{"id":2113931,"date":"2025-11-07T05:00:00","date_gmt":"2025-11-07T10:00:00","guid":{"rendered":"https:\/\/kffhealthnews.org\/?post_type=article&#038;p=2113931"},"modified":"2025-11-07T08:17:18","modified_gmt":"2025-11-07T13:17:18","slug":"states-competing-rural-health-transformation-program-cms","status":"publish","type":"article","link":"https:\/\/kffhealthnews.org\/news\/article\/states-competing-rural-health-transformation-program-cms\/","title":{"rendered":"Concerns Over Fairness, Access Rise as States Compete for Slice of $50B Rural Health Fund"},"content":{"rendered":"\n<p>RAPID CITY, S.D. \u2014 Echo Kopplin wants South Dakota\u2019s leaders to know that money from a new $50 billion federal rural health fund should help residents with limited transportation options.<\/p>\n\n\n\n<aside class=\"block--sidebar alignright \">\n\t\n\n<div class=\"wp-block-kaiser-health-news-partner block--partner\">\n\t\t\t\t<h3 class=\"partner__header\">\n\t\t\tUse Our Content\t\t<\/h3>\n\t\t<p class=\"partner__content\">\n\t\t  It can be <a href=\"https:\/\/kffhealthnews.org\/news\/article\/states-competing-rural-health-transformation-program-cms\/view\/republish\/\">republished for free.<\/a>\t<\/p>\n<\/div>\n\n<\/aside>\n\n\n\n<p>Kopplin, a physician assistant who works with seniors, low-income people, and mental health patients in the rural Black Hills, shared her thoughts at a meeting hosted by state officials.<\/p>\n\n\n\n<p>South Dakota\u2019s leaders did a \u201cgood job of diving in\u201d and asking questions to get \u201cdeeper at the root of the problem,\u201d she said.<\/p>\n\n\n\n<p>Kopplin later told KFF Health News how one of her rural patients recently missed two appointments because of a broken-down car and no access to public transportation.<\/p>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"900\" height=\"1184\" src=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/11\/Kopplin.jpg\" alt=\"A photo of a woman taking a selfie indoors. A stethoscope is around her neck.\" class=\"wp-image-2113981\" style=\"width:362px;height:auto\" srcset=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/11\/Kopplin.jpg 900w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/11\/Kopplin.jpg?resize=114,150 114w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/11\/Kopplin.jpg?resize=380,500 380w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/11\/Kopplin.jpg?resize=768,1010 768w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/11\/Kopplin.jpg?resize=120,158 120w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/11\/Kopplin.jpg?resize=170,224 170w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/11\/Kopplin.jpg?resize=300,395 300w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/11\/Kopplin.jpg?resize=500,658 500w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/11\/Kopplin.jpg?resize=315,414 315w, https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/11\/Kopplin.jpg?resize=630,829 630w\" sizes=\"auto, (max-width: 900px) 100vw, 900px\" \/><figcaption class=\"wp-element-caption\">Echo Kopplin, a physician assistant in rural South Dakota, says she&#8217;s glad officials hosted public meetings across the state to hear from &#8220;front-line workers&#8221; before crafting their application to the Rural Health Transformation Program.<span class=\"photo-credit\">(Echo Kopplin)<\/span><\/figcaption><\/figure>\n\n\n\n<p>Nationwide, health care workers like Kopplin and thousands of others \u2014 from patient advocates to technology executives \u2014 flocked to town halls or online portals during the seven weeks state leaders had to craft and submit their applications for the Rural Health Transformation Program to the federal Centers for Medicare &amp; Medicaid Services. That deadline was Nov. 5.<\/p>\n\n\n\n<p>\u201cWe will give $50 billion away by the end of the year,\u201d CMS Administrator Mehmet Oz said Nov. 6 at a Milken Institute event in Washington. He said all 50 states had submitted applications.<\/p>\n\n\n\n<p>The program will \u201callow us to right-size the health care system,\u201d Oz said, adding that innovations from the rural work \u201cwill spill over to suburban and urban America as well.