The Trump administration’s new $50 billion Rural Health Transformation Program promises “radical transparency,” yet many states are declining to release their full applications. The result is growing frustration among rural hospitals and lawmakers seeking clarity as Medicaid cuts loom.
CMS says it is simply following federal competitive grant rules that prohibit releasing application materials during the review period to protect confidentiality and maintain the integrity of scoring. Still, disclosure varies widely. Nearly 40 states have posted project narratives, but only a small group have released full applications. Others, such as Nebraska and Kentucky, have withheld documents entirely, citing proprietary information or draft exemptions.
The stakes are high. The One Big Beautiful Bill Act pairs this new rural fund with $137 billion in projected Medicaid reductions over 10 years, according to KFF Health News. Since states may use only 15 percent of their new rural health dollars for direct patient care, hospitals want to understand how their state intends to stabilize access. Advocates warn that absent transparency, rural communities will struggle to prepare for financial and operational impacts.
Politics are also driving anxiety. Part of the funding will be awarded through a points system tied to the administration’s Make America Healthy Again objectives. Democratic lawmakers fear that states that diverge from those priorities may be disadvantaged. Illinois officials, for example, have already pressed CMS Administrator Dr. Mehmet Oz for assurances of a fair review.
Early glimpses into state plans show creative proposals, from drones for medication delivery in Alaska to telerobotics in Georgia and Alabama, mobile markets in Maryland, and faith-based health initiatives in Arkansas. Workforce investments, home-based care, telehealth expansion, and behavioral health infrastructure appear across many summaries. Advocates note that the innovation is encouraging, but execution will be the true test.
Awards are expected by year-end. Until then, uneven transparency will continue to complicate planning for rural providers navigating both new investment and significant financial risk.
Key Takeaways for Hospital and Health System Leaders
• Expect continued inconsistency in state disclosures until CMS completes its competitive review.
• Engage state officials now to understand proposed initiatives and to advocate for rural hospital priorities.
• Plan for the combined effect of Medicaid cuts and limited flexibility in the new funding stream.
• Monitor how alignment with federal priorities may influence award decisions, particularly in politically divided states.
• Prepare for rapid implementation of technology, workforce, and community-based innovations once awards are announced.