Around 50 Oklahomans gathered at the Southwest Technology Center in Altus in late September, representing nearly every part of health care, with voices in public health, hospitals, pharmacies, EMS and behavioral health.
They were all there to talk about the same thing: a $50 billion pot of money, and what it could mean for their communities.
The fund is called the Rural Health Transformation Program. It was signed into law in President Donald Trump’s megabill alongside an estimated $911 billion in reductions to federal Medicaid spending over a decade. It was included amid concerns from some lawmakers about the policy’s impact on rural hospitals and providers.
But the goal is not to make up for the cuts. Officials want to transform how care is delivered in rural communities, according to a notice of funding document. The Centers for Medicare and Medicaid Services (CMS) is administering the program, with $10 billion available annually for state grants from FY 2026 to FY 2030.
Attendees at an Altus listening session made clear they each wanted a piece of the pie. The health care workers hope to address the unique challenges they face in a state ranking 49th nationally for its health care system.
The state had 60 pages and about 50 days to describe its proposed project for the fund in a plan it submitted Tuesday, a day before the Nov. 5 deadline.
As Oklahoma awaits award announcements at the end of the year, local stakeholders are grappling with what they want to see the investment spent on and whether the fund can truly transform rural health.
What is the opportunity?
CMS will distribute $25 billion equally among all states with approved applications. The other half is competitive and will be awarded based on a plan’s content and quality, and rural factors. The agency advised, for planning purposes, that states use a $200 million annual estimate over five years as they built their applications.
The program has five strategic goals: Make rural America healthy again, sustainable access, workforce development, innovative care and tech innovation. State applications must cover at least three permitted funding uses, including items like provider payments, prevention and chronic disease, and IT advances.
They also have to work within certain funding restrictions and describe how they plan to sustain successful initiatives after funding ends. And, if federal officials determine a state has misused funds, they can be withheld, reduced or clawed back.
Gov. Kevin Stitt’s office designated the Oklahoma State Department of Health as the lead agency to develop and submit the application. An agency spokesperson said it worked with several partners to develop Oklahoma’s plan, including state agencies like the Health Care Authority, Department of Human Services and Department of Mental Health and Substance Abuse Services, and stakeholder groups, like hospitals, tribal nations and rural providers.
The state also engaged with a global firm, the Boston Consulting Group. The agency spokesperson said the group led efforts to perform a needs assessment and acted as a conduit to federal listening sessions. It also helped synthesize input from over 300 responses to a request for information, listening sessions, more than 50 group and individual interviews, and feedback from associations.
Common themes they heard included workforce shortages, options for leveraging technology, transportation challenges, chronic disease prevention and management, and coordinated care. The agency defined certain focuses based on feedback.
The opportunity is a cooperative agreement, meaning the state and CMS will have roles in it. The state will be required to submit agreed-upon performance measures, alongside other reports.
“At the end of the day, we recognize that no single plan will solve all the issues rural Oklahoma communities face,” the Department of Health spokesperson wrote. “The RHTP is a meaningful step forward, and one that will create transformational change for generations to come, but it must be part of a broader, sustained effort.”
What do hospital professionals have to say?
Brian Roland has been in health care for decades, working in Texas, New Mexico and Kansas. He took on the role of CEO of Elkview General Hospital in Hobart a few months ago. The facility converted to a rural emergency hospital over a year ago, meaning it benefits from enhanced payments but no longer offers inpatient services. The status supports sustainability.
Elkview relies heavily on Medicare and Medicaid. It has an estimated $1 million in annual Medicaid cuts coming down the line, Roland said. He’s trying to make it all work.
That means sitting at whatever tables he can get a chair at to voice how his facility could benefit from the grant program, while forming plans to manage expenses and revenue to offset some of the cuts. He’s also educating his new community about how they could be impacted by changes to Medicaid eligibility and the looming expiration of the Affordable Care Act enhanced premium tax credits.
“You're kind of juggling two different mindsets here as you're doing everything,” Roland said.
Roland said his hospital would benefit from funding for electronic health records, or investments in health care workforce and chronic care management. He also wants to see more regional collaboration among providers and tailoring care to benefit particular community needs.
“When you pass three hospitals to go somewhere because they can't do the service, how do we look at those tiers and work before we just automatically send everybody to Oklahoma City?” Roland said. “What can these smaller facilities do, and maybe expand them."
Collaboration is also a goal of the Oklahoma Hospital Association, which consulted its network and made a pitch to the Department of Health. One of its ideas was to help more facilities participate in a clinically integrated network – whether that’s supporting an existing one or creating one.