\u201d<\/p>\n\n\n\n<p>Among applications and summaries publicly shared by states, themes include workforce development, telehealth, and access to healthy food. In Kansas, leaders want to build a \u201cFood is Medicine\u201d program. Wyoming officials propose a new program called \u201cBearCare,\u201d a state-sponsored health insurance plan that patients could use only after medical emergencies.<\/p>\n\n\n\n<p>But many health policy experts and Democrats are raising alarms that the Republican-backed program will become a \u201cslush fund.\u201d Critics worry it will fail to reach the small-town patients they say need it most, especially as states face nearly a trillion dollars in Medicaid spending reductions over the next decade. Medicaid, a joint federal-state program, serves nearly <a href=\"https:\/\/www.kff.org\/medicaid\/5-key-facts-about-medicaid-coverage-for-people-living-in-rural-areas\/#:~:text=1.,at%20the%20p%20%3C%200.05%20level.\">1 in 4<\/a> rural Americans.<\/p>\n\n\n\n<p>\u201cThe status quo is tremendous distress in rural communities,\u201d said Heather Howard, a professor of the practice at Princeton University and director of the university\u2019s State Health and Value Strategies program, which is tracking the rural health fund. The new funding won\u2019t be enough to offset the Medicaid losses, she said.<\/p>\n\n\n<div\n\tclass=\"wp-block block--newsletter  \"\n\tdata-type=\"kaiser-health-news\/newsletter\"\n\tdata-align=\"center\"\n\tstyle=\"\"\n>\n\t<h4 class=\"newsletter__title\">\n\t\t<a href=\"\/email\/\">\n\t\t\tEmail Sign-Up\t\t<\/a>\n\t<\/h4>\n\t<p class=\"newsletter__description\">\n\t\tSubscribe to KFF Health News&#039; free weekly newsletter, &quot;The Week in Brief.&quot;\t<\/p>\n\t\n<form\n\taction=\"\/email-signup\/\"\n\tclass=\"kaiser-hubspot-mini-signup-form\"\n\tmethod=\"post\"\n>\n\t<input type=\"hidden\" id=\"kaiser_hubspot_nonce\" name=\"kaiser_hubspot_nonce\" value=\"9a9925ea75\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/article\/2113931\" \/>\t\t\t\t<label\n\t\tclass=\"kaiser-hubspot-mini-signup-form__label--email\"\n\t\tfor=\"kaiser-hubspot-mini-signup-form-email\"\n\t>\n\t\t<span class=\"screen-reader-text\">\n\t\t\tYour Email Address\t\t<\/span>\n\t\t<input\n\t\t\tautocomplete=\"email\"\n\t\t\tclass=\"kaiser-hubspot-mini-signup-form__input--email\"\n\t\t\tid=\"kaiser-hubspot-mini-signup-form-email\"\n\t\t\tname=\"kaiser_hubspot_email\"\n\t\t\ttype=\"email\"\n\t\t\t\t\t\t\tplaceholder=\"Your email address\"\n\t\t\t\t\t\/>\n\t<\/label>\n\t<button class=\"kaiser-hubspot-mini-signup-form__submit\">\n\t\tSign Up\t<\/button>\n<\/form>\n<\/div>\n\n\n\n<p>Congressional Republicans added the five-year, $50 billion Rural Health Transformation Program as a last-minute sweetener to President Donald Trump\u2019s massive tax-and-spending legislation. The move helped win support for the One Big Beautiful Bill Act from conservative holdouts who worried that the Medicaid cuts in the bill would harm rural hospitals in their states.<\/p>\n\n\n\n<p>In Montana, which hosted an online public forum before submitting its application, a nonprofit director pitched youth peer support as a way of battling high suicide rates. A registered nurse asked state leaders to \u201cthink maybe even bigger\u201d and consider statewide universal health care.<\/p>\n\n\n\n<p>And in Georgia, a technology-focused chain of primary care clinics that serves seniors proposed expanding its operations into that state in its online public comment. A rural grant writer asked for \u201csafe and stable housing.\u201d<\/p>\n\n\n\n<p>The law says half of the $50 billion will be divided equally among all states with an approved application. The rest will be doled out according to a points-based system. Of <a href=\"https:\/\/www.documentcloud.org\/documents\/26181303-workload-funding-split-10-06\/\">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 <a href=\"https:\/\/www.documentcloud.org\/documents\/26179766-points-scoring-screenshot-2025-10-03\/\">score well<\/a> on initiatives and policies that, in part, mirror the Trump administration\u2019s \u201c<a href=\"https:\/\/www.cms.gov\/priorities\/innovation\/about\/cms-innovation-center-strategy-make-america-healthy-again\">Make America Healthy Again<\/a>\u201d objectives.