$50B rural health transformation program needs more transparency, groups say

One year after its inception, a $50 billion federal program designed to enhance rural healthcare is lacking transparency, potentially hindering efforts to combat fraud, recognize successful initiatives, and guarantee the program achieves its goal of transforming the system. According to Maya Sandalow, director of health policy at the Bipartisan Policy Center, transparency is crucial for safeguarding the program's integrity, ensuring funds reach their intended beneficiaries.

While the federal government and states are legally obligated to disclose documents upon request, these requests can take months to process, rendering them ineffective for timely oversight under the program's stringent deadlines. Currently, the Centers for Medicare & Medicaid Services (CMS) and some states are not proactively disclosing information about the allocation and utilization of funds.

CMS spokesperson Timothy Foster mentioned that the agency will publish an annual report on state progress, but individual state reports will only be shared upon request, without proactive publication of examples of successful or unsuccessful projects or a funding recipient tracker. State governments have largely been responsible for transparency efforts, with varying levels of detail shared.

Some states engage with lawmakers, hold public meetings, and explain their plans for funding allocation, while others maintain secrecy, with certain states refusing to release public records in response to Freedom of Information Act requests. Mississippi's governor vetoed a transparency bill, West Virginia holds closed-door meetings, and South Dakota officials have expressed a desire to keep application details private.

Critics argue that the lack of transparency is concerning, even if not necessarily nefarious, and emphasize the importance of openness for effective oversight and accountability. Some states may be overwhelmed by hiring staff and meeting deadlines, leading to delayed information disclosure. Meanwhile, media outlets, nonprofits, and private companies are working to provide public access to tracking tools, but many resources are behind paywalls.

Previous federal programs, such as the CARES Act and COVID relief initiatives, have also been criticized for lacking transparency and oversight, leading to instances of fraud and improper payments. In March, CMS released proposed quarterly and annual reporting requirements and sought public comments, receiving feedback from various groups urging for greater transparency, including sharing state progress reports, funding recipients, and intended uses of funds.

Health associations and hospitals have also called for detailed disclosure of fund destinations, particularly given the complexity of the grant process and the involvement of large health systems and academic medical centers.