Texas in the Running for Federal Rural Health Care Funding
By Amy Lynn Sorrel and Alisa Pierce

Texas is officially contending for a share of federal funding intended to support rural health care systems across the country after submitting its application for the Rural Health Transformation Program.

The initiative under the One Big Beautiful Bill Act aims to provide up to $50 billion over five years across the country to promote and support the development of initiatives that:

• Address chronic disease prevention and management;
• Strengthen the recruitment and retention of the health care workforce in rural communities; and
• Support the use of technologies, including artificial intelligence (AI), to improve health outcomes and coordination of care in rural areas.   

The Texas Health and Human Services Commission (HHSC) sought public comments from stakeholders, including the Texas Medical Association, to contribute ideas for how the state should apply for funding, and then submitted one, sweeping application on behalf of the state on Nov. 6. The Centers for Medicare & Medicaid Services (CMS) will announce awardees by Dec. 31.

Texas’ application, “Rural Texas Strong: Supporting Health and Wellness,” requested $1 billion in total over the course of the five-year program. The plan includes six key initiatives covering each of Texas’ 202 rural counties. The initiatives include:

• Grants to rural hospital districts that fund initiatives to reduce chronic disease through prevention, wellness, and nutrition services;
• Investments into technology that will establish patient-facing health portals that facilitate health information exchanges between patients, physicians, and payers;
• Efforts to invest in and support AI and telehealth technologies used to bridge service gaps in rural communities, including those for specialties and complex care;
• Workforce recruitment and retention efforts that attract rural health care workers through career development, scholarships, relocation payments, and training programs;
• Initiatives that improve rural cybersecurity defenses to protect patient data; and
• Upgrades to equipment in rural hospitals and clinics.

“Rural health care is critical for the continued health and well-being of Texans across our great state,” said Gov. Greg Abbott in a press release. “To keep Texas thriving, we must strengthen our rural hospitals, expand access to critical mental and physical health care, and help reduce chronic disease through wellness and nutrition initiatives. Working with our federal partners, we will ensure Texans from every corner of the state have greater access to the quality health care services they need and deserve.” 

Texas’ final submission did include chronic disease prevention initiatives that the Texas Public Health Coalition, of which TMA is a member, advocated for in its public feedback to HHSC. Although TMA’s suggestion for creating a new state grant program to fund dedicated rural physician training tracks was not included, the association is analyzing the potential for one of HHSC’s stated goals to create residency and fellowship programs in rural areas.

The application includes a strategy for transforming rural health that focuses on “the next generation of the small-town doctor and team.” While this is not fully explained, TMA is evaluating other portions of the state application indicating independent physician practices may be eligible for funding opportunities, along with hospitals, rural health clinics, federally qualified health centers, behavioral health providers, and a list of other entities. Still other initiatives hint at ways to boost Medicaid payment rates for rural physicians and hospitals.

Amarillo family medicine physician Rodney Young, MD, regional chair of the Texas Tech University Health Sciences Center’s Department of Family and Community Medicine, is “cautiously optimistic” federal funding will help support Texas’ rural communities and hopeful Texas will find ways to “create opportunities for physicians to go to rural areas.”

“We are long overdue for attention to be given to health care access in rural areas,” he said. “Hopefully this infusion of resources will give us the opportunity to do some things that we have been unable to do because of limited resources.”

Meanwhile, TMA is reviewing what appears will be a competitive process for physicians and others to apply for any federal funds Texas receives, should CMS approve the state’s application.

Since any funding Texas receives will expire in five years, however, Dr. Young has reservations that unless ongoing methods of financial assistance are identified, programs started under the federal transformation program could be left without support. 

“The wise use of the money will be to go to programs that hopefully are able to be sustained with other funding pathways, whether those are local or through the state,” the TMA Board Trustee said.

TMA remains in communication with HHSC on the status of its application. Continue to read Texas Medicine Today for updates.