Medicine-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,” mentioned in an FAQ that it plans to publish the “challenge abstract” 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,” mentioned Alan Morgan, chief government of the Nationwide Rural Well being Affiliation. “The hospital CEOs, the clinic directors, the neighborhood leaders: They are going to wish 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 Well being Transformation Program.
Morgan mentioned his members are focused on what states suggest, which of their concepts are accredited or rejected, and their finances narratives, which element how the cash may very well be spent.
Enhancing rural well being care is an “insanely difficult and troublesome process,” Morgan mentioned.
The five-year Rural Well being Transformation Program was accredited by Congress in a legislation — the One Massive Stunning Invoice Act — that additionally drastically cuts Medicaid spending, on which rural suppliers closely rely. It is being watched intently as a result of it is 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 legislation says half of the $50 billion will probably be divided equally amongst all states with an accredited software. The remainder will probably be distributed by a points-based system. Of the second half, $12.5 billion will probably be allotted based mostly on every state’s rurality. The remaining $12.5 billion will go to states that rating nicely on initiatives and insurance policies that, partially, mirror the Trump administration’s “Make America Wholesome Once more” aims.
Well being and Human Providers 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 essentially the most clear HHS in its 70-year historical past,” Kennedy mentioned in written testimony to lawmakers in September.
Lawrence Gostin, a professor of public well being legislation at Georgetown College, mentioned HHS is “appearing in a method that completely lacks transparency” and that the general public has the suitable to demand “larger openness and readability.” With out transparency, the general public can’t maintain HHS accountable, he mentioned.
Facilities for Medicare & Medicaid Providers spokesperson Catherine Howden mentioned the company will comply with the federal rules governing aggressive grant supplies when releasing details about the agricultural well being program.
Grant purposes are “not launched to the general public through the advantage assessment course of,” Howden mentioned, including, “The aim of this coverage is to guard the integrity of evaluations, applicant confidentiality, and the aggressive nature of the method.”
Democrats and plenty of well being care advocates are involved politics will have an effect on how a lot cash states get.
“I’m very involved about retaliation,” mentioned Rep. Nikki Budzinski (D-Sick.). As a result of Democrats management her state’s politics, “our software may not be as severely thought of as different states which have Republican management,” she added.
Illinois’ Democratic members of the U.S. Home despatched a letter to CMS Administrator Mehmet Oz in November asking for “full and honest consideration” of their state software. Illinois officers haven’t but launched their state’s proposal to KFF Well being Information, which has a pending public information request.
Heather Howard, a professor of the apply at Princeton College, mentioned she is “pleasantly stunned at how clear the states have been.”
Howard directs the college’s State Well being and Worth Methods program, which is monitoring the agricultural well being fund, and praised most states for publicly posting their challenge summaries.
“To me, it speaks to the extraordinary curiosity on this program,” Howard mentioned. Her crew, reviewing about two dozen state summaries, discovered themes together with growth of home-based and cell providers, elevated use of know-how, and workforce growth initiatives like scholarships, signing bonuses, and baby care help for high-demand positions.
“I believe it is thrilling,” Howard mentioned. “What’s nice right here is the experimentation we will be taught from.”
Telerobotics appeared in Georgia’s and Alabama’s purposes, she mentioned, together with a proposal to make use of robotic tools for distant ultrasounds.
One other theme that “warms my coronary heart,” Howard mentioned, was the trouble amongst states to create advisory teams or committees, together with in Idaho, the place work teams are anticipated to deal with 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 tip of the 12 months, in line with CMS.
As of late November, almost 40 states had launched their challenge narrative, the primary a part of the appliance, which describes proposed initiatives, in line with KFF Well being Information monitoring. Greater than a dozen states have additionally launched their finances narratives.
A handful of states — Idaho, Iowa, Kansas, Minnesota, New Mexico, North Dakota, South Carolina, and Wyoming — launched all elements of the appliance.
KFF Well being Information 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 business data” that “would give benefit to enterprise opponents.”
Kentucky shared its software abstract however mentioned the rest of the appliance is a “preliminary draft” not topic to launch beneath state legal guidelines.
Erika Engle, a spokesperson for Hawaii Gov. Josh Inexperienced, mentioned the governor “is dedicated to transparency” however declined to share any of the state’s proposal.
Hawaii and different states are nonetheless processing formal public information requests.
The agricultural well being program is a part of the July legislation projected to scale back federal Medicaid spending in rural areas by $137 billion over 10 years.
These cuts are anticipated to have an effect on rural well being amenities’ backside traces, threatening their potential to remain open. A latest Commonwealth Fund report discovered that rural areas proceed to lack entry to major care. However the pointers 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 enhance from the brand new program, “there’s actual alternative for nationwide coverage to affect rural, each within the damaging and the constructive probably,” mentioned Celli Horstman, a senior analysis affiliate on the New York-based coverage suppose tank who co-authored the report.
Among the many publicly obtainable rural well being transformation proposals, Democratic-leaning states present assist, or are keen to undertake, a number of the administration’s objectives however will lose out on factors from eschewing others.
For instance, New Mexico mentioned it might introduce laws requiring college students to take the Presidential Health Check and physicians to finish persevering with training programs on vitamin. But it surely will not stop folks from utilizing their Supplemental Diet Help Program advantages to purchase “non-nutritious” meals comparable to soda and sweet.
Many states wish to put money into know-how, together with telehealth, cybersecurity, and distant affected person monitoring tools. Different themes embrace growing entry to wholesome meals, enhancing emergency providers, stopping and managing continual diseases, and enlisting neighborhood well being employees and paramedics for residence visits.
Particular proposals embrace:
- Arkansas needs to spend $5 million by its “FAITH” program — Religion-based Entry, Interventions, Transportation, & Well being — to enlist rural non secular establishments to host training and preventive screening occasions. Congregations may additionally set up strolling circuits and health tools.
- Alaska, which traditionally relied on dogsled groups to deliver remedy to distant areas, is seeking to check using “unmanned aerial techniques” to hurry up pharmacy deliveries to such communities.
- Tennessee needs to extend entry to wholesome actions by spending cash on parks, trails, and farmers markets.
- Maryland needs to begin cell markets and set up fridges and freezers to enhance entry to contemporary, 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, mentioned he nonetheless expects rural hospitals to shut regardless of his state’s rural well being transformation program.
“I believe we’re treating signs with out curing the illness,” he mentioned after listening to a presentation on Kentucky’s proposal at a state committee assembly.
Morgan, whose group represents rural hospitals more likely to shut, mentioned the state’s concepts might sound good.
“You may craft a story that sounds great,” he mentioned. “However then translating the aspirational objectives to a functioning program? That is troublesome.”
KFF Well being Information staffers Phil Galewitz, Katheryn Houghton, Tony Leys, Jazmin Orozco Rodriguez, Maia Rosenfeld, Bram Sable-Smith, and Lauren Sausser contributed to this report.
KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is among the core working packages at KFF — the impartial supply for well being coverage analysis, polling, and journalism.
