A $50 billion federal program aimed at improving rural healthcare lacks transparency, which could make it difficult to protect against fraud, identify successful projects and ensure the program delivers on its promise to transform the system.
Transparency is really important to help protect the integrity of the program, ensure funds are reaching the communities they’re meant to serve, said Maya Sandalow, director of health policy for the Bipartisan Policy Center, a nonprofit think tank.
The federal government and states are compelled by public records laws to share documents when requested, but those requests can take months to fulfill, making their release too late for meaningful oversight as states rush to spend their allotments under tight federal deadlines.
In the meantime, the Centers for Medicare & Medicaid Services — which oversees the program — and some states aren’t proactively sharing information about where the funding is going and how it will be used.
CMS spokesperson Timothy Support said the agency will publish an annual report on state progress.
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Some states are sharing information with lawmakers, holding public meetings and explaining where organizations plan to invest their money, while others are more secretive, with multiple states declining to release public records in response to requests.
Mississippi’s governor vetoed a transparency-related bill, West Virginia holds closed-door advisory meetings, and a South Dakota official wrote that he hoped CMS would keep its application from public view.
Mississippi state Sen. Hob Bryan said he just doesn’t believe in all this secrecy, adding that there’s bipartisan concern about the lack of transparency in his state.
Congressional Republicans created the five-year program last summer as an eleventh-hour sweetener to President Donald Trump’s signature One Big Beautiful Bill Act.
As groups ask CMS to share more information, some states have created their own rural health spending dashboards or recipient lists, with varying levels of detail.
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Mississippi state Sen. Hob Bryan said there’s bipartisan concern about the lack of transparency in his state.
Congressional Republicans created the five-year program last summer as an eleventh-hour sweetener to President Donald Trump’s signature One Big Beautiful Bill Act, which is expected to reduce overall Medicaid spending by more than $900 billion over a decade.
KFF Health News is collecting states’ applications and approved plans and budgets, not all of which have been posted on state websites.
It is possible that CMS and states will increase transparency as the program progresses, allowing for more effective oversight and evaluation of the program’s impact.
The lack of transparency in the program remains a concern, with many calling for greater accountability and transparency in the program’s funding and operations.