a public records request.
“I’m surprised by the transparency of many states,” said Princeton University professor Heather Howard.
Howard hosts the show. State Health and Value Strategy University graduate, monitor It supported rural health funding and praised most states for publishing project summaries.
“This shows tremendous interest in the program,” Howard said.
After reviewing summaries from nearly two dozen states, his team identified common themes such as expanding mobile and in-home services, increasing use of technology, workforce development through scholarships, hiring bonuses and child care support for high-demand positions.
“I think it’s interesting,” Howard said. “I think what we can learn from these proposals is very valuable.”
Howard noted that Georgia and Alabama’s requests include the use of telerobotics, a proposal to use robots to perform remote ultrasounds.
He said another issue that “excites me” is efforts by states, like Idaho, to create advisory groups or commissions. Here, the working group is expected to focus on skills, workforce development, partnerships with Indigenous communities, and mental and behavioral health.
All 50 states submitted applications to federal regulators before the Nov. 5 deadline, and a resolution is expected to be issued before the end of the year, according to CMS.
As of late November, nearly 40 states had released project summaries, the main part of their applications outlining proposed initiatives, according to tracking by KFF Health News. More than a dozen states also released budgets.
Smaller states including Idaho, Iowa, Kansas, Minnesota, New Mexico, North Dakota, South Carolina, and Wyoming have rolled out all components of the application.
KFF Health News filed a public records request to obtain the state’s full request. Some refused to hand over the materials.
The state of Nebraska, for example, denied the request, arguing that the content was “commercial or proprietary information” that “could benefit competitors.”
Kentucky shared a summary of the application but said the rest was a “preliminary draft” not subject to public disclosure under state law.
Erika Engle, a spokeswoman for Hawaii Gov. Josh Green, said the governor is “committed to transparency” but declined to share the state’s proposal.
Hawaii and other states are still processing formal public records requests.
This rural health program is part of legislation passed in July and is expected to reduce federal Medicaid spending in rural areas by: $137 billion For the next 10 years.
These cuts are expected to impact the finances of rural centres, jeopardizing their ability to continue operating. A recent Commonwealth Fund report found that many rural areas remain. without proper access In primary care. But under Rural Health Program regulations, only 15% of the new funds can be used to pay for direct patient care.
Between the Medicaid cuts and new investments in the program, “there is a real opportunity for state policies to impact rural areas, either negatively or positively,” said Celli Horstman, a senior fellow at the New York Foundation and co-author of the report.
Among the proposals available to the public, states with Democratic governments demonstrate a willingness to support some of the government’s goals but also reject others that could result in points being deducted.
For example, the state of New Mexico said it would introduce legislation to require students to take the Presidential Physical Fitness Test.presidential fitness test) and doctors take continuing education courses on nutrition. But that won’t stop people from using their Supplemental Nutrition Assistance Program (SNAP) benefits to buy “non-nutritious” products like soda or candy.
Many states plan to invest in technologies such as telehealth, cybersecurity, and remote patient monitoring equipment. Other topics include improving access to healthy food, strengthening emergency services, preventing and treating chronic diseases, and using community health workers and paramedics for home visits.
Here are some specific suggestions:
- Arkansas wants to spend $5 million on “FAITH,” a “Faith-Based Access, Transportation and Health” program to help rural religious institutions host preventive screenings and educational events. Walking circuits and exercise equipment will also be set up in the congregation.
- Alaska, which has historically used dog sleds to deliver medicines to remote areas, wants to test the use of ‘unmanned aerial systems’ to speed up the delivery of medicines.
- Tennessee wants to increase access to healthy activities through investments in parks, trails and farmers markets.
- Maryland proposes opening mobile markets and installing refrigerators and freezers to facilitate access to fresh, healthy food that often goes bad in rural areas where supermarkets are few and far between.
State Sen. Stephen Meredith, a Republican who represents western Kentucky, said he expects rural hospitals to continue to close despite the state program.
“I think we’re not treating the disease, we’re just treating the symptoms,” he said. Presentation on Kentucky Proposal.
Morgan, whose organization represents rural hospitals that could potentially close, said he thinks the state’s idea is a good one.
“You can write a story that sounds great,” he said. “But turning those aspirational goals into functional programs is more difficult.”
KFF Health News reporters Phil Galewitz, Katheryn Houghton, Tony Leys, Jazmin Orozco Rodriguez, Maia Rosenfeld, Bram Sable-Smith and Lauren Sausser contributed to this article.
