The federal rural health fund — totaling $50 billion over five years for all states combined — required a quick turnaround for applicants. One part of the fund will be split evenly among the states, but the other mandated a detailed plan to reshape rural healthcare in at least three areas selected from a predetermined list included in the bill.
This is unique. This is clawing back money you may have already spent.Dr. Steven Stack, Cabinet for Health and Family Services Secretary
Kentucky's application proposed five: rural health hubs for chronic care innovation; increasing timely perinatal care in maternity care deserts; improving behavioral health care through expansion of the EmPATH model; a rural dental access program; and better integrated EMS and trauma response systems.
But unlike with similar federal grants, Kentucky and other applicants will be re-scored yearly and the money isn't a sure thing — even if it's already gone out the door. Under the terms of the rural health grants, states could have the dollars yanked away if the federal government doesn't see the results states promise.
"This is unique. This is clawing back money you may have already spent," Cabinet for Health and Family Services Secretary Dr. Steven Stack explained. "That's a real risk that has caused a number of states, I would say most, to not make policy commitments."
Stack said the program isn't shaping up as originally advertised during the debates in Washington.
"This is clearly not the Rural Hospital Stabilization Fund. This is not what Congress seemed to convey they were doing," he said. "What they did was a different fund. Now, had we not had H.R. 1 taking a trillion dollars out of the healthcare system, this on top of that could have helped. But it's certainly not going to plug the crater left by H.R. 1."
H.R. 1 being the so-called "One Big Beautiful Bill" signed into law in July.
Using a healthcare analogy, Sen. Stephen Meredith said the grant might address symptoms but doesn't get at the heart of the problem facing rural health systems.
"The immediate reaction to H.R. 1 was that 35 hospitals could close in rural Kentucky. That's half of our rural hospitals," the Republican said. "This is not going to save them."
States will be made aware of how much money they'll receive on December 31.