Georgia requests $1.4B to transform rural health care

Congress and President Donald Trump created the $50 billion fund in last summer’s One Big, Beautiful Bill Act in order to win over some Republicans who were anxious about voting for the bill’s $1 trillion in health cuts.

Overall the fund does not come close to filling the law’s deep cuts to rural health care. It is also a one-time, five-year expenditure, whereas the cuts will be ongoing.

But that’s not the point, its advocates say. The goal is to pivot, federal officials say — not to keep shelling out for today’s system, but to invent tomorrow’s.

“Our hope is not to pay the bills, because that’s not sustainable, because it’s not working,” Centers for Medicare and Medicaid Services Administrator Mehmet Oz told an Atlanta audience this fall. “It’s to transform the system.”

Oz oversees the fund.

Georgia’s application envisions contracting with Elon Musk’s Starlink satellite system to boost rural telehealth, expanding a newborn screening laboratory in Waycross, providing better cybersecurity for hospitals and spending $17 million on the telehealth “pods,” among other plans. The largest single line item is $175 million to bolster rural Georgia health facilities’ ability to shelter in place during disasters and severe storms.

Some analysts have noted that the federal rules for spending the fund could end up siphoning the money to urban care after all. In one example, eligible targets include community clinics called Federally Qualified Health Centers, but FQHCs exist in urban areas too, including huge ones in metro Atlanta. According to news outlets such as STAT, Oz lobbied for the bill by assuring wavering lawmakers that the money wasn’t strictly rural.

In addition, as transformative as the ideas might be, the line items in Georgia’s application are sometimes partial fixes. For example, it would put $30 million toward fixing one part of the state’s Medicaid Gateway computer system, but users have complained of far broader problems with the Medicaid eligibility system.

Rural health advocates in Georgia praised the state’s effort in interviews with the AJC. But their biggest concern was that rural hospitals and clinics still need the income to pay nurses, doctors and suppliers. Medicaid doesn’t pay them enough and a lot of Georgia patients are uninsured altogether.

Robin Rau, CEO of Miller County Hospital in Colquitt, wondered whether the grant money would end up benefiting rural patients or just consultants and tech and insurance companies. She recalled a similar moment under President Barack Obama when billions were allotted to created a seamless electronic health record system.

“That’s my concern about all of this: Whenever the government puts a bunch of money out there, you know, you’ve got some bad actors,” Rau said. “So my fear, my hope, is that we don’t make the same mistake again.”

Jimmy Lewis, CEO of HomeTown Health, emphasized that hospitals operating on a shoestring would need additional resources just to try to implement whatever new programs are created, all while keeping their operations running.

“We got to figure out how to educate ourselves to use the money properly,” Lewis said. “We’re talking about a total transformation of the delivery of health care and access. And we have to do all of that in the face of a general workforce shortage.

“The monies that are allocated for transformation are a great start,” Lewis said. “But they’re totally insufficient to cover the losses that started (decades ago in underfunded government health budgets).”

Gov. Brian Kemp’s office declined to comment to the AJC on the application while it’s pending.