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 “undertaking abstract” for states that win awards. Following the lead of federal regulators, many states are withholding their full functions, 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 group leaders: They’ll wish to know what their states are doing.” The NRHA’s members embody 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 enthusiastic about what states suggest, which of their concepts are authorized or rejected, and their finances narratives, which element how the cash could possibly be spent.
Enhancing rural well being care is an “insanely sophisticated and tough job,” Morgan mentioned.
The five-year Rural Well being Transformation Program was authorized by Congress in a regulation — the One Massive Lovely 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 regulation says half of the $50 billion will probably be divided equally amongst all states with an authorized software. The remaining will probably be distributed by way of 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 rating effectively on initiatives and insurance policies that, partially, mirror the Trump administration’s “Make America Wholesome Once more” goals.
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 regulation at Georgetown College, mentioned HHS is “performing in a means that totally 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 observe the federal laws governing aggressive grant supplies when releasing details about the agricultural well being program.
Grant functions are “not launched to the general public throughout the benefit overview 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-Ailing.). As a result of Democrats management her state’s politics, “our software may not be as critically 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 truthful 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 data request.
Heather Howard, a professor of the apply at Princeton College, mentioned she is “pleasantly shocked 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 undertaking summaries.
“To me, it speaks to the extreme curiosity on this program,” Howard mentioned. Her staff, reviewing about two dozen state summaries, discovered themes together with growth of home-based and cell companies, elevated use of know-how, and workforce improvement 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’ll study from.”
Telerobotics appeared in Georgia’s and Alabama’s functions, she mentioned, together with a proposal to make use of robotic gear 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 give attention to know-how, workforce improvement, tribal collaboration, and behavioral well being.
All 50 states submitted functions to federal regulators by the Nov. 5 deadline and awards will probably be introduced by the tip of the yr, in keeping with CMS.
As of late November, almost 40 states had launched their undertaking narrative, the principle a part of the appliance, which describes proposed initiatives, in keeping 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 components of the appliance.
KFF Well being Information filed public data requests for states’ full functions. Some states have refused to launch any of their software supplies.
Nebraska, for instance, rejected a public data request, saying its software supplies are “proprietary or industrial data” that “would give benefit to enterprise rivals.”
Kentucky shared its software abstract however mentioned the rest of the appliance is a “preliminary draft” not topic to launch underneath 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 data requests.
The agricultural well being program is a part of the July regulation projected to cut 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 services’ backside traces, threatening their capability to remain open. A current Commonwealth Fund report discovered that rural areas proceed to lack entry to main 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 increase from the brand new program, “there’s actual alternative for nationwide coverage to impression rural, each within the damaging and the optimistic doubtlessly,” mentioned Celli Horstman, a senior analysis affiliate on the New York-based coverage assume tank who co-authored the report.
Among the many publicly accessible rural well being transformation proposals, Democratic-leaning states present help, or are prepared to undertake, a few of the administration’s targets 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 schooling programs on diet. However it will not forestall folks from utilizing their Supplemental Diet Help 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 gear. Different themes embody growing entry to wholesome meals, enhancing emergency companies, stopping and managing power diseases, and enlisting group well being staff and paramedics for dwelling visits.
Particular proposals embody:
- Arkansas desires to spend $5 million by way of its “FAITH” program — Religion-based Entry, Interventions, Transportation, & Well being — to enlist rural spiritual establishments to host schooling and preventive screening occasions. Congregations may additionally set up strolling circuits and health gear.
- Alaska, which traditionally relied on dogsled groups to carry medicine to distant areas, is trying to take a look at the usage of “unmanned aerial programs” 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 cell 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, 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 could sound good.
“You’ll be able to craft a story that sounds fantastic,” he mentioned. “However then translating the aspirational targets to a functioning program? That is tough.”
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 likely one of the core working packages at KFF — the impartial supply for well being coverage analysis, polling, and journalism.
