In Maine, state well being officers hoped to steer a slice of $190 million in new federal rural well being funding to protect hospitals and clinics from the fallout brought on by cuts to federal well being applications.
Their plan would have helped pay to deal with low-income, uninsured sufferers.
However federal leaders overseeing the five-year, $50 billion Rural Well being Transformation Program stated no.
“It was not our decision,” stated Lisa Letourneau, a senior adviser at Maine’s well being division.
Letourneau instructed an viewers of healthcare suppliers, advocates, and group teams throughout a March webinar that the change was “disappointing.”
Maine isn’t alone in having to make adjustments to plans pitched to win a share of the Trump administration’s new rural well being fund.
Facilities for Medicare & Medicaid Providers Administrator Mehmet Oz praised states’ plans when asserting the agricultural well being program awards final yr and stated his company would assist states “turn their ideas into lasting improvements for rural families.”
However state officers and healthcare leaders stated it’s additionally clear the company needs to encourage particular coverage adjustments and maintain states accountable to the guarantees they made and guidelines they agreed to comply with.
Through the previous six months, as states raced to fulfill this system’s looming federal deadlines, CMS staffers labored with state well being departments to make a flurry of adjustments, together with scrapping some initiatives. The federal company has the facility to rescind present funding — or cut back future awards — if states don’t comply with guidelines or meet their objectives. “We will take the money back” if states “don’t abide by what they wrote, if they don’t do a good job,” Oz stated at an occasion this month in Washington, D.C.
Congressional Republicans created the Rural Well being Transformation Program as a last-minute sweetener of their One Huge Stunning Invoice Act final summer season. The funding was supposed to offset issues concerning the outsize fallout anticipated in rural communities from the regulation, which is anticipated to scale back Medicaid spending by greater than $900 billion over a decade.
On a name with reporters in December, Oz stated “one of the smartest things the president and Congress” did when creating this system was to create a menace of “clawbacks,” or taking a reimbursement if states don’t do what they promised of their purposes.
Oz went on to explain how the clawback mechanism provides governors leverage to press their legislatures to undertake the Trump administration’s priorities, akin to instituting the presidential health take a look at in faculties.
“This gives you extra umph, a little bit of gusto to go after these issues,” he stated.
That message was obtained loudly and clearly in Tennessee. Michael Hendrix, coverage director for the governor’s workplace, stated throughout a listening to that federal officers stated the state “would be more competitive for more funding through policy change.” He stated CMS additionally relayed that “some share of this year’s funding, if policies are not implemented, might be clawed back.”
The specter of rescinding funding has precipitated worry and confusion amongst well being group leaders, stated Alan Morgan, CEO of the Nationwide Rural Well being Affiliation.
“We’re worried that facilities and organizations won’t apply for the grant money because of the fears of the clawbacks,” he stated, including that he would really like the administration to make clear if federal officers might take again grant cash that states have already awarded to rural well being organizations.
Whereas clawbacks are a “necessary, important tool” to handle misuse of funds and make sure the cash goes towards serving to rural communities, they’re additionally “a dangerous tool,” stated Morgan, whose group represents rural hospitals and clinics.
CMS didn’t reply to a number of requests for remark.
States should file progress studies by the tip of August. They then have till Oct. 30 to commit their first-year funding and Sept. 30, 2027, to spend it.
States are progressing at wildly completely different charges, with some nonetheless creating grant purposes and others already distributing cash, based on a tracker created by Morgan’s rural well being affiliation.
In late January, Iowa grew to become the primary to award funding. The tracker reveals that the majority states have opened grant purposes, however 11 others, together with Wyoming, Maine, and Colorado, have but to publish any funding alternatives.
CMS’ tight management over state applications is one motive for such disparity in progress.
As an alternative of typical grants, the agricultural well being program makes use of cooperative agreements, which require a back-and-forth partnership, stated Charlie Sagona, a grant specialist at Assel Grant Providers, a consulting agency that helps organizations handle grants.
“You are going to be working very, very closely with them; things will ebb and flow and change and move,” stated Sagona, who helps a number of massive hospital techniques all in favour of successful among the rural funding.
Kate Sapra, deputy director of CMS’ Workplace of Rural Well being Transformation, stated at a Might occasion that the company has “many avenues of oversight.” Staffers are monitoring purposes for state funding and “looking to see when contracts are executed,” she stated.
Sapra stated the company needs to “have conversations with states before they get to the point” of placing out one thing that’s not allowed. It’s “really important to us” for the funding to achieve rural suppliers, she added.
Sapra stated her workplace has stuffed about half of 30 new slots for undertaking officers. The officers and the states examine in “at least twice a month, if not on a weekly basis.”
Vermont Medicaid Director Jill Mazza Olson, who led her state’s rural well being software, stated the officers are “very responsive.”
Vermont is without doubt one of the states that needed to ditch or tweak its plans. Olson stated the state pulled its plan to extend housing for rural healthcare staff after federal officers stated they might consider the proposal based mostly on the company’s pointers for building tasks at healthcare services. These guidelines enable solely “minor” renovations to present buildings or campuses.
In Colorado, state leaders modified grant eligibility guidelines after they “received feedback” from CMS and healthcare suppliers, stated Marc Williams, a spokesperson for the state’s Division of Well being Care Coverage and Financing.
Wyoming legislators and state officers spent months designing, discussing, and voting on a plan to take a position most of its award right into a perpetuity fund that might have generated $28.5 million for the state to spend yearly, “forever,” based on supplies offered to lawmakers.
The state needed to pull the thought as a result of it “was a degree too innovative for CMS to swallow,” stated Republican state Sen. Charles Scott, a veteran lawmaker and cattle rancher. “This whole thing has been a bit of a disappointment to us in Wyoming.”
Stefan Johansson, director of the state’s well being division, stated Wyoming’s last spending plan wasn’t accepted till mid- to late Might. He stated the division hopes to start awarding cash in late summer season or early fall.
“Make no mistake — it is a very compressed timeline,” he stated.
Throughout the nation, Maine was compelled to remodel its plan to reimburse hospitals and clinics once they present “essential” care to sure uninsured sufferers.
Letourneau stated throughout her March remarks that federal officers rejected this concept as a result of “provider payments had to be more directly linked to a rural transformation kind of activity.”
Lindsay Hammes, a spokesperson for Maine’s well being division, instructed KFF Well being Information that funding will as a substitute assist suppliers transition to reimbursement fashions that aren’t based mostly on what number of sufferers they deal with.
Reworked plans name for spending $28.5 million to assist suppliers, Letourneau stated in March.
“But there definitely will be more strings attached.”
KFF Well being Information correspondent Darius Tahir contributed to this report.
