Medication-delivering drones and telehealth at local libraries are among the ideas state leaders revealed in November for spending their share of a $50 billion federal rural health program.<\/p>\n
The Trump administration, which has promised \u201cradical transparency,\u201d said in an FAQ<\/a> that it plans to publish the \u201cproject summary\u201d for states that win awards. Following the lead of federal regulators, many states are withholding their complete applications, and some have refused to release any details.<\/p>\n \u201cLet\u2019s be clear,\u201d said Alan Morgan, chief executive of the National Rural Health Association. \u201cThe hospital CEOs, the clinic administrators, the community leaders: They\u2019re going to want to know what their states are doing.\u201d The NRHA\u2019s members include struggling rural hospitals and clinics, which federal lawmakers promised<\/a> would benefit from the Trump administration\u2019s Rural Health Transformation Program.<\/p>\n Morgan said his members are interested in what states propose, which of their ideas are approved or rejected, and their budget narratives, which detail how the money could be spent.<\/p>\n Improving rural health care is an \u201cinsanely complicated and difficult task,\u201d Morgan said.<\/p>\n The five-year Rural Health Transformation Program was approved by Congress in a law \u2014 the One Big Beautiful Bill Act \u2014 that also drastically cuts Medicaid spending, on which rural providers heavily depend. It\u2019s being watched closely because it\u2019s a much-needed influx of funds \u2014 with a caveat from the Trump administration that the money be spent on transformational ideas, not just to prop up ailing rural hospitals.<\/p>\n The law says half of the $50 billion will be divided equally among all states with an approved application. The rest will be distributed through a points-based system. Of the second half<\/a>, $12.5 billion will be allotted based on each state\u2019s rurality. The remaining $12.5 billion will go to states that score well<\/a> on initiatives and policies that, in part, mirror the Trump administration\u2019s \u201cMake America Healthy Again<\/a>\u201d objectives.<\/p>\n Health and Human Services Secretary Robert F. Kennedy Jr. has repeatedly promised to open the government to the American people. His agency has a webpage<\/a> devoted to \u201cradical transparency.\u201d<\/p>\n \u201cWe\u2019re working to make this the most transparent HHS in its 70-year history,\u201d Kennedy said<\/a> in written testimony to lawmakers in September<\/a>.<\/p>\n Lawrence Gostin, a professor of public health law at Georgetown University, said HHS is \u201cacting in a way that utterly lacks transparency\u201d and that the public has the right to demand \u201cgreater openness and clarity.\u201d Without transparency, the public cannot hold HHS accountable, he said.<\/p>\n Centers for Medicare & Medicaid Services spokesperson Catherine Howden said the agency will follow the federal regulations governing competitive grant materials<\/a> when releasing information about the rural health program.<\/p>\n Grant applications are \u201cnot released to the public during the merit review process,\u201d Howden said, adding, \u201cThe purpose of this policy is to protect the integrity of evaluations, applicant confidentiality, and the competitive nature of the process.\u201d<\/p>\n Democrats and many health care advocates are concerned politics will affect<\/a> how much money states get.<\/p>\n \u201cI am very concerned about retaliation,\u201d said Rep. Nikki Budzinski (D-Ill.). Because Democrats control her state\u2019s politics, \u201cour application might not be as seriously considered as other states that have Republican leadership,\u201d she added.<\/p>\n Illinois\u2019 Democratic members of the U.S. House sent a letter<\/a> to CMS Administrator Mehmet Oz in November asking for \u201cfull and fair consideration\u201d of their state application. Illinois officials have not yet released their state\u2019s proposal to KFF Health News, which has a pending public records request.<\/p>\n Heather Howard, a professor of the practice at Princeton University, said she is \u201cpleasantly surprised at how transparent the states have been.\u201d<\/p>\n Howard directs the university\u2019s State Health and Value Strategies program, which is tracking<\/a> the rural health fund, and praised most states for publicly posting their project summaries.<\/p>\n \u201cTo me, it speaks to the intense interest in this program,\u201d Howard said. Her team, reviewing about two dozen state summaries, found themes including expansion of home-based and mobile services, increased use of technology, and workforce development initiatives like scholarships, signing bonuses, and child care assistance for high-demand positions.<\/p>\n \u201cI think it\u2019s exciting,\u201d Howard said. \u201cWhat\u2019s great here is the experimentation we\u2019re going to learn from.\u201d<\/p>\n Telerobotics appeared in Georgia\u2019s and Alabama\u2019s applications, she said, including a proposal to use robotic equipment for remote ultrasounds.