LISTEN: Georgia is primed to receive $218 million this year from the Rural Health Transformation Program, a federal funding mechanism. How are the state's hospitals getting set to use the funds? GPB's Sofi Gratas explains.
Georgia is primed to receive $218 million this year from the Rural Health Transformation Program, a federal funding mechanism authorized by H.R. 1, also known as the One Big Beautiful Bill Act.
The program falls in line with Health and Human Services Secretary Robert F. Kennedy Jr.’s Make America Healthy Again agenda and promises to "catalyze needed change" in rural health access.
Here, the Georgia Department of Community Health is in charge of managing the funds, which it applied for. Details for how the funds will be spent haven't been released yet, but department spokesperson Fiona Roberts confirmed eligible health care providers will have to apply for the funds through a grant process, under the stipulation that the funds “cannot maintain the status quo.”
Roberts said the money will have to be allocated by October of this year.
Applications for projects will have to fall under the strategies highlighted in Georgia’s Rural Enhancement and Transformation of Health (GREAT) plan, said Caylee Noggle, president and CEO of the Georgia Hospital Association, a hospital advocacy and lobbying group.
Those strategies include increased investments in telehealth and mobile health, infrastructure improvements for emergency preparedness and workforce development.
“The funding is intended to be hopefully transformational,” Noggle said.
Georgia had originally applied for $1.4 billion over five years from the fund. Only awards for Year 1 have been approved.
Noggle said she’s been focused on educating the hospital association’s over 100 members about next steps for those applications that fall under a relatively tight deadline.
“We're hopeful that there are some real pieces in here that can lead to longer-term innovation, and treat some of the underlying causes for some rural hospital challenges,” said Noggle, who has been working closely with the Department of Community Health.
A budget made public by the Georgia Department of Community Health in January shows the biggest share of grant money, $56.7 million, will be set aside to help health care providers transition to a new model of care, called the Achieving Healthcare Efficiency through Accountable Design (AHEAD).
Under AHEAD, hospitals would receive fixed annual payments from the Centers for Medicare and Medicaid to cover the cost of services they provide, like inpatient and outpatient care, rather than receive payments based on patient intake.
Hospitals that adopt the AHEAD model will be prioritized for grant money, said DCH spokesperson Fiona Roberts.
The idea of the voluntary program is to encourage hospitals to make investments in population health. Van Loskoski, CEO of Stephens County Hospital, said he’s still unsure about how the switch to fixed funding from the federal government would impact his bottom line.
“Level-funding us based off historic performance might not necessarily translate to something that's helpful for us in the long run,” he said. “We're still trying to work out the nuances."
At Stephens County Hospital, the majority of patients skew older, Loskoski said, the result of an increased migration of retirees to Georgia’s Blue Ridge region. And about a quarter of patients are coming in from surrounding counties. Of that growing patient load, most rely on Medicare to pay their hospital bills.
“We're going to have to have mechanisms of funding to support growth and increasing access to care,” Loskoski said. “Population growth is fun ... [but] it’s also challenging, because this is a population that, like many other rural communities, is older and presents many complex medical issues.”
A more immediate concern, and one that, during a recent visit to the state Capitol, Loskoski said he hopes to bring to the attention of state lawmakers, is addressing delays in getting payments from insurers, including Medicare and Medicaid.
With money from the Rural Health Transformation Program, Loskoski’s needs go to an even more basic level.
“We just, in the last two weeks, have had two events where we've had the shelter staff in place for an extended period of time with snowy and icy weather,” he said. “There's funding built into this package that helps hospitals in emergency situations to shelter in place and to beef up their infrastructure so that they're better prepared for these types of events.”
Vicki Lewis, CEO of Coffee Regional Medical Center in Douglas and Georgia Hospital Association board member, said her hospital would benefit from a streamlining of electronic medical records, and a better system to collect data on patient spending and needs.
“We do all kinds of analytics when we decide to spend money, and so those are the things that have really paid off for us,” Lewis said.
For example, she said, her hospital used years of data about how many people were leaving Coffee County for chemotherapy to support the opening of an oncology program.
"And it's four times the size we ever thought that it would be because there was such a need," Lewis said. "It's really, really important that these key and core services we offer, that we understand the social determinants of health in addition to the most prevalent diseases."
She's hoping funding from new federal program could bolster the hospital's ability to identify other service lines her community needs, and in turn, sustain the hospital financially.
Critics of the Rural Health Transformation Program say it doesn’t even begin to skim the surface of what’s needed to bolster and grow rural health, especially in light of cuts to federally funded health care programs expected to increase the number of people who are uninsured or underinsured.
There’s also a concern that a guarantee of future funding is too closely tied to the Trump administration’s priorities.
Then, there’s the worry that the money might not even go to the hospitals that need it, because language in H.R.1 is relatively vague.
“We want to make sure, number one, that it goes to rural hospitals,” said Monty Veazy with the Georgia Alliance of Community Hospitals.
In recommendations sent to the Department of Community Health, Veazy’s lobbying group argues that rural hospitals and health systems take on the burden in rural communities of providing care “to all residents without regard to their ability to pay,” and “are best situated to determine the local and regional needs of their communities.”
Their recommendations do say that there should be room for collaboration with Federally Qualified Health Centers, emergency service providers, senior living centers and “certain clinics.”
Since 2010, eight rural hospitals providing in-patient care have closed in Georgia.
Noggle, with the Georgia Hospital Association, recognizes there is “no single silver bullet.”
“A one-time infusion of cash is not going to fix the fact that Medicare and Medicaid often are underpaying for cost to provide care,” Noggle said.
She also argues that long-term solutions shouldn’t come on the federal government’s dime.
But Noggle said she is confident that the Rural Health Transformation Program funding can help “chip away” at some of the root challenges facing rural hospitals.
“We're very, very appreciative and grateful for the increased focus on rural health care and some of the challenges,” she said. “And we're hopeful that there are some real pieces in here that can prove to lead to longer-term innovation and supports.”
The Department of Community Health will release detailed updated on applications for Rural Health Transformation Program funds at https://dch.georgia.gov/.
An earlier version of this story read:
Noggle, with the Department of Community Health, recognizes there is “no single silver bullet.”
