In the whirlwind of health news in the past several months between the passage of H.R. 1 (AKA the “One Big Beautiful Bill”) and the public debate about premium tax credit enhancements and marketplace coverage, you may have heard about something called the Rural Health Transformation Program. This is a piece of the larger H.R 1, intended to invest in rural health systems, and all states were able to apply for a portion of the $50 billion fund. In October, Arkansas applied for a portion of the federal funding that would be paid out over five years. About 45% of Arkansas is rural, making us one of the most rural states in the country. We certainly needed this investment — considering 70% of rural hospitals are operating in the red and at risk of closure.
What is it?
Arkansas’s application can be found here. Our application focused on investments in prevention, workforce recruitment and retention, and systems infrastructure. The four pillars of activities in Arkansas’s plan include:
Healthy Eating, Active Recreation, and Transformation (HEART): a program focused on improving health outcomes and access to preventative care by creating a coordinated, community-driven approach to nutrition, physical activity, and chronic disease management.
Promoting Access Coordination and Transformation (PACT): integrating specialty care, preventative screenings, telehealth, and trauma-ready services into rural communities while fostering locally driven, clinically integrated networks to improve efficiency, data sharing, and regional collaboration.
Recruitment Innovation Skills and Education for Arkansas (RISE AR): strengthening the rural health care workforce through expanded physician residencies and other clinical training programs, providing incentives to recruit and retain health care professionals in rural Arkansas, and providing training to ensure leaders and board members of local hospitals and clinics are prepared for the transformation required in rural health care.
Telehealth Health Monitoring and Response Innovation for Vital Expansion (THRIVE): a plan to leverage AI to provide coordinated patient records across delivery systems and fund telehealth platforms, technology-enabled monitoring for chronic diseases, such as diabetes and high blood pressure, and the modernization of emergency medical transport and services.
The HEART component plans activities around addressing chronic disease through increased partnerships, community health worker trainings, investing in recreational/physical activity pilots, and leveraging SNAP “food as medicine” initiatives. It also seeks to use community-based partnerships to identify and address transportation issues. PACT strategies aim to impact 12,500 rural residents with mobile unit services and expanding telehealth. It aims to promote various health professionals work at “top of license” by providing dietary counseling and chronic disease support. It also invests in rural hospital facility improvements. RISE AR proposes a “leadership academy” and expansion of training slots through expanding rural preceptors, scholarships, residencies, and fellowships. THRIVE focuses on telehealth and modernizing EMS systems as well as expanding medical technologies targeting rural patients like at-home remote monitoring devices.
Our application also included some planned changes to regulation and legislation, including a revival of the “Presidential Fitness Test”, increasing nutrition education in Continuing Medical Education and in medical schools, and planning for legislation to expand the scope of care for certain health professionals like pharmacists.
In the first year of funding, Arkansas was awarded $208,779,396. Arkansas requested $1 billion dollars in funding for the entire project, and future awarded funding will be announced in the coming year.
Thoughts from a rural Arkansan
As someone who grew up in rural Arkansas, I know the difficulty of access to care for rural Arkansans. I remember having to ride for nearly an hour in a car with a broken collarbone because there wasn’t an ambulance that could get to us fast enough. Rural residents have fewer providers, longer travel times, and often fewer built spaces for recreation and physical activity. We frequently live in food deserts with limited access to fresh produce.
So, investments aimed at tackling different choke points in rural health are generally something I can get behind — with some caveats. I’d like to see more about the parameters placed around AI usage in decision-making (as there is good reason to be cautious) and reinstating the Presidential Fitness Test as it existed in the 1950s is an odd choice (versus programs focused on skill-building rather than testing).
But I’m also thinking about the bigger picture here in terms of what the future of the rural health system looks like. This fund was part of H.R. 1, which constituted the largest cut to Medicaid in its entire 50-year history. H.R 1 is expected to result in a loss of nearly $800 billion dollars to Arkansas over the next decade. My concern with the Rural Health Transformation Program is that it is a band-aid over a soon-to-be gaping wound in our state’s health system. Arkansas is already struggling — 70% of our rural hospitals are operating at a loss and at risk of closure. That includes my home town of Camden, where the local hospital is filing for bankruptcy and closed its labor and delivery unit this month. As H.R. 1 provisions continue to affect Arkansas and more people become uninsured, rural providers will be under even more strain. We need to do something about improving rural health in Arkansas, and investing in early prevention with healthy foods, physical activity, and addressing social determinants of health that put rural Arkansans at high risk of chronic disease and premature death is a worthwhile undertaking. But when that “investment: is a drop in the bucket to what is being cut, it’s going to be very difficult to achieve those goals.