Missouri secured $216 million in December from the federal Rural Health Transformation program, a new funding stream aimed at bolstering healthcare access in rural communities.
The grant is intended to “strengthen healthcare access, improve outcomes, and support innovative care in rural communities,” according to a statement from Gov. Mike Kehoe’s office announcing the award.
But stakeholders involved in rural healthcare access say the plan is a “drop in the bucket” compared with what Missouri’s healthcare system has lost because the federal government cut Medicaid and Affordable Care Act in July. Some estimates project that up to 8.6 million people nationwide could lose health coverage during that period, including up to 170,000 people within a decade.
But they say it's still better than nothing.
“We’ve been asking for an infusion of funds for decades to help our rural providers,” said Heidi Lucas, executive director of the Missouri Rural Health Association. “It’s a blessing for it to come through. We wish it wasn’t tied so closely to the potential loss of Medicaid dollars, but this type of investment is something we’ve been asking for for a very long time.”
Inside the plan
Missouri plans to spend the federal dollars through an existing pilot initiative known as the Transformation of Rural Community Health program, or ToRCH, which has been operating for the past year. The Missouri Department of Social Services says ToRCH will serve as the framework for the state’s use of the funds.
Under the plan, ToRCH will function as the backbone of the initiative, supporting four key components: alternative payment models tied to improved health outcomes, a centralized data-sharing system, workforce development, and technical assistance for healthcare providers.
The Missouri Hospital Association has tracked the condition of rural hospitals statewide and has expressed interest in partnering with the state to manage the centralized database.
“We’re going to be a critical partner in helping inform that,” said Dave Dillon, Missouri Hospital Association communications director. “Things that happen at hospitals are things that we capture. And the type of data that can drive health improvement is something we’re doing a much better job of collecting and delivering back to help understand the root causes of poor health.”
Missouri’s plan divides responsibilities across county, regional and state systems. The state will establish 30 local hubs across Missouri, each connecting behavioral health providers, rural clinics, federally qualified health centers, public health agencies, emergency responders, pharmacies and community groups.
Those hubs will convene monthly to exchange patient data and improve referrals. Seven regional hubs will coordinate the networks, oversee funding and streamline data sharing statewide through a newly formed Rural Health Transformation office in the Department of Social Services.
The state is currently setting up that office and hiring a director to lead the program.
State officials have set five-year benchmarks for the program, including a 10% reduction in emergency room visits, a 10% reduction in uncontrolled hypertension, a 5% reduction in low birth weight and a 5-10% increase in the use of pharmacotherapy to treat opioid use disorder.
Rural hospitals under pressure
According to the state’s plan document, 12 rural hospitals in Missouri have closed since 2014, while others have scaled back services such as obstetrics or specialty care. Nearly 55% of Missouri’s rural hospitals are currently operating at a loss.
The federal funding cannot be used to build new infrastructure. Instead, it must be spent on improving existing systems and resources, which amounts to roughly $100 per rural resident over the life of the program.
Dillon said the initiative could help address health issues before they become medical emergencies.
“We’re always going to be really good at what we call sick care,” he said. “What hospitals are just beginning to build is well care. Success there is really about who your partners are. This program could reduce significant over-utilization of health care services that can’t be solved in a clinical room.”
At the same time, broader federal policy changes continue to worry rural health leaders.
The Missouri Foundation for Health estimates the state could lose $23 billion in federal funding over the next decade under the legislation.
Lucas said reductions in Medicaid and the loss of Affordable Care Act subsidies could ripple through rural hospitals regardless of new programs.
“We will most likely see facilities close because of that,” she said. “This investment is great, but it’s hard to build a new system to track patient data when a hospital might close two years later because of Medicaid cuts. It feels like there’s a light at the end of the tunnel — but it’s a train coming straight at us.”
The fund was created after the U.S. Sen. Josh Hawley (R-Missouri) pushed for its inclusion following Medicaid cuts tied to President Donald Trump’s budget legislation last year.
The plan totals $50 billion nationwide. Half of the money will be divided evenly among states with approved applications, while the remaining half will be distributed based on factors such as the number of rural residents, the number of rural health facilities and the amount of uncompensated care provided in each state.
