Drones delivering medicine. Telehealth in libraries. Wellness activities conducted by the church.
Those are some of the ideas states have proposed in their bids for part of the new $50 billion federal rural health care transformation program. Congress approved a five-year spending plan in the One Big Beautiful Bill Act, the same legislation that enshrined nearly $1 trillion in cuts to Medicaid.
The legislation is expected to have a huge impact on rural America, where cuts are expected to reduce health care funding by $137 billion more than 10 years.
So how rural health fund money is distributed is closely watched by people like Alan Morgan, executive director of the National Rural Health Association. State applications were due in early November, and federal officials have promised to announce awards by Dec. 31.
“Let’s be clear,” Morgan said. “Hospital CEOs, clinic administrators, community leaders: They're going to want to know what their states are doing.”
As of last week, nearly 40 states had stories about projects publishedthe main part of the application, which describes the initiatives they propose. These include Maryland's plan to create demand for healthy foods in addition to increasing their supply.
“Many rural children and adults in Maryland have low intakes of fruits, vegetables and water and limited physical activity,” the state said in a statement. Among other initiatives, officials are proposing to open mobile markets and install refrigerators and freezers to improve access in rural areas with limited grocery stores.
More than a dozen states also released their budget reports. And several states—Idaho, Iowa, Kansas, Maine, Minnesota, New Mexico, North Dakota, Pennsylvania, South Carolina and Wyoming—have released their full applications.
KFF Health News collected application documents from both informal and formal public records requests and published them. on the map.
Heather Howard, a professor of practice at Princeton University, said she was “pleasantly surprised by how transparent the states have been.” Princeton's Health Strategies and Values Program also government document tracking.
But others are unhappy with what federal regulators are publishing (or not publishing). Centers for Medicare and Medicaid Services spokeswoman Katherine Howden said the applications will not be released while they are under review.
CMS plans to follow federal laws regulation of competitive grant materials releasing information about the rural health program, Howden said.
In Illinois, where Democrats control state politics, Rep. Nikki Budzinski joined other Democratic members of the state's delegation to the U.S. House of Representatives. sending a letter to CMS Administrator Mehmet Oz last month, asking for a “full and fair review” of their state's application.
“I’m very concerned about retaliation,” she said.
