The rural healthcare dollars — $50 billion set aside over five years for all states combined — is split into two buckets.
One is relatively straightforward. Money will be split evenly between states that successfully apply. The other bucket, however, mandates that states fashion a detailed plan to reshape rural healthcare in at least three of a number of areas designated within the bill.
The amount of specificity is a bureaucrat's dream.Dr. Steven Stack, Cabinet for Health and Family Services Secretary
Kentucky Cabinet for Health and Family Services Secretary Dr. Steven Stack says it's not merely a stabilization fund.
"The title of the (section) in H.R. 1 is 'Rural Hospital Stabilization Fund,' but it is clearly not the way that they're implementing it," Stack told an interim committee Tuesday. "They want it to be a rural health transformation program."
And states only have until November 5 to craft the plan — a process Stack said would normally involve lots of conferring with stakeholders.
But this will be a sprint.
"My approach is generally very collaborative and participatory," Stack said. "People feel a lot more ownership in a work product if they contribute to its creation. The difficulty here is there's just not enough time. There just simply isn't. So we're going to have to move lightning fast."
As for which of the designated areas Kentucky might focus on, Stack pointed to shoring up behavioral health, looking into greater use of telehealth and other related technologies, and efforts to spur workforce growth.
Yet it may be difficult to plan ahead, the secretary noted, because the rural health transformation plans will be re-scored every year, meaning states will not know how much of that money they will be awarded on an ongoing basis.
"It's going to be a challenge," Stack commented. "The amount of specificity is a bureaucrat's dream. There is a great deal of concrete requirement outlined in the grant application."
Critics of the signature Trump bill have warned the cuts could lead to shuttered rural hospitals.
"It is going to damage rural health care in a way that we might not be able to recover from," Gov. Andy Beshear said in a video post following its passage.
It's not a concern that necessarily runs along partisan lines. Some Republicans, including GOP Sen. Mitch McConnell, pushed to increase the rural hospital fund inside the reconciliation bill.
Ultimately, the chamber landed on $50 billion.
The number may sound hefty, but Dustin Pugel with the left-leaning Kentucky Center for Economic Policy said the figure pales in comparison to what would actually be needed.
"Kentucky alone stands to lose $10 billion over 10 years in rural parts of our state, which is almost double what any other state in America would face," he said. "So a $50 billion fund for all 50 states is a drop in the bucket compared to what we stand to lose, with 200,000 fewer people covered."