One year after its creation, a $50 billion federal program aimed at improving rural health care lacks transparency that could hinder efforts to protect against fraud, identify successful projects and ensure the program delivers on its goals, health policy groups say. 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.
The Centers for Medicare & Medicaid Services oversees the Rural Health Transformation Program but is not proactively publishing detailed information about where funding is going and how it will be used. CMS spokesperson Timothy Foster said the agency "will publish an annual report on state progress," but individual states' reports to CMS are "intended to be" shared only upon request, according to a CMS document. Foster did not respond to questions about whether the agency will share examples of working and non-working projects or create a public tracker of funding recipients and award amounts.
States have taken varying approaches to transparency. Some are sharing information with lawmakers and holding public meetings, while others are more secretive. Mississippi's governor vetoed a transparency-related bill, West Virginia holds closed-door advisory meetings, and a South Dakota official expressed hope that CMS would keep its application from public view. Mississippi state Sen. Hob Bryan, a Democrat who chairs his chamber's public health committee, said there is bipartisan concern about the lack of transparency in his state.
The Rural Health Transformation Program was created last summer as part of congressional Republican efforts to offset rural impacts from broader federal legislation expected to reduce overall Medicaid spending by more than $900 billion over a decade. In March, CMS published proposed reporting requirements and sought comments; at least three groups responded with concerns about transparency. Sandalow said states may be struggling to share information because they are busy meeting the program's tight deadlines, including an annual report that was due Aug. 31.
Media outlets, nonprofits and companies are attempting to fill the transparency gap by collecting and tracking states' applications, plans and budgets. Advocacy groups have urged CMS to share states' progress reports, funding recipients and details about how organizations plan to use their awards, saying such information is essential to ensure funds reach intended rural communities and to identify programs other states might replicate.
