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 “project summary” 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 administrators, the community leaders: They’re going to want 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 considering 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 complicated and difficult task,” Morgan mentioned.
The five-year Rural Well being Transformation Program was authorized by Congress in a regulation — the One Large Lovely Invoice Act — that additionally drastically cuts Medicaid spending, on which rural suppliers closely rely. It’s being watched intently as a result of it’s 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 can be divided equally amongst all states with an authorized utility. The remainder can be distributed via 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 Healthy Again” targets.
Well being and Human Companies Secretary Robert F. Kennedy Jr. has repeatedly promised to open the federal government to the American individuals. His company has a webpage dedicated to “radical transparency.”
“We’re working to make this the most transparent HHS in its 70-year history,” Kennedy mentioned in written testimony to lawmakers in September.
Lawrence Gostin, a professor of public well being regulation at Georgetown College, mentioned HHS is “acting in a way that utterly lacks transparency” and that the general public has the proper to demand “greater openness and clarity.” With out transparency, the general public can’t maintain HHS accountable, he mentioned.
Facilities for Medicare & Medicaid Companies 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 purposes are “not released to the public during the merit review process,” Howden mentioned, including, “The purpose of this policy is to protect the integrity of evaluations, applicant confidentiality, and the competitive nature of the process.”
Democrats and lots of well being care advocates are involved politics will have an effect on how a lot cash states get.
“I am very concerned about retaliation,” mentioned Rep. Nikki Budzinski (D-Ailing.). As a result of Democrats management her state’s politics, “our application might not be as seriously considered as other states that have Republican leadership,” she added.
Illinois’ Democratic members of the U.S. Home despatched a letter to CMS Administrator Mehmet Oz in November asking for “full and fair consideration” of their state utility. 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 observe at Princeton College, mentioned she is “pleasantly surprised at how transparent 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 intense interest in this program,” Howard mentioned. Her staff, reviewing about two dozen state summaries, discovered themes together with enlargement of home-based and cell providers, elevated use of expertise, and workforce improvement initiatives like scholarships, signing bonuses, and youngster care help for high-demand positions.
“I think it’s exciting,” Howard mentioned. “What’s great here is the experimentation we’re going to learn 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 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 expertise, workforce improvement, tribal collaboration, and behavioral well being.
All 50 states submitted purposes to federal regulators by the Nov. 5 deadline and awards can be introduced by the top of the 12 months, in keeping with CMS.
As of late November, practically 40 states had launched their undertaking narrative, the primary a part of the applying, 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 elements of the applying.
KFF Well being Information filed public data requests for states’ full purposes. Some states have refused to launch any of their utility supplies.
Nebraska, for instance, rejected a public data request, saying its utility supplies are “proprietary or commercial information” that “would give advantage to business competitors.”
Kentucky shared its utility abstract however mentioned the rest of the applying 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 committed 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 amenities’ backside traces, threatening their skill 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 increase from the brand new program, “there’s real opportunity for national policy to impact rural, both in the negative and the positive potentially,” mentioned Celli Horstman, a senior analysis affiliate on the New York-based coverage assume tank who co-authored the report.
Among the many publicly obtainable rural well being transformation proposals, Democratic-leaning states present assist, or are prepared to undertake, among 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 gained’t forestall individuals from utilizing their Supplemental Diet Help Program advantages to purchase “non-nutritious” meals comparable to soda and sweet.
Many states need to spend money on expertise, together with telehealth, cybersecurity, and distant affected person monitoring tools. Different themes embody growing entry to wholesome meals, enhancing emergency providers, stopping and managing power diseases, and enlisting group well being employees and paramedics for dwelling visits.
Particular proposals embody:
- Arkansas desires to spend $5 million via 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 tools.
- Alaska, which traditionally relied on dogsled groups to convey treatment to distant areas, is trying to take a look at the usage of “unmanned aerial systems” 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 always 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 think we’re treating symptoms without curing the disease,” 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 can craft a narrative that sounds wonderful,” he mentioned. “But then translating the aspirational goals to a functioning program? That’s difficult.”
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.
