Ohio is vying for a share of a new $50 billion federal program called the Rural Health Transformation Fund. It was formed out of the U.S. budget reconciliation bill earlier this year, and is being hailed by officials as the largest one-time federal investment targeted at rural health care.
But some rural Ohio health leaders wonder whether the funding, if awarded, will be enough to lift a system weakened by years of underinvestment and federal Medicaid cuts.
How important is this funding?
Over 70 of Ohio’s 88 counties are rural or partially rural. Many face staffing shortages, rising costs and cuts to services. Four rural Northeast Ohio counties have limited access to labor and delivery care, and Ashland County has none, according to a 2022 March of Dimes report.
Ohio is competing against all other states for funding, but experts say it has a strong chance because of high need — including rural hospitals' distance from residents, physician shortages and health disparities across income and racial groups.
The Centers for Medicare & Medicaid Services is expected to announce the winners this month.
What's in Ohio's proposal?
Ohio’s application focuses on three key areas: keeping rural hospitals open by helping them modernize equipment and expand specialty services; building the rural medical workforce pipeline; and improving access through telehealth, EMS upgrades, mobile clinics and school-based health centers.
Carly Salamone, the president of Vantage Healthcare of Ohio, a collaborative of independent rural hospitals, said these investments will directly improve rural residents’ health.
“More school-based health centers to mobile optometry, dental and vision services for kids in rural communities — that’s huge because there just aren’t many dentists who take Medicaid in these areas," she said. "Being able to bring those resources directly to families who haven’t had that access before is going to make a significant difference.”
Do rural health providers think this proposal meets their needs?
In some respects, yes. Mike Appleman, who runs the rural education program at Northeast Ohio Medical University (NEOMED), said Ohio's plan to expand rural medical training could help attract doctors to rural areas and keep them there.
“So much of medical training occurs in urban places, so leveraging our great rural partners is an excellent way to increase student interest and comfortability of working in rural places," he said.
He also hopes the state will push further to support students from rural backgrounds, low-income families, or the military, groups who often face bigger financial hurdles entering medical school.
Are there any concerns about the plan?
Yes. Most of the funds, if awarded, must go to new initiatives and innovation, while only 10% can go to paying for uncompensated care — in this case, patients who can’t pay or who aren't covered by Medicaid.
That matters because according to the Health Policy Institute of Ohio, the state is estimated to lose more than $33 billion in federal Medicaid funding over the next 10 years. So even with $1 billion in new funds over 5 years for rural hospitals — which is at the high end of what Ohio could expect to get — leaders worry the money won’t be enough to support struggling facilities or keep maternity care open.
There’s also the challenge of getting rural communities comfortable with expanded telehealth, which is a big part of Ohio’s proposal, said Carly Salamone.
"A lot of people in our rural communities, they [don't] want telehealth," she said. "They want they want to see their doctor in their office. So there's a lot of hesitancy and trust and relationships that still need to be built."
What could Ohioans actually see on the ground if the money comes through?
People could start to see more mobile clinics, updated equipment at smaller hospitals and broader access to maternity and neonatal home visiting programs — all of which have been show to make have a real difference in health outcomes.
But a major question remains whether the investments will be sustainable once the federal funding ends. And, again, experts warn that a large one-time infusion of cash won’t fully offset the financial losses rural hospitals are facing from Medicaid cuts.
