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 on the root of the issue,” she stated.
Kopplin later informed KFF Well being Information how certainly one of her rural sufferers lately missed two appointments due to a broken-down automotive and no entry to public transportation.
Nationwide, well being care employees like Kopplin and 1000’s of others — from affected person advocates to know-how executives — flocked to city halls or on-line portals in the course of the seven weeks state leaders needed to craft and submit their functions for the Rural Well being Transformation Program to the federal Facilities for Medicare & Medicaid Providers. That deadline was Nov. 5.
“We’ll give $50 billion away by the top of the 12 months,” CMS Administrator Mehmet Oz stated Nov. 6 at a Milken Institute occasion in Washington. He stated all 50 states had submitted functions.
This system will “enable us to right-size the well being care system,” Oz stated, including that improvements from the agricultural work “will spill over to suburban and concrete America as properly.”
Sarah Jane Tribble/KFF Well being Information
Amongst functions and summaries publicly shared by states, themes embrace workforce improvement, telehealth, and entry to wholesome meals. In Kansas, leaders wish to construct a “Meals is Medication” 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.
However many well being coverage specialists and Democrats are elevating alarms that the Republican-backed program will grow to be a “slush fund.” Critics fear it is going to fail to succeed in the small-town sufferers they are saying want it most, particularly as states face practically a trillion {dollars} in Medicaid spending reductions over the subsequent decade. Medicaid, a joint federal-state program, serves practically 1 in 4 rural People.
“The established order is large misery in rural communities,” stated Heather Howard, a professor of the follow at Princeton College and director of the college’s State Well being and Worth Methods program, which is monitoring the agricultural well being fund. The brand new funding will not be sufficient to offset the Medicaid losses, she stated.
Congressional Republicans added the five-year, $50 billion Rural Well being Transformation Program as a last-minute sweetener to President Donald Trump’s large tax-and-spending laws. The transfer helped win assist for the One Large Lovely Invoice Act from conservative holdouts who frightened 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 assist as a approach of battling excessive suicide charges. A registered nurse requested state leaders to “assume perhaps even larger” and take into account statewide common well being care.
And in Georgia, a technology-focused chain of major care clinics that serves seniors proposed increasing its operations into that state in its on-line public remark. A rural grant author requested for “secure and steady housing.”
The legislation says half of the $50 billion can be divided equally amongst all states with an accredited utility. The remaining can be doled out in keeping with a points-based system. Of the second half, $12.5 billion can be allotted based mostly on every state’s rurality. The remaining $12.5 billion will go to states that rating properly on initiatives and insurance policies that, partially, mirror the Trump administration’s “Make America Wholesome Once more” goals.
High 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 referred to as on a federal watchdog company to research the equity and implementation of the fund. Taylor Harvey, a Wyden aide, stated the Authorities Accountability Workplace has confirmed it is going to examine.
Based on the federal statute, at least 1 / 4 of states with an accredited utility could share the second half of the funding every fiscal 12 months, CMS spokesperson Catherine Howden stated. The company plans to publish summaries of accredited state tasks, in keeping with CMS steerage.
A handful of conservative-leaning states — together with Texas, Arkansas, Louisiana, and Oklahoma — have already instituted regulatory and legislative initiatives, comparable to prohibiting “non-nutritious” meals in profit applications, that garner further factors in this system utility course of.
Michael Chameides, a county supervisor in rural New York, stated he fears the cash might “be utilized in ways in which would harm sure states or reward sure states.” Chameides can be the communications and coverage director with the Rural Democracy Initiative, a nationwide advocacy group that launched a rural motion report final month.
Edwin Park, a analysis professor at Georgetown College’s Middle for Youngsters and Households, stated federal lawmakers gave Oz and his company “actually extreme discretion” when awarding the cash.
Federal directors have added guidelines that are not inside the statute that created this system, Park stated. For instance, its utility tips say states can not use greater than 15% of their funding to pay suppliers for affected person care — funds which might be anticipated to take a success as a result of Medicaid cuts.
Georgetown’s well being coverage specialists and Democrats aren’t the one ones with considerations. Some Republicans and small hospitals in Ohio fear the cash will go to giant well being techniques as a substitute of smaller, impartial hospitals that serve individuals inside their rural communities.
CMS’ Oz repeated the thought of getting “massive hospitals to undertake smaller establishments” on the Washington gathering after functions have been filed. He used comparable language at a rural well being summit hosted by South Dakota-based Sanford Well being. “How can we get massive hospitals to undertake smaller hospitals? To not take them over, however to maintain them viable by giving them good telehealth companies, specialty assist, radiology assist,” 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 in the course of the first six months of fiscal 12 months 2025, in keeping with a current bond score report.
Final 12 months, Sanford opened a “command middle” for its systemwide telehealth initiative. It launched a telehealth growth in 2021 and provides digital take care of 78 medical specialties, Sanford President and CEO Invoice Gassen stated.
“We have tried to think about, what if that quantity doubles?” Gassen stated. The startup prices for telehealth are excessive, he stated, and the agricultural fund might be a singular alternative “for us to make digital care obtainable to extra sufferers, to extra communities, to extra hospitals and well being techniques throughout the nation.”
Gassen, who is ready to chair the American Hospital Affiliation in 2027, stated Sanford leaders have met with state and federal officers, together with Oz, whom he is identified for years, and Chris Klomp, a high deputy at CMS and a senior adviser to Well being and Human Providers Secretary Robert F. Kennedy Jr.
The phrase “telehealth” seems 36 occasions within the rural well being program’s 124-page utility tips. However Don Robbins Jr., chief govt of a small hospital on the Illinois-Kentucky border, chuckled on the concept of utilizing the funding for that objective.
Robbins, whose 25-bed Massac Memorial Hospital averages 5 to seven sufferers in its beds every day, stated his hospital doesn’t commonly provide telehealth. Even when it did, he stated, sufferers dwelling greater than a mile exterior of city could not use it as a result of they do not have web connection.
The small hospital reported a $31,314 loss in September, Robbins stated. “I believe if we get something out of it,” Robbins stated of the agricultural well being program, “we’ll be fortunate.”
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 likelihood for states to check out concepts and study from what works and what does not.
However “in lots of methods this invoice goes to be a band-aid strategy” for rural well being, she stated. “It is probably not going to repair the issue.”
KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is likely one of the core working applications at KFF — the impartial supply for well being coverage analysis, polling, and journalism.