Chief legal officer Maggie Martin said this helps providers partner on patient outcomes and collectively negotiate better insurance rates while remaining independent. The idea is, eventually, facilities would see shared savings, making the model sustainable.
“As part of that, they have to clinically integrate,” Martin said. “So they have to really look at ‘How do we share records back and forth? How do we improve population health?’”
Other recommendations included Medicaid payments for swing bed services, an uncompensated care pool and workforce investments, like in a clinical apprenticeship model expansion. The grow-your-own model would allow certain high school seniors to be hired part-time at a hospital on top of classroom time at a technical education campus.
Emily Coppock, the association’s vice president of clinical excellence, said unlicensed nursing assistants are a good example of how the concept could work.
“You can do that today at a career tech. It’s typically all classroom-based with a little bit of clinical hours. But this model would be an upfront, 600 hours total model,” Coppock said. “You may spend the first couple of weeks mainly in classroom, didactic type, but then the remainder of it may be on-site in that hospital where they're earning while they’re learning.”
The association also recommended maternal health improvements, such as midwifery care expansion and working with the Oklahoma Perinatal Quality Improvement Collaborative to help hospitals with obstetric readiness, with the resources they have available. Over half of Oklahoma’s counties are maternity care deserts.
Brian Whitfield, president and CEO at McCurtain Memorial Hospital in Idabel, said maternal care is his top priority. The critical access hospital is 90% dependent on Medicare and Medicaid and serves one of the largest counties in Oklahoma. It also recently lost its obstetrics coverage, he said.
“And that has resulted … [in] babies being born in ambulances, being born at home, a lack of prenatal care and so forth for women,” Whitfield said. “And then, obviously, the follow-ups and so forth, they're just not taking place like they should.”
Whitfield said he needs help now to expand midwifery care and build incentives for providers to come work in Idabel. He said small facilities operating with small margins are going to experience the negative impact of federal cuts.
Although he thinks there is “fraud, waste and abuse” that needs to be addressed in health care, he doesn’t think cuts were the right approach.
“The bottom line is that as cuts come, we are looking at establishing new service lines that will help offset those cuts,” Whitfield said. “As a not-for-profit, we are not interested, we're not trying to follow the model of your larger health systems. … We want to be able to pay our bills. We want to be able to pay our employees and we want to be able to provide the absolute best health care that we can in our county.”
How are other sectors responding?
Although the program was initially touted as a “rural hospital fund,” it’s meant to support various efforts across different sectors. Steve Buck, president and CEO of Care Providers Oklahoma, said nursing homes face a unique situation amid federal Medicaid cuts, as the nursing home provider fee was exempted from new limits.
But these facilities experience many challenges, Buck said, like an estimated $22 per resident, per day gap between Medicaid reimbursements and the cost of care for state nursing homes and significant barriers in maintaining and attracting staff. He said he hopes building the workforce is a central part of the plan.
“Workforce needs are only going to grow as our population ages,” Buck said. “I believe that a concentrated health care workforce-centric approach, candidly, it'll benefit all providers, regardless of what your specific array of specialty is.”
He pitched for the continuation of staffing initiatives to bring front-line caregivers into the workforce. Currently, Care Providers Oklahoma is using $4.5 million in ARPA funding that expires next year to connect Oklahomans to certified nursing aide (CNA) jobs.
Through the Care Careers Oklahoma program, people can start in an entry-level role at a nursing home of their choosing, enter a training program and get to work as a CNA once they obtain their certification. He would like to see funding extended and used to further connect these professionals to programs that help them climb the health care ladder.
He also supported using funds to help nursing homes better address local community needs beyond traditional nursing care.
“You have a building that is staffed, you have it serving certain functions that could have value to the rest of the community,” Buck said. “... This is the type of observation to take our community assets and really try to magnify them in a way that the entire community benefits.”
Healthy Minds Policy Initiative also suggested investments in behavioral health professionals, expanding access to telehealth services and supporting models to integrate behavioral health care into primary care settings.
“Rural Oklahoma is up against urgent challenges: high rates of suicide, untreated mental health and substance use disorders, shortage of healthcare professionals, hospital financial instability, and limited high-speed internet access that hinders telehealth,” a brief stated. “Rural Health Transformation Fund dollars are a critical opportunity to invest in initiatives that can address these challenges for years to come.”
As stakeholders await a decision from CMS, many are hopeful but also concerned about where this funding will go and if it will support the right solutions. Roland, from Hobart, wonders if all of the pieces of the puzzle will be there.
“I'm glad I'm not sitting at the top of the pillar right now trying to decide where all this is going to go because, as smart as everybody thinks they are, we're going to miss something somewhere,” Roland said. “And it's going to be an interesting two years as this starts to funnel out and to see what the game plans are.”
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