Feds Promised ‘Radical Transparency’ but Withhold $50B Rural Fund Details

Medication-delivering drones. Telehealth at libraries. Church-hosted wellness events.

These are a few ideas proposed by states in their bids to win a portion of the new $50 billion federal Rural Health Transformation Program. Congress approved the five-year spending plan in the One Big Beautiful Bill Act, the same law that codified nearly $1 trillion in Medicaid spending reductions.

That law is expected to have an outsize effect on rural America, where the cuts are expected to slash health funding by $137 billion over 10 years.

So, how the rural health fund money rolls out is being watched closely by people like Alan Morgan, chief executive 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. “The hospital CEOs, the clinic administrators, the community leaders: They’re going to 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 describes their proposed initiatives. Those include Maryland’s plan to create demand for healthy foods in addition to increasing their supply.

“Many rural Maryland children and adults have low intake of fruits, vegetables, and water, and limited engagement in physically active behaviors,” the state said in its application. Among other initiatives, officials propose to start mobile markets and install refrigerators and freezers to improve access in rural areas with limited grocery stores.

More than a dozen states have also released their budget narratives. 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 documents through both informal and formal public records requests and published them on a map.

Heather Howard, a professor of the practice at Princeton University, said she is “pleasantly surprised at how transparent the states have been.” Princeton’s State Health and Value Strategies program is also tracking state documents.

But others are not pleased with what federal regulators are (or are not) releasing. Centers for Medicare & Medicaid Services spokesperson Catherine Howden said applications will not be released while they are being reviewed.

CMS plans to follow the federal regulations governing competitive grant materials 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 state’s U.S. House delegation in sending a letter to CMS Administrator Mehmet Oz last month asking for “full and fair consideration” of their state’s application.

“I am very concerned about retaliation,” she said.