Texas health officials want public input for the state's application for its share of new federal rural health funding.
The Rural Health Transformation Program was created as part of the new sweeping budget bill that also made significant cuts to Medicare and Medicaid. Those cuts could have a negative effect on several health care industry concerns — but for rural communities specifically, it could lead to even more hospital and clinic closures.
Dr. Kia Parsi, executive director of the A&M Rural and Community Health Institute, said between less funding and more uninsured patients, some rural facilities have to focus on just staying open.
"Any shift in the payer arena having more un-insured patients would adversely affect these rural institutions, rural clinics, rural hospitals," Parsi said. "There are rural hospitals in Texas that are doing well, but there are many that are at risk for having enough for payroll."
However, Parsi said this program isn't exactly a fix for those facilities.
While Medicaid and Medicare provided continuous funding to rural areas, the Rural Health Transformation Program is a one-time investment of $50 billion dispersed over five years.
Half of the money is shared evenly between states with an approved application, and the other half is distributed to states based on need.
Parsi said Texas needs to focus on long-term sustainability created through short-term projects — like investments in infrastructure or workforce development.
"If you could grow that workforce and that workforce stays for the rest of their career, well, that has a lasting impact," Parsi said. "I had some incentives to help with loan repayment that paid off my loans in four years, but I stayed in the community for almost 20 years."
Parsi's organization plans to make suggestions tackling rural health access from several different angles. That includes utilizing pharmacists for chronic disease management, a regional telehealth program and rural maternal care innovations. He said they also plan to recommend an alternative payment model under Medicare that would direct more money to rural hospitals and providers that remains "budget-neutral" to the Centers for Medicare and Medicaid Services.
Parsi said with about three to four million people living in rural Texas, the state has a lot of rural health needs to address — and avoiding further loss of health care access and services is critical in rural areas.
"In an urban area, if a hospital closes, people might have access to another hospital," Parsi said. "That's not the case in most rural communities. It's either having care or having no care."
In the last decade, Texas has lost 14 rural hospitals. Of the 156 rural hospitals currently in the state, about 70 percent have lost services, and more than half are at risk of closing, according to an August report from the Center for Healthcare Quality and Payment Reform.
Nationally, more than one out of every three rural hospitals are at risk of closing, with 322 at immediate risk.
People and organizations can submit their comments for the application through Tuesday, Sept. 9. Parsi said he's hopeful the state will submit a strong proposal informed by public comments to secure a large amount of funding for Texas.
"There are opportunities to help improve the sustainability of rural healthcare, but it has to change," Parsi said. "The current environment is not sustainable."
Abigail Ruhman is KERA's health reporter. Got a tip? Email Abigail at aruhman@kera.org.
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