When a rural Floridian misses a routine checkup because the nearest clinic is 50 miles away, the consequences can be serious — and sometimes life-threatening.
The state hopes to change that with its application for a share of $50 billion available through the federal Rural Health Transformation Program, a fund aimed at improving care in rural communities nationwide.
All 50 states have sent applications to the federal Centers for Medicare and Medicaid Services, which will review the submissions and announce the awards by Dec. 31.
Florida’s plan, submitted by the Agency for Health Care Administration on Nov. 3, is focused on three core priorities:
- Workforce development: Training programs and recruitment incentives aimed at bolstering the rural health care workforce.
- Expanding access to primary and preventive care: Funding for satellite clinics, mobile health units and expanded services in dental, behavioral health, maternal health and chronic disease management.
- Advancing access to specialty care through technology: Investments in telehealth, including remote patient monitoring, tele-specialty clinics, tele-psychiatry hubs, tele-ICU support and hub-and-spoke telestroke services.
Additional strategies include leveraging community paramedics, expanding retail clinics, and promoting healthy lifestyles through nutrition and physical activity initiatives.
AHCA Secretary Shevaun Harris said the state is “laser-focused on creating a lasting impact” for rural communities.
“Florida’s application reflects what we have heard directly from our providers, stakeholders, and rural communities about the challenges they face and the solutions they need,” Harris said in a statement announcing the application.
“This plan is designed to ensure that rural families across Florida can count on a health system that is sustainable, responsive and built around their needs."
Seeking innovations in rural care
Congressional Republicans added the five-year program as a last-minute sweetener to President Donald Trump’s “Big Beautiful Bill Act.” The move helped win support from conservative holdouts worried Medicaid cuts in the bill would harm rural hospitals.
Dr. Mehmet Oz, administrator of the federal Centers for Medicare and Medicaid Servies, said the program is intended to “right-size the health care system,” according to KFF Health News.
“We will give $50 billion away by the end of the year,” Oz said Nov. 6 at a Milken Institute event in Washington, D.C., adding that innovations from the rural work “will spill over to suburban and urban America as well.”
Across the country, health care workers, patient advocates and technology executives have engaged with state leaders as concepts were crafted.
Other state applications followed similar themes as those proposed by Florida.
Kansas and Wyoming included unique initiatives, from “Food is Medicine” programs to state-sponsored emergency insurance plans.
Echo Kopplin, a physician assistant in the Black Hills of South Dakota, told KFF Health News that she highlighted transportation challenges for rural patients, many of whom miss appointments because of distance or lack of public transit.
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.
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 “safe and stable housing.”
Concerns and critiques
While the $50 billion program is intended to benefit rural Americans, many health policy experts and Democrats are raising alarms that the Republican-backed program will become a “slush fund.”
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 1 in 4 rural Americans.
Heather Howard, a Princeton University health policy expert, told KFF Health News the fund won’t fully offset projected Medicaid spending reductions, which could total nearly $1 trillion over the next decade.
“The status quo is tremendous distress in rural communities,” Howard said.
Others worry large hospital systems could disproportionately benefit compared with small, independent hospitals serving isolated communities.
According to federal statute, half of the funding with be divided equally among states with approved application, with the other half awarded based on rurality and the quality of state initiatives.
A handful of conservative-leaning states have instituted regulatory and legislative initiatives that garner additional points in the program application process. For example, Florida has received federal approval to ban the use of SNAP benefits for certain non-nutritious foods Jan. 1.
Top Senate Democrats, including Ron Wyden of Oregon and Tina Smith of Minnesota, have called on a federal watchdog agency to investigate implementation of the fund. Taylor Harvey, a Wyden aide, said the Government Accountability Office confirmed it will investigate.
Information from Sarah Jane Tribble and Arielle Zionts of KFF Health News was used in this report. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source of health policy research, polling, and journalism.
