Federal government promised ‘radical transparency’ but refuses to release details of $50 billion rural fund
Drones delivering medicine. Telehealth in libraries. Wellness events hosted by the church.
These are some ideas states are proposing in their bid to win a piece of the new $50 billion federal Rural Health Transformation program. Congress approved the five-year spending plan as part of the One Big Beautiful Bill Act, the same law that codified nearly $1 trillion in Medicaid spending cuts.
The law is expected to have an outsized effect on rural America, where budget cuts are expected to reduce health funding by $137 billion over 10 years.
So how rural health fund money is distributed is closely watched by people like Alan Morgan, chief executive of the National Rural Health Association. State applications were due in early November, and federal officials promised to announce awards by Dec. 31.
“Let’s be clear,” Morgan said. “Hospital CEOs, clinic administrators, community leaders: They will want to know what their states are doing.”
As of last week, nearly 40 states had released project narratives, the main part of the application, which outlines proposed initiatives. These include Maryland’s plan to create demand for healthy foods in addition to increasing their supply.
“Many children and adults in rural Maryland consume little fruit, vegetables, and water and engage little in physically active behaviors,” the state said in its request. Among other initiatives, officials propose launching mobile markets and installing refrigerators and freezers to improve access in rural areas where grocery stores are limited.
More than a dozen states also released their budget statements. And a handful of 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 materials through informal and formal public records requests and posted them on a map.
Heather Howard, a professor of the practice at Princeton University, said she was “pleasantly surprised to see how transparent states have been.” Princeton’s State Health and Value Strategies program also tracks state documents.
But others aren’t happy with what federal regulators are publishing (or not publishing). Centers for Medicare & Medicaid Services spokeswoman Catherine Howden said the applications will not be released while they are reviewed.
CMS plans to follow federal regulations governing competitive grants when 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 U.S. House delegation to send a letter to CMS Administrator Mehmet Oz last month demanding a “full and fair review” of their state’s application.
“I’m very concerned about retaliation,” she said.
