Rural health transformation grants roll into region

Tennessee's funds from the Rural Health Transformation Program will soon support local projects aiming to improve sustainable healthcare systems. The program — a five-year $50-billion federal fund created in the wake of Medicaid cuts from President Trump's One Big Beautiful Bill — awarded Tennessee more than $206 million to spend by the end of next year. The state plans to prioritize maternal and child health, workforce pipeline, improved food and fitness and more over the fund's lifetime. For local nonprofits, schools, charitable clinics and first responders, the grants will fund healthy living practices, medical equipment and professional training. But while all of the recipients are grateful for the monies, some note it won't make up for upcoming Medicaid cuts, which the Congressional Budget Office estimates at $911 billion over the next 10 years. Preventive health measures Some grants are going toward preventive health measures as part of the health department's Healthy Active Rural Tennessee program. HART projects are meant to increase the percentage of rural populations living near "health-promoting" environments by improving nutrition, physical fitness and community social support. The Southern Off-Road Bicycle Association is one recipient of the initiative. Executive Director Abraham McIntyre said they have received $150,000 over two years to create beginner-friendly trails at Unaka Bike Park near Erwin. It's a project that will increase the accessibility of the park, he added, and create active and healthy lifestyles for the youth. "People have to have good, fun, accessible, welcoming spaces to ride," McIntyre said, adding that they look "upstream" to prevent unhealthy conditions that might need medical attention. The funds are "critical" to support these projects, he added, even with other donors. "[The] Tennessee Department of Health is the major partner in this," McIntyre said. Hawkins County Schools received $100,000 through the same grant program for new playground equipment. The funds will be split evenly between Carter's Valley Elementary School and Clinch School to complete the projects in two years. Erika Phillips, supervisor of coordinated school health, said in an email that playground maintenance is extremely expensive and they are thrilled about the funds. "Research shows that increasing physical activity leads to better focus in the classroom," she said in the email. "Playgrounds are also places where students build social skills." Medical care and long-term support Other grants address other state priorities, like providing a new ambulance and lift for every county. A $305,000 grant for the vehicles and systems have already been approved in both Washington and Hawkins counties. While the money won't add a new truck to the service, Washington County-Johnson City EMS Chief and Executive Director Dan Wheeley said, it will take the place of an old one and allow the department to get ahead on its fleet replacement schedule. "Budgets are always tight, especially in election years, and it's a big benefit," Wheeley said. "It will essentially replace the funding that we would've had to pay to buy that unit." It also frees up money that could be used for other service-enhancing capital expenses, like video laryngoscopes or devices that could help lift patients up and down stairs. In Bristol, Tennessee, Healing Hands Health will receive about $357,000 over the next five years through a health department office. Amy Moseley, director of development and community engagement, said in an email that the funding will support emergency and resiliency efforts. The clinic, which offers primary, dental and vision care for people who are un- and underinsured, is still keeping an eye on other rural health grants. However, Moseley said the bandwidth needed to apply for and manage the grants is hard for their 30-person staff. "Anything that comes from the federal government originally, there are a lot of rules," she said. "It's got to really be something that's really going to work for us… to go for it." A $3.8 million five-year grant will also support a new maternal care fellowship at ETSU Health that addresses maternity care deserts across the region. The one-year program will give family medicine residents more surgical obstetric skills and require physicians to practice in rural Tennessee for at least five years. ETSU Health Family Medicine Chair Dr. Jason Moore added that Medicaid cuts will hit rural areas the hardest, since they have higher rates of eligibility and need for the federal health coverage program. "That's why we're trying to use some of those funds to target particularly the rural areas and most vulnerable populations: women, young infants, children," he said. Medicaid cuts Federal cuts could result in a $5 to $8 billion decrease in Medicaid spending in Tennessee over the next decade, according to 2025 CBO estimates. The slash has drawn concern from health professionals across the nation. "The transformation investment, while good, is not a backfill for the cuts that are happening," Michael Meit, director of East Tennessee State University's Center for Rural Health Research, said in August. "Transforming a system, creating innovation, is exciting, but the problem that our rural facilities are facing is that they are soon to be… providing a lot more uncompensated care, and they're already operating in ways that are not profitable." EMS Chief Wheeley said cuts to Medicaid and its fee-based payments will have a huge impact on ambulance providers across the state, causing them to rely more on funds from county and local governments. "While this [grant] does help, I don't feel like it bridges that gap," he said. Their department is currently trying to balance the increasing needs of a growing population in Washington County. The cost of an additional ambulance, Wheeley said, is just a third of what it would cost to staff it 24/7 year round. "I wouldn't say we're in a critical situation," he said. "[But it's] something in the next few years that we're gonna have to address with adding additional units to the coverage area to handle the call volume." Moseley, with Healing Hands, said they do expect an impact from people falling off of Medicaid, especially in Virginia. Some enrollees there will soon have to prove every six months that they meet new work requirements. The clinic has 800 people on their dental waitlist and are booking further out than ever for medical appointments, Moseley added. They've also picked up "quite a few" medical patients who fell off of marketplace insurance after increases to Affordable Care Act premium payments. "We're concerned that it'll be a funding cut for us," she said. "And just having enough staff to take care of everyone who needs our care." But Moseley has worked for the group for more than 11 years — through the implementation of the Affordable Care Act, Medicaid expansion, program cuts and other changes, she's learned to roll with the punches. "We can't control policy, so we just have to be here to meet the need of the community the best way we can."