<\/p>\n\n\n\n<p>Top Senate Democrats have raised alarms about the rural health program. They include Ron Wyden of Oregon and Tina Smith of Minnesota, who <a href=\"https:\/\/www.finance.senate.gov\/ranking-members-news\/wyden-and-smith-call-on-watchdog-to-review-slush-funds-in-republican-budget-bill\">called on<\/a> a federal watchdog agency to investigate the fairness and implementation of the fund. Taylor Harvey, a Wyden aide, said the Government Accountability Office has confirmed it will investigate.<\/p>\n\n\n\n<p>According to <a href=\"https:\/\/www.documentcloud.org\/documents\/26217694-the-rhtp-law-pl-119-21-section-71401-508\/#document\/p3\/a2676470\">the federal statute<\/a><a href=\"https:\/\/www.documentcloud.org\/documents\/26217694-the-rhtp-law-pl-119-21-section-71401-508\/#document\/p3\/a2676470\"><\/a>, no less than a quarter of states with an approved application may share the second half of the funding each fiscal year, CMS spokesperson Catherine Howden said. The agency plans to publish summaries of approved state projects, <a href=\"https:\/\/www.cms.gov\/files\/document\/rural-health-transformation-frequently-asked-questions.pdf\">according to CMS guidance<\/a>.<\/p>\n\n\n\n<p>A handful of conservative-leaning states \u2014 including Texas, Arkansas, Louisiana, and Oklahoma \u2014 have already instituted regulatory and legislative initiatives, such as prohibiting \u201cnon-nutritious\u201d foods in benefit programs, that <a href=\"https:\/\/embed.documentcloud.org\/documents\/26217729\/annotations\/2676492\/?embed=1\">garner additional points<\/a> in the program application process.<\/p>\n\n\n\n<p>Michael Chameides, a county supervisor in rural New York, said he fears the money could \u201cbe used in ways that would hurt certain states or reward certain states.\u201d Chameides is also the communications and policy director with the Rural Democracy Initiative, a national advocacy organization that released <a href=\"https:\/\/ruralpolicyaction.us\/wp-content\/uploads\/2025\/11\/Rural-Policy-Action-Report-2025.pdf\">a rural action report<\/a> last month.<\/p>\n\n\n\n<p>Edwin Park, a research professor at Georgetown University\u2019s Center for Children and Families, said federal lawmakers gave Oz and his agency \u201creally excessive discretion\u201d when awarding the money.<\/p>\n\n\n\n<p>Federal administrators have added rules that aren\u2019t within the statute that created the program, Park said. For example, its application guidelines say states cannot use more than 15% of their funding to pay providers for patient care \u2014 payments that are expected to take a hit due to the Medicaid cuts.<\/p>\n\n\n\n<p>Georgetown\u2019s health policy experts and Democrats aren\u2019t the only ones with concerns. <a href=\"https:\/\/www.cleveland.com\/news\/2025\/09\/ohio-republicans-move-to-block-urban-hospitals-from-taking-rural-health-dollars.html\">Some Republicans<\/a> and <a href=\"https:\/\/www.dispatch.com\/story\/news\/healthcare\/2025\/08\/05\/rural-independent-ohio-hospitals-team-up-for-say-in-federal-spending\/85462191007\/?gnt-cfr=1&amp;gca-cat=p&amp;gca-uir=true&amp;gca-epti=z114947p000650c000650d00----v114947b0059xxd005965&amp;gca-ft=195&amp;gca-ds=sophi&amp;sltsgmt=0154_A\">small hospitals<\/a> in Ohio worry the money will go to large health systems instead of smaller, independent hospitals that serve people within their rural communities.<\/p>\n\n\n\n<p>CMS\u2019 Oz repeated the idea of getting \u201cbig hospitals to adopt smaller institutions\u201d at the Washington gathering after applications were filed. He used similar language at a rural health summit hosted by South Dakota-based Sanford Health. \u201cHow do we get big hospitals to adopt smaller hospitals? Not to take them over, but to keep them viable by giving them good telehealth services, specialty support, radiology support,\u201d he said at the October event.