A new statewide program will distribute roughly $200 million in federal funding this year toward rural healthcare needs in New Hampshire. Over five years, the state expects to receive a total of $1 billion.
The money comes from the Rural Health Transformation Program, part of the federal spending bill, the One Big Beautiful Bill, signed into law by President Trump last year. The $50 billion fund distributed to all states for healthcare was created to compensate for deep cuts to Medicaid and other federal health spending in that bill.
Donnalee Lozeau is the director of the Governor’s Office of New Opportunities & Rural Transformational Health (GO-NORTH). She spoke with NHPR’s All Things Considered host Julia Barnett about the program’s long-term goals and how Granite Staters can expect the money to show up in their lives.
This interview has been edited for length and clarity.
Transcript
So there's a lot of ground that this program is covering, from health care infrastructure [to] workforce development. What are the top priorities?
Well, I think the top priority is getting our arms around what our core issues are and how we can sustainably transform health care, particularly in the rural areas. The core challenge that we have, of course, is that our system is designed to treat illness, not keep people well. We tend to be reactive more than proactive, services are fragmented, [there’s] limited support for daily life needs, volume-based more than value-based, if you know what I mean by that.
And so, we can't accomplish overcoming those where we are today because today, we're dealing with — and there's no surprises here, right? We have workforce shortages, particularly in the rural areas or the areas that border other states with the competition. We have financial pressures on providers. And clearly in the North Country, access challenges in rural communities and even in more populated communities, you see challenges sometimes with access because of the workforce shortages. And then of course, the rising burden of behavioral health and chronic disease are things that we're really looking at.
We see this grant as an opportunity. I mean, for the federal government to invest over $200 million, hopefully per year, if we get it all right. That can really make a big impact. And the application went in as a five-year implementation, transformational project. So it gives us a little bit of a road to make things happen, to adjust, as we move forward and learn. So our success certainly drives the future funding or investment, as I like to call it, right? Because we're investing in this in New Hampshire.
You mentioned that your philosophy in distributing money is about long-term investments, not short-term patches or fixes. But there are some acute issues that people, particularly in rural New Hampshire, are facing now: loss of Medicaid, years of consolidation [and] closures among our rural hospitals and sometimes long waits even to see primary care physicians. And the way this fund is set up, states can only use up to 15% of it to pay providers for patient care. How are you expecting this program to alleviate these real pressures for Granite Staters when it comes to healthcare access right now?
So our approach, we're saying we have four things, right? We want to stabilize. We want to strengthen. We want to transform. We want to sustain. So part of it is billing models that could be done differently. So if you're a certified behavioral health center, you're able to bill differently than you can today without that certification. It's not so much about paying providers, it's about having more providers, right? So the workforce issues go through all of the funding to be able to try to build capacity for that workforce.
And taking a different approach to some of it — mobile access, telehealth, looking at how else can we bring services to people. The community college system of New Hampshire is looking at building capacity. For example, Manchester is adding two new faculty to their nursing program. You may have recently seen that UNH [University of New Hampshire] doubled their enrollment and had to stop taking in new nursing students. So there are good signs. The governor's award program as part of this grant is designed to cover the cost of tuition if a student commits to five years in some of these areas where we need more workforce.
So what are the levers, if any, in this program that would mitigate some of the effects of Medicaid loss with new eligibility rules and federal funding cuts to the program?
I have to say, I really can't. My experience is not a deep dive into Medicare and Medicaid. I came to this work with the strength of trying to organize, be nimble, be flexible, hear people implement things that we can, what we can do, right? We can't change decisions that the federal government is making right now, but we can take this opportunity to invest what they're giving us.
The conversations around what we're going to get, less Medicaid money or Medicare money, is right now for me, a different conversation. Right now, we have this significant amount of money for the state of New Hampshire to do some of this work. And if we get it right — and I think New Hampshire is ahead of a lot of states, because the approach that we took is having immediately, five, what we're calling hubs, that are working with us, doing this work, expanding their work, and I think that that's going to have a more immediate impact on how things are going and what can be done in this short window of time, particularly this first budget period.
How will the state maintain this program after the grant wraps up in 2030?
So the plan is, that as we're doing this work, we have to find ways to be able to fund it or maintain funding if that's what it requires. So for example, I used the behavioral health one earlier. If they can bill differently for their services, that helps them to be more sustainable long term.
I visited the Ammonoosuc [Community] Health [Services] center yesterday and they have some really innovative programs that they're doing around food for medicine. So if we can change the dynamic on how people are getting care and when they're getting care and that they're in the care system before they're in trouble, we can have them be healthier and therefore the cost will be less. So finding some of those things — we don't know all the answers yet. And it's one of the things that we're going to ask the people that we partner with as they propose new approaches to things.
I'll use the community college as a good example as well. When the Manchester Community College said, “We're adding two faculty.” I said, “That's great. So when the money is gone from this program, how are you keeping those two faculty?” We have to think about that, right? Can we partner with the hospitals that want those nurses to help contribute to the cost of teaching those nurses? There's not like 1 or 2 solutions. Everything is connected in a way and knowing which levers to move, I think, will dictate some of the success.
How is the state going to measure its success?
We have to measure our success primarily through the goals and milestones that we have set as a state and that CMS [Centers for Medicare and Medicaid Services] ]has set. And so I could rattle off a few, potentially, but I think that what we'll know what’s working when people are staying healthier longer, when we have avoidable ED [Emergency Department] visits and hospitalizations, when providers are more stable, when we have more of them, when communities can feel that difference and then ongoing evaluation and adaptation. And we have to be honest about our success and transparent about, you know, what? We tried this and here's what we learned. So we're going to pivot and we're going to do it this way instead.
