As Mississippi prepares to spend tens of millions of federal dollars to strengthen rural health care, lawmakers in both state legislative chambers have advanced bills aimed at increasing transparency and oversight. 

In December, Mississippi was awarded nearly $206 million as a part of the Rural Health Transformation Program. This fund was designed to support rural health care and offset the disproportionate impact already-struggling rural hospitals are expected to bear as a result of federal spending cuts Congress passed into law last summer. All 50 states were allocated funding as a part of the five-year, $50 billion program, which will be doled out in annual installments. 

Republican Gov. Tate Reeves led Mississippi’s application for the funds, with support from the  Mississippi State Department of Health and Division of Medicaid. According to a December press release, Reeves’ office will also oversee and coordinate distribution of the one-time funds. 

Some lawmakers, including House Speaker Jason White, have expressed frustration with their limited role in the funding application process. Senate Public Health and Welfare Chairman Hob Bryan, a Democrat from Amory, echoed those concerns during a committee meeting Feb. 3.

“There is a feeling among some of us in the Legislature that at minimum, the Legislature should have some input into those funds,” Bryan said. “I’m of the old school that it’s always useful to have people sit around a table and have a conversation and try to work something out, but none of that has occurred yet.” 

A bill passed the House Wednesday with a vote of 121-1 to enhance legislative oversight. The Senate Public Health and Welfare committee passed a similar bill Tuesday. Both would require state agencies that distribute grants or funding under the program to submit quarterly reports to the Legislature. 

The bills would also require vendors or subcontractors, including those tasked with performing a statewide assessment of rural health needs, providing medical equipment, creating workforce programming or designing a statewide health information system, to be selected by a competitive bidding process. 

The legislation would prioritize subgrantees in rural areas and, for medical equipment or facility upgrades, those that have not received appropriations for similar projects in the past five years.

“House Bill 1067 does not pick winners and losers,” said Public Health and Welfare Chairman Sam Creekmore, the Republican from New Albany who sponsored the bill. “It simply says if you want to do business in Mississippi on this $206 million program, you’ll compete in daylight and we’ll send the money out as grants — we deliberately point out — toward the rural communities with the least resources and the most to lose.”

Reeves did not respond to a request for comment on the bills or his engagement with the Legislature on the program. 

Ryan Kelly, the executive director of the Mississippi Rural Health Association, said he supports efforts to steer funding to rural areas or programs that benefit rural communities. Urban providers that do not directly serve rural areas should not receive the funds, he said. 

“It’s not for them,” Kelly said. “It’s for rural providers that are struggling.”

Nationally, supporters have lauded the Rural Health Transformation Program as a boon for struggling rural hospitals, which will allow states to make innovative investments in care. But critics have called the fund a “Band-Aid,” pointing to the fact that it will not offset funding cuts to hospitals, or a “slush fund” that could enable state leaders to fund pet projects or providers in urban areas with little oversight.

In Mississippi, cuts to state-directed payments, which help hospitals offset low Medicaid payments, will amount to a loss of $160 million a year statewide beginning in 2029, Mississippi Medicaid Director Cindy Bradshaw told lawmakers last September. 

Mississippi’s application for the funding includes a plan for program oversight. An organization will help to distribute the funds, track milestones, evaluate outcomes and ensure compliance, according to the application. The state issued a request for qualifications to hire a company to fulfill these tasks in December. 

Mississippi plans to fund an array of projects. The program application proposes using the funding to perform a statewide assessment of rural health needs, which it projects will be complete in September, to inform funding decisions for the program. The state will conduct procurement for these services, according to the application.

Other proposed uses of funding included in the application include: 

• Creating regionalized EMS systems to share data and resources.
• Piloting a program that encourages EMTs to treat patients in place and reduce unnecessary emergency room visits.
• Establishing remote medical assistance and nurse navigation lines for real-time symptom assessment, treatment planning and care coordination support.
• Developing workforce recruitment incentives like signing bonuses, relocation support and retention awards, establishing “earn while you learn” programs and increasing residency slots in rural areas.
• Funding technology upgrades for rural health providers, including upgrades to outdated electronic health record systems and for enhanced cybersecurity.
• Creating a statewide health information exchange to support real-time data sharing between providers.
• Supporting purchases of telehealth equipment and subsidizing provider reimbursements for telehealth care.
• Funding infrastructure projects, including facility upgrades, clinic expansions and equipment acquisition. 

The governor’s office published a copy of the state’s full application with funding estimates redacted. 

Nationwide, states’ programs are being led by a range of state agencies. Most programs are being led by state departments of health or Medicaid divisions, according to a report from Princeton University’s State Health & Value Strategies program. Mississippi and New Hampshire are the only states where the governor is leading implementation. 

States’ awards averaged $200 million this year, ranging from $147 million to $281 million. Mississippi received $260 million — above the median award — but ranked lower when compared to its rural population. 

According to a report from KFF, Mississippi received $118 per rural resident — roughly $40 below the national average — while several states received over $500 per rural resident. More than half of Mississippi’s rural hospitals are at risk of closing, one of the highest rates in the nation, according to a recent report by the Center for Healthcare Quality and Payment Reform. 

Half of the $50 billion federal program is to be distributed evenly among all states with approved applications. Awards for the other half of the funding are determined based on a formula that calculates states’ rurality, the quality of its application and implementation of several policies aligned with the White House’s Make America Healthy Again agenda.

Mississippi has recently taken steps to adopt policies that receive higher scores, including reestablishing the Presidential Fitness Test in schools and seeking a waiver to restrict purchases of sugary foods and drinks through the Supplemental Nutrition Assistance Program, or SNAP, in October.

Scoring also privileges states that have eliminated or loosened certificate of need laws, which require hospitals to obtain permission from the state before opening new facilities and services or purchasing expensive equipment this session. 

A bill raising the threshold that triggers state approval for capital improvements passed the Legislature on Jan. 28. Lawmakers are weighing additional changes to the law. 

State legislators have taken additional steps to exert greater control over parts of the program’s rollout. On Jan. 21, the House passed a bill to designate a state-recognized health information exchange, an element included in the state’s Rural Health Transformation Program application. The measure would require that a single nonprofit entity be selected by the health department through a competitive bidding process to build an information system used by all state hospitals and community mental health centers to share patient admission, discharge and transfer data, as well as bed availability. 

Some lawmakers raised concerns about patient data sharing on Jan. 21, but a proposed amendment to require patients to opt in to the system failed. The bill was sent to the Senate Public Health and Welfare committee for consideration. 

According to the Centers for Medicare and Medicaid Services, states’ funding through the program for coming years will hinge on their progress implementing the proposed initiatives. This makes it especially important to demonstrate measurable impact and maintain transparency, said Khaylah Scott, program manager for the Mississippi Health Advocacy Program.

“The ball is really in our court to perform well and follow through on our promises,” Scott said.