<\/p>\n\n\n\n<p>Sanford owns or manages dozens of hospitals and hundreds of clinics and long-term care centers, as well as a health insurance company. The system reported about $81 million in operating income during the first six months of fiscal year 2025, according to <a href=\"https:\/\/www.fitchratings.com\/research\/us-public-finance\/fitch-rates-sanford-health-sd-ser-2025-revs-aa-f1-affirms-outstanding-debt-outlook-stable-24-07-2025\">a recent bond rating report<\/a>.<\/p>\n\n\n\n<p>Last year, Sanford opened a \u201ccommand center\u201d for its systemwide telehealth initiative. It launched a telehealth expansion in 2021 and offers virtual care for 78 medical specialties, Sanford President and CEO Bill Gassen said.<\/p>\n\n\n\n<p>\u201cWe\u2019ve tried to imagine, what if that number doubles?\u201d Gassen said. The startup costs for telehealth are high, he said, and the rural fund could be a unique opportunity \u201cfor us to make virtual care available to more patients, to more communities, to more hospitals and health systems across the country.\u201d<\/p>\n\n\n\n<p>Gassen, who is set to chair the American Hospital Association in 2027, said Sanford leaders have met with state and federal officials, including Oz, whom he\u2019s known for years, and Chris Klomp, a top deputy at CMS and a senior adviser to Health and Human Services Secretary Robert F. Kennedy Jr.<\/p>\n\n\n\n<p>The word \u201ctelehealth\u201d appears 36 times in the rural health program\u2019s 124-page application guidelines. But Don Robbins Jr., chief executive of a small hospital on the Illinois-Kentucky border, chuckled at the idea of using the funding for that purpose.<\/p>\n\n\n\n<p>Robbins, whose 25-bed Massac Memorial Hospital averages five to seven patients in its beds each day, said his hospital does not regularly offer telehealth. Even if it did, he said, patients living more than a mile outside of town couldn\u2019t use it because they don\u2019t have a good internet connection.<\/p>\n\n\n\n<p>The small hospital reported a $31,314 loss in September, Robbins said. \u201cI think if we get anything out of it,\u201d Robbins said of the rural health program, \u201cwe\u2019ll be lucky.\u201d<\/p>\n\n\n\n<p>Kopplin, the physician assistant who attended the South Dakota meeting, is cautiously optimistic about the rural health fund. She views it as a wonderful chance for states to test out ideas and learn from what works and what doesn\u2019t.<\/p>\n\n\n\n<p>But \u201cin a lot of ways this bill is going to be a band-aid approach\u201d for rural health, she said. \u201cIt&#8217;s not really going to fix the problem.\u201d<\/p>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Amid public forums and local cries for help, states are also talking with large health systems, technology companies, and others amid intensifying competition for shares of a $50 billion fund to improve rural health.<\/p>\n","protected":false},"featured_media":2113980,"template":"","meta":{"_cr_original_post":"","_cr_replace_post_id":"","_cr_replacing_post_id":"","jetpack_post_was_ever_published":false,"kff_featured_video":0,"kff_show_featured_video":false,"kff_show_mute_audio_button":false,"custom_shortlink":"\/MjExMzkzMQ","kaiser_health_news_byline_override":"","kaiser_health_news_can_republish":true,"kaiser_health_news_featured_image_caption":"","kaiser_health_news_header_overlay_color":"","kaiser_health_news_header_theme_slug":"","kaiser_health_news_hero_image":0,"kaiser_health_news_backdrop_padding":115,"kaiser_health_news_hide_partner":false,"kaiser_health_news_kicker":"","kaiser_health_news_kicker_background_color":"","kaiser_health_news_kicker_text_color":"","kaiser_health_news_kicker_url":"","kaiser_health_news_nav_theme_slug":"compact","kaiser_health_news_nav_transparency":false,"kaiser_health_news_sharing_title":"","kaiser_health_news_show_featured_image":true,"kaiser_health_news_subheadline":"","kaiser_health_news_suppress_kicker":false,"kaiser_health_news