<\/p>\n Another theme that \u201cwarms my heart,\u201d Howard said, was the effort among states to create advisory groups or committees, including in Idaho, where work groups are expected to focus on technology, workforce development, tribal collaboration, and behavioral health.<\/p>\n All 50 states submitted applications to federal regulators by the Nov. 5 deadline and awards will be announced by the end of the year, according to CMS.<\/p>\n As of late November, nearly 40 states had released their project narrative, the main part of the application, which describes proposed initiatives, according to KFF Health News tracking. More than a dozen states have also released their budget narratives.<\/p>\n A handful of states \u2014 Idaho, Iowa, Kansas, Minnesota, New Mexico, North Dakota, South Carolina, and Wyoming \u2014 released all parts of the application.<\/p>\n KFF Health News filed public records requests for states\u2019 complete applications. Some states have refused to release any of their application materials.<\/p>\n Nebraska, for example, rejected a public records request, saying its application materials are \u201cproprietary or commercial information\u201d that \u201cwould give advantage to business competitors.\u201d<\/p>\n Kentucky shared its application summary but said the remainder of the application is a \u201cpreliminary draft\u201d not subject to release under state laws.<\/p>\n Erika Engle, a spokesperson for Hawaii Gov. Josh Green, said the governor \u201cis committed to transparency\u201d but declined to share any of the state\u2019s proposal.<\/p>\n Hawaii and other states are still processing formal public records requests.<\/p>\n The rural health program is part of the July law projected to reduce federal Medicaid spending in rural areas by $137 billion over<\/a> 10 years.<\/p>\n Those cuts are expected to affect rural health facilities\u2019 bottom lines, threatening their ability to stay open. A recent Commonwealth Fund report found that rural areas continue to lack access<\/a> to primary care. But the guidelines for the rural health program say states can use only 15% of their new funding to pay providers for patient care.<\/p>\n Between the Medicaid cuts and funding boost from the new program, \u201cthere\u2019s real opportunity for national policy to impact rural, both in the negative and the positive potentially,\u201d said Celli Horstman, a senior research associate at the New York-based policy think tank who co-authored the report.<\/p>\n Among the publicly available rural health transformation proposals, Democratic-leaning states show support, or are willing to adopt, some of the administration\u2019s goals but will lose out on points from eschewing others.<\/p>\n For example, New Mexico said it would introduce legislation requiring students to take the Presidential Fitness Test and physicians to complete continuing education courses on nutrition. But it won\u2019t prevent people from using their Supplemental Nutrition Assistance Program benefits to buy \u201cnon-nutritious\u201d foods such as soda and candy.<\/p>\n Many states want to invest in technology, including telehealth, cybersecurity, and remote patient monitoring equipment. Other themes include increasing access to healthy food, improving emergency services, preventing and managing chronic illnesses, and enlisting community health workers and paramedics for home visits.<\/p>\n Specific proposals include:<\/p>\n Arkansas wants to spend $5 million through its \u201cFAITH\u201d program \u2014 Faith-based Access, Interventions, Transportation, & Health \u2014 to enlist rural religious institutions to host education and preventive screening events. Congregations could also install walking circuits and fitness equipment.<\/p>\n Alaska, which historically relied on dogsled teams to bring medication to remote areas, is looking to test the use of “unmanned aerial systems” to speed up pharmacy deliveries to such communities.<\/p>\n Tennessee wants to increase access to healthy activities by spending money on parks, trails, and farmers markets.<\/p>\n Maryland wants to start mobile markets and install refrigerators and freezers to improve access to fresh, healthy food that often spoils in rural areas with few grocery stores.<\/p>\n State Sen. Stephen Meredith, a Republican who represents part of western Kentucky, said he still expects rural hospitals to close despite his state\u2019s rural health transformation program.<\/p>\n \u201cI think we\u2019re treating symptoms without curing the disease,\u201d he said after listening to a presentation on Kentucky\u2019s proposal at a state committee meeting<\/a>.<\/p>\n Morgan, whose organization represents rural hospitals likely to close, said the state\u2019s ideas may sound good.<\/p>\n \u201cYou can craft a narrative that sounds wonderful,\u201d he said. \u201cBut then translating the aspirational goals to a functioning program? That\u2019s difficult.\u201d<\/p>\n KFF Health News staffers Phil Galewitz, Katheryn Houghton, Tony Leys, Jazmin Orozco Rodriguez, Maia Rosenfeld, Bram Sable-Smith, and Lauren Sausser 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>.<\/p>\nUSE OUR CONTENT<\/h3>\n