Rae Woods (00:05):
Hey, it's Rae. I'm recording this special episode in the morning of Wednesday, October 1st, because the United States government has officially entered a shutdown following a breakdown in funding negotiations, and healthcare is the central point of contention. Democrats are pushing to permanently extend the enhanced ACA premium tax credits, which reminder are currently set to expire at the end of 2025. They're also seeking to roll back some of the key Medicaid provisions included in the one Big Beautiful Bill Act, specifically work requirements for bodied adults and the six-month redetermination cycle that increases administrative churn. But given the current legislative gridlock, any sweeping changes are unlikely. It is possible we'll see a short-term extension of the ACA tax credits or maybe modifications to the Medicaid work requirements, but not a full repeal. But I want to remind you, there are other healthcare programs caught in the crosshairs of a government shutdown.

(01:06):
For example, the Acute Hospital at Home waiver and the Medicare telehealth flexibilities both expired on October 1st. These programs require explicit legislative action to be reinstated. So until Congress acts, we're essentially back to pre-pandemic restrictions. That means patients who were receiving hospital level care at home must be transferred back to brick and mortar hospitals, and Medicare beneficiaries can no longer receive reimbursed virtual care. It's a lot of wait and see, but here is something you can do now. When Trump's Big Beautiful Bill was signed into law, it included a $50 billion rural health transformation fund, allocating $10 billion annually from 2026 to 2030 to support rural health care. And for months, details were sparse. Frankly, that's all we knew. Until now. CMS has released new guidance and there's urgency for healthcare leaders to act. The most important thing to know is that funding will be awarded to states that submit applications and have them accepted.

(02:13):
It will not be awarded to hospitals or any other individual organizations. That means your health system would not receive funding directly, and while the first round of funding will become available around the same time that rural providers are anticipating very real headwinds from things like Medicaid cuts, it's not meant to be an emergency fund to help backstop provider operations. Instead, state applications need to include a comprehensive plan to address three or more approved uses of funds, including things like provider payments, workforce incentives, technology upgrades, behavioral health services, and care model innovation. States must report annually on progress and use funds by the end of the following fiscal year. While the scope and purpose of this program is different than what we expected in July, there is money on the table and the window to apply to participate in the fund opened on September 15th, but the big date to keep in mind is the final deadline for applications on November 5th.

(03:17):
The awardees will be announced by the end of this year. If you're a rural organization, you need to act now. Most states are submitting applications through their state health or rural health offices. While you're calling your state representatives to advocate around the government shutdown, you also need to call your governor's office. Call your state Medicaid agency, the rural health context that you have so that you can engage in drafting the project narrative and funding distribution plan. CMS has indicated that they want to see stakeholder collaboration reflected in these applications. Bottom line, if your organization touches rural health, now is the time to plug in and activate your advocacy team.