Tory Starr is worried about the people who get medical care at Open Door Community Health Centers along California\u2019s North Coast.<\/p>\n
\u201cThey\u2019re the folks that work at restaurants. They\u2019re the teacher\u2019s aides,\u201d said Starr, a registered nurse who became Open Door\u2019s chief executive more than six years ago. Those patients, he said, are \u201creally the heart and soul of rural America.\u201d<\/p>\n
He said if his remote health centers don\u2019t get a share of the billions of dollars Congress earmarked to transform health care in rural America, patients may soon lose services. About 50% of Open Door\u2019s 60,000 patients are on Medicaid, the joint state and federal insurance program that, together with the related Children\u2019s Health Insurance Program, covers about 76 million people<\/a> with low incomes or disabilities.<\/p>\n When Congress approved the One Big Beautiful Bill Act last summer, it cut nearly $1 trillion from Medicaid over the next decade. Now, Starr hopes the $50 billion Rural Health Transformation Program, which was part of the same bill, will help keep his patients covered.<\/p>\n Yet, small community health care providers, such as Open Door, may find they are sharing the billions with an army of corporate giants before it reaches their patients.<\/p>\n Months after federal leaders announced that all 50 states won first-year awards, ranging from $147 million for New Jersey to $281 million for Texas, state plans reveal that a heavy dose of prescribed spending will go to companies that can increase the use of electronic health records, strengthen cybersecurity, and improve state and health system technology platforms.<\/p>\n And at least four large-scale coalitions of companies are now pitching multipronged services to the states. Many of the companies already work with regional health systems and states through Medicaid contracting or mobile and telehealth operations.<\/p>\n How those services will help improve the health care of rural Americans at places such as Open Door remains an open question.<\/p>\n States Stare Down Reporting Deadlines<\/strong><\/p>\n Federal regulators were \u201creally interested in seeing digital health investments\u201d when they crafted the five-year rural health program rules last year, said Maya Sandalow, an associate director at the Bipartisan Policy Center, a think tank based in Washington, D.C. She co-authored a recent report on how the 50 states plan to invest in technology, including modernizing health care infrastructure and expanding virtual care options such as telehealth and remote patient monitoring.<\/p>\n \u201cThe rural health fund isn\u2019t really designed to directly replace or offset the lost Medicaid funding,\u201d Sandalow said, noting that the federal staffers in charge of the program capped provider payments<\/a> \u2014 money that could help rural hospitals and clinics pay for patient care \u2014 at 15% of the total funding awarded to a state.<\/p>\n Federal regulators also established tight reporting deadlines, forcing states to move quickly.<\/p>\n States must file progress reports by the end of August<\/a> and obligate all first-year funding by Oct. 30<\/a>, <\/a>according to the Centers for Medicare & Medicaid Services, the federal agency overseeing the program. States could see their awards decreased or terminated at any time if they fail to follow federal requirements, according to the CMS notice of funding opportunity<\/a>.<\/p>\n As of early April, CMS had not approved or had only partially approved some state budgets, including those of Wyoming, Colorado, and Vermont, according to state officials. CMS spokesperson Catherine Howden, who declined to say which states still needed revised budgets approved, said the agency does not provide \u201cstate-by-state updates.\u201d<\/p>\n In Alaska, the budget is approved but the state has not announced when it will release full grant proposals and awards, said Tricia Franklin, program coordinator for Alaska\u2019s rural health transformation.<\/p>\n \u201cEarly summer was the target,\u201d Franklin said. But the response from vendors and applicants has been \u201cmuch greater than expected, so it may take us a little longer.\u201d<\/p>\n Working with consulting companies is an established way for states to \u201cquickly and effectively\u201d meet federal deadlines and roll out grant money, said Morgan McDonald<\/a>, national director for population health at the Milbank Memorial Fund, a nonprofit focused on state health policy work.<\/p>\n Upgrading Technology, Modernizing Rural Health<\/strong><\/p>\n Science Applications International Corp., a Fortune 500 government contractor, pulled together the Alliance for Advancing Rural Healthcare<\/a>. SAIC does a variety of technology work such as cybersecurity and engineering support. The alliance also includes Walgreens and Mission Mobile Medical, which turns RVs into primary care clinics. A data analytics company, a telemedicine and software company, and a company that helps place medical graduates in health systems are also part of the coalition.<\/p>\n The SAIC alliance offers \u201can ecosystem\u201d of companies that can coordinate the work states have promised, said Suresh Soundararajan<\/a>, SAIC\u2019s Rural Health Transformation Program lead and a former chief information officer for the Virginia Department of Health. Each of the companies has representatives focused on the rural program, he said.