_suppress_subheadline":false,"kaiser_health_news_update_time":"","kaiser_health_news_vertical_image":0,"kaiser_health_news_title_align_left":false,"kaiser_health_news_custom_header_image":0,"photo_byline":[],"story_update":"","update_position":"bottom","kaiser_syndication_sites":[],"apple_news_api_created_at":"2025-11-07T10:11:05Z","apple_news_api_id":"ed08ab22-9ede-4c88-8a54-fe4ec44450a1","apple_news_api_modified_at":"2025-11-07T13:17:24Z","apple_news_api_revision":"AAAAAAAAAAAAAAAAAAAAAA==","apple_news_api_share_url":"https:\/\/apple.news\/A7QirIp7eTIiKVP5OxERQoQ","apple_news_cover_media_provider":"image","apple_news_coverimage":0,"apple_news_coverimage_caption":"","apple_news_cover_video_id":0,"apple_news_cover_video_url":"","apple_news_cover_embedwebvideo_url":"","apple_news_is_hidden":"","apple_news_is_paid":"","apple_news_is_preview":"","apple_news_is_sponsored":"","apple_news_maturity_rating":"","apple_news_metadata":"\"\"","apple_news_pullquote":"","apple_news_pullquote_position":"","apple_news_slug":"","apple_news_sections":["https:\/\/news-api.apple.com\/sections\/20265c01-23d7-4d15-96e0-0691b89c3772"],"apple_news_suppress_video_url":false,"apple_news_use_image_component":false,"footnotes":""},"categories":[439525647,439525648,10314551,439528530,31304,36835],"tags":[50255,646,22721,11106,14041,59349,59350,3837,4614,4458,303404682,303298089,1575],"primary-topic":[],"partners":[],"funder":[439527044,439528999,439525512,439527043,439528750],"coauthors":[439524138,439529015],"class_list":["post-2113931","article","type-article","status-publish","has-post-thumbnail","hentry","category-midwest-bureau","category-mountain-states-bureau","category-rural-health","category-southern-bureau","category-states","category-syndicate","tag-arkansas","tag-cms","tag-georgia","tag-illinois","tag-kansas","tag-kentucky","tag-louisiana","tag-montana","tag-new-york","tag-ohio","tag-oklahoma","tag-south-dakota","tag-texas","funder-headwaters-foundation","funder-helmsley-charitable-trust","funder-missouri-foundation-for-health","funder-montana-healthcare-foundation","funder-robert-wood-johnson-foundation"],"apple_news_notices":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.9 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Concerns Over Fairness, Access Rise as States Compete for Slice of $50B Rural Health Fund - KFF Health News<\/title>\n<meta name=\"description\" content=\"Amid public forums and local cries for help, states are also talking with large health systems, technology companies, and others amid intensifying competition for shares of a $50 billion fund to improve rural health.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/kffhealthnews.org\/news\/article\/states-competing-rural-health-transformation-program-cms\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Concerns Over Fairness, Access Rise as States Compete for Slice of $50B Rural Health Fund - KFF Health News\" \/>\n<meta property=\"og:description\" content=\"Amid public forums and local cries for help, states are also talking with large health systems, technology companies, and others amid intensifying competition for shares of a $50 billion fund to improve rural health.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/kffhealthnews.org\/news\/article\/states-competing-rural-health-transformation-program-cms\/\" \/>\n<meta property=\"og:site_name\" content=\"KFF Health News\" \/>\n<meta property=\"article:modified_time\" content=\"2025-11-07T13:17:18+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2025\/11\/Oz_Milken.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1744\" \/>\n\t<meta property=\"og:image:height\" content=\"1163\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/kffhealthnews.org\/news\/article\/states-competing-rural-health-transformation-program-cms\/\",\"url\":\"https:\/\/kffhealthnews.org\/news\/article\/states-competing-rural-health-transformation-program-cms\/\",\"name\":\"Concerns Over Fairness, Access Rise as States Compete for Slice of $50B Rural Health Fund - 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