States Prepare for the Rural Health Transformation Program Deadline

States Prepare for the Rural Health Transformation Program Deadline

States must apply by Nov. 5 for funds to improve the delivery of health care in rural America.

As the November deadline approaches, states are gathering public input, engaging with stakeholders and tailoring Rural Health Transformation Program applications to meet their residents' most urgent needs. The federal tax cut and domestic policy law signed by President Trump in July includes a Rural Health Transformation Program, which provides $50 billion for states to dedicate to rural health.

Rural Health Transformation Program

State governors, or a state agency or office they designate, must apply by Nov. 5 to the Centers for Medicare & Medicaid Services, or CMS, which will distribute funds. Half of the fund, $25 billion, will be evenly distributed among states with approved applications; the other half will be distributed based on a series of rural and policy measures developed by CMS. The policy measures include several health care access issues that legislatures have addressed in recent years, such as scope of practice changes, participation in interstate licensure compacts, telehealth flexibilities, certificate of need requirements or data infrastructure investments.

The announcement of the grants' availability includes several approved uses for the funds, including chronic disease prevention and management, technology-driven solutions, technical assistance, workforce recruitment and retention strategies, bolstering rural service lines, opioid use and mental health services, and innovative payment models.

For additional information on previous state actions to address the topics listed in the announcement, see NCSL's new resource page, Rural Health Transformation Program State Legislative Resources.

States Gather Public Input

As of early October, 48 states had requested public input into the state's application, according to State Health & Value Strategies. Some states are coordinating across the executive and legislative branches. Alabama formed an advisory group, Indiana formed a working group and North Dakota formed an interim committee, all of which include state legislators.

While most requests for public input contain limited or no information about state priorities, some states include broad priorities. Florida's Agency for Health Care Administration requested ideas on developing new health care delivery strategies, adopting technology solutions and advancing workforce recruitment and retention. Minnesota's focus areas include emergency services, primary care, care for individuals with complex and chronic conditions, mental and behavioral health, maternal health and other at-risk services or unmet needs.

States were encouraged (but not required) to submit a letter of intent to CMS by Sept. 30. Some states, including Arkansas, Montana and Washington, shared their letters of intent publicly.

The Role of State Legislatures

In addition to state legislative participation in working groups and interim committees, at least five states introduced (North Carolina and Pennsylvania) or enacted (California, Michigan and Utah) legislation addressing the Rural Health Transformation Program. Most create a dedicated fund for the money to go into once it is awarded and distributed, or they provide necessary approvals for state agencies to receive large sum federal awards.

State legislative health policy is a significant component of the factors CMS will consider in the applications. States may also take lessons from recent history. Specifically, securing legislative approval and budget authority contributed to successful use of time-limited pandemic funding.

State legislators who are interested in contributing to the application process should reach out to the office of their governor or the agency delegated by the governor to lead the application process.

Kelsie George is a senior policy specialist with NCSL's Health Program.