<\/p>\n A lack of digital infrastructure \u2014 such as electronic health records at different clinics and hospitals that can talk to one another \u2014 has been a consistent barrier for rural medical care teams, said the Bipartisan Policy Center\u2019s Sandalow.<\/p>\n \u201cThe funding hasn\u2019t always been there in order for rural areas to create the infrastructure that\u2019s needed to fully adopt remote patient monitoring, telehealth, artificial intelligence in ways that will really be supportive,\u201d Sandalow said. \u201cIt takes things like updating infrastructure, changing workflows.\u201d<\/p>\n Sandalow\u2019s recent report<\/a> found that Maine and Utah are investing in cybersecurity; Indiana, Missouri, and New Mexico plan to modernize their electronic health records; Oklahoma plans to buy hardware and software, subsidize subscriptions, and give technical support to rural providers; and states such as Arizona and South Carolina will use funds to create telehealth hubs or buy remote patient monitoring equipment.<\/p>\n Federal regulators, when creating the rural program\u2019s spending rules, also said no more than 5% of a state\u2019s total funding awarded could be used to replace electronic medical records systems that already meet federal standards. Sandalow said that means states will focus on enhancements and upgrades to their current systems.<\/p>\n Gainwell Technologies, which operates the systems for dozens of state Medicaid programs, is spearheading another coalition<\/a>. Rushil Desai, a Gainwell senior vice president, said states\u2019 detailed spending plans are \u201cchanging in real time.\u201d<\/p>\n Maine\u2019s Medicaid plan contracts with Gainwell, and the state\u2019s initial application listed four contracts worth more than $16 million over five years for the company. The state confirmed it has received federal approval for only its first year of spending, which includes a $250,000 contract<\/a> to implement changes to the state\u2019s Medicaid claims system.<\/p>\n James Lomastro, a senior-care advocate in rural Massachusetts with the nonprofit Dignity Alliance<\/a>, said he worries that large vendors and health systems will get the state\u2019s transformation dollars.<\/p>\n Clinics, home care agencies, and nursing homes that \u201cactually provide day-to-day support in the community are mostly on the margins\u201d of state discussions about how to spend the money, he said. A spokesperson for Massachusetts\u2019 Executive Office of Health and Human Services, Olivia James, said state officials would \u201censure that everyone has a seat at the table\u201d with training, financial incentives, and direct investments.<\/p>\n Arizona\u2019s rural fund budget, which is $167 million for the first year, allocates up to about $30 million<\/a> for medical diagnostic equipment and technology upgrades, including to electronic health records, specifically for rural health care facilities.<\/p>\n But it also prioritizes grants<\/a> for county public health departments, said Pima County Public Health Director Theresa Cullen. The approved budget includes up to $4 million for grants to support community health workers.<\/p>\n Tory Starr is a registered nurse and the chief executive officer of Open Door Community Health Centers.<\/p>\n \u201cIn these rural communities, you need to be present,\u201d Cullen said.<\/p>\n Alina Czekai, director of the CMS rural health transformation office, said her team plans to visit all 50 states. She spoke at the National Rural Health Association\u2019s policy conference in Washington, D.C., in February and told the audience that her team wants \u201cthe money to go to rural communities, rural providers, rural patients.\u201d The association\u2019s members include rural hospitals and clinics, which are expected to suffer big losses under the Medicaid cuts.<\/p>\n In California, Open Door\u2019s Starr said he provided input on his state\u2019s initial application, which won $234 million in first-year funding, but he is not clear on what the next steps will be for getting money from the program.<\/p>\n For his patients, Starr said, money is needed for technology upgrades. After all, he said, updated electronic health systems could operate seamlessly and store the documentation needed to keep a patient enrolled in Medicaid.<\/p>\n Updated technology could be exactly what Open Door and other area clinics need to \u201chelp keep people covered,\u201d Starr said.<\/p>\n KFF Health News senior correspondent Phil Galewitz and rural health care correspondent Arielle Zionts contributed to this report.<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/em><\/p>\n This <a target=”_blank” href=”https:\/\/kffhealthnews.org\/rural-health\/rural-health-transformation-program-cms-state-contractors-ehr-patients\/”>article<\/a><\/a>; first appeared on <a target=”_blank” href=”https:\/\/kffhealthnews.org”>KFF<\/a> Health News<\/a> and is republished here under a <a target=”_blank” href=”https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/”>Creative<\/a> Commons Attribution-NonCommercial-NoDerivatives 4.0 International License<\/a>.<img src=”https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2023\/04\/kffhealthnews-icon.png?w=150"<\/a>; style=”width:1em;height:1em;margin-left:10px;”><\/p>\n
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