By CJ Baker
Powell Tribune
Via- Wyoming News Exchange

POWELL — Congress has set aside $50 billion to transform rural health care, and the Trump administration is asking the nation’s governors to “think big and submit audacious proposals” for the funding.

Gov. Mark Gordon’s administration is currently seeking public input in preparation for a possible proposal.

The Wyoming Department of Health hosted a town hall meeting in Powell earlier this month, during which about three dozen local health care providers and community members from around the Big Horn Basin offered some suggestions.

Among other ideas, they said the state should find ways to help recruit and retain health care workers, ensure rural residents have access to services and add inpatient mental health care facilities.

Hundreds of millions of dollars could be available through the federal government’s new Rural Health Transformation Program. Created within the One Big Beautiful Bill Act, the program aims to: promote preventative health care; improve efficiency and sustainability; attract and retain workers; and encourage innovative technologies and care models.

It’s not exactly a windfall, as the nonprofit health policy organization KFF estimates that the $50 billion will be more than offset by $137 billion worth of cuts to federal Medicaid spending in rural areas over the next 10 years.

Still, Wyoming could potentially receive between $500 million and $800 million over the coming years — if the state can demonstrate a need and fit the criteria outlined by the Centers for Medi- care and Medicaid Services, said Franz Fuchs, the Department of Health’s deputy director.

“It has the potential, if spent wisely, to be truly meaningful and transformative,” Fuchs said of the money.

That’s why the department is hosting public meetings in some more rural parts of the state and issuing a statewide survey next month.

“It’s kind of like, ‘Help us, help you, help the state,’ right?” Fuchs told those in attendance on Sept. 18. “If we can build the best application possible, that really gives us the best chance of pulling down more federal dollars that might be available.”

 

Measuring priorities

The department said it isn’t looking for specific projects to fund, but broader priorities.

Attendees at the Sept. 18 meeting were asked to rank cost, access and quality by relative importance. 

Of those who raised their hands, 17 ranked access as their top priority, 11 picked cost and three chose quality.

But in their explanations, attendees noted how the three criteria often overlap. 

For instance, one commenter said health care isn’t accessible if it’s too expensive, as people won’t go to the doctor if they can’t afford it.

North Big Horn Hospital CEO Eric Connell of Lovell noted estimates that nearly $1 out of every $5 spent in the United States goes toward health care.

“That’s a problem,” Connell said, adding that the idea of injecting more government dollars into the system to make it more cost effective is “an interesting concept.”

 

Maintaining services

Given their own high costs, rural providers can struggle to make a profit on some services. There are plenty of examples from recent years: Powell Valley Healthcare stopped offering home care and hospice service in 2015 after losing hundreds of thousands of dollars annually; it just announced the pending closure of its oncology services and internal medicine clinic in Cody.

Elsewhere in the state, in 2022, Three Rivers Health in Basin had to shutter its nursing home; South Lincoln Hospital in Kemmerer and Memorial Hospital of Carbon County in Rawlins stopped offering labor and delivery services; and Evanston Regional Hospital ended its labor services in 2024. 

Platte County Hospital in Wheatland announced a pause of its maternity services just days before the meeting in Powell.

A couple attendees said emergency medical services are also in a precarious financial position

in much of the state. EMS providers are often volunteers — who are dwindling in number — while an aging population presents greater health care needs.

Pat McConnell, who’s long worked in health care in the Big Horn Basin and beyond, said los- ing services has a big impact on a community.

He recalled the emotional comments Basin area residents shared when Three Rivers Health leaders closed the nursing home.  

McConnell also noted that many local hospitals are taxpayer supported and recently had their funding cut by property tax relief measures. 

“It’s even making some of the facilities look further at what services that they are going to have to discontinue in order to keep their facility open,” he said.  

The state should work to keep services viable, he added. 

 

Expanding services

Though just preserving existing offerings can be a challenge, multiple commenters said they’d like rural facilities to offer more.

Linda Dalton, the director of the Powell Senior Center, said it can be hard for older residents to travel to Billings for care.

“We’re just too rural,” Dalton said, “and we need some more of those specialized care [provid- ers] closer to us.”

Meanwhile, Cody Regional Health CFO Coby LaBlue said Wyoming needs more facilities offering inpatient mental health care, “so there’s access all across the state, instead of just southern Wyoming.”

Currently, “we don’t have enough facilities in this state,” LaBlue said, “and so patients that need psychiatric care are languishing in critical access hospitals or jails where they’re not getting the treatment that they need.”

 

Investing in buildings or people

One hurdle is that the federal dollars apparently can’t be spent on capital and infrastructure projects, like a new building.

But McConnell encouraged the Department of Health to advocate for reasonable solutions that may require some capital.

“Because what else are we going to spend money on? Staff for a few years, and then it’s going away?” he asked.  “It’s going to be really hard to find sustainable things that we can spend money on that aren’t going to require additional ongoing funds.” 

Dr. Dean Bartholomew of 307Health agreed the funding should go toward sustainable projects. He said it’s frustrating when an organization gets money to launch a new service and then goes away when the funding runs out.

However, Bartholomew said new buildings aren’t a silver bullet.

“I think looking at [the] health care worker pipeline has gotta be number one with some of this money,” he said. “That’s how you’re going to regain services.”

LaBlue also said she sees a need to bolster recruiting and support the next generation of providers.

“‘We’re fortunate to have very good primary care providers in this community,” she said, but many are approaching the end of their careers.

Hot Springs Health in Thermopolis launched a rural residency training program that’s helped with its recruiting, said CFO Natalya Keller. 

She said the program has led to the hiring of three physicians over the past five years or so. However, Keller said Hot Springs Health’s program — which costs about $200,000 a year — was funded by grant dollars that have run out.

One attendee wondered if there is a way to create a kind of endowment with the Rural Health Transformation Program dollars so the proceeds could provide a benefit for future generations.

Dirk Dijkstal, the Department of Health’s business operations administrator, said that concept “is definitely something that we have looked into and are looking into.”

 

Next steps

After wrapping up its public meetings — specifically scheduled in more rural areas — the department will use the input to survey residents across the state in October. Area hospital administrators are finalizing what they would like to have funded ahead of an early October deadline. The department will then submit a proposal to Gordon, who faces a Nov. 5 deadline for submitting an application to the feds.

PVHC interim CEO Sean McCallister told the Tribune final decisions are expected to be made by the end of the year.

“It’ll come down to the wire,” he said.

Meanwhile, the Wyoming Legislature’s Joint Appropriations Committee has formed a three- member subcommittee to dive into the Department of Health’s budget. 

The group is set to meet this week.