2026年4月27日 美国东部时间早上5:00 / KFF健康新闻
托里·斯塔尔十分担忧加州北海岸地区“开放社区健康中心”接诊的患者。
“他们是餐厅员工、教师助理，”斯塔尔说，这位注册护士六年前多出任该中心首席执行官。他表示，这些患者“才是美国农村真正的核心与灵魂”。
他说，如果自己旗下的远程医疗中心无法分得国会拨款用于改善美国农村医疗的数十亿美元，患者可能很快就会失去医疗服务。“开放社区健康中心”的6万名患者中约有50%享受医疗补助计划——这一由州政府与联邦政府联合出资的保险项目，连同相关的儿童健康保险计划，覆盖了约7600万低收入或残障人群。
国会去年夏天通过《一项宏大而完美的法案》时，计划在未来十年内从医疗补助计划中削减近1万亿美元开支。如今斯塔尔希望，同一法案中包含的500亿美元农村医疗转型基金，能帮助留住他的患者。
然而，像“开放社区健康中心”这样的小型社区医疗服务机构，可能会发现这笔巨额资金在抵达患者手中前，就已被大批企业巨头分走一部分。
托里·斯塔尔是注册护士，同时也是“开放社区健康中心”首席执行官。该中心在北加州两个县设有13个临床站点，约50%的患者享受医疗补助计划——这项由州与联邦联合出资的低收入人群保险项目。
开放社区健康中心
联邦官员宣布全美50个州均可获得第一年拨款后数月，各州拨款计划浮出水面：新泽西州获得1.47亿美元，得克萨斯州获得2.81亿美元。计划显示，大量指定拨款将流向那些能推广电子健康档案应用、强化网络安全，并升级州级和医疗系统技术平台的企业。
目前至少有四大企业联盟正在向各州推销多维度服务。其中许多企业早已通过医疗补助合同、移动医疗或远程医疗业务，与地区医疗系统和州政府开展合作。
但这些服务将如何帮助改善“开放社区健康中心”这类机构的美国农村居民医疗状况，仍是未知数。
各州面临报告截止时限
华盛顿两党政策中心（一家智库）的副主任玛雅·桑达洛表示，联邦监管机构在去年制定这项为期五年的农村医疗项目规则时，“非常希望看到数字医疗投资”。她共同撰写了一份最新报告，内容涉及50个州计划如何投资技术，包括升级医疗基础设施、拓展远程医疗和远程患者监护等虚拟护理选项。
“农村医疗基金并非旨在直接替代或抵消削减的医疗补助资金，”桑达洛说道。她指出，负责该项目的联邦工作人员将可用于帮助农村医院和诊所支付患者护理费用的provider payments（提供者付款）上限设定为各州获得总拨款的15%。
联邦监管机构还设定了严格的报告截止时限，迫使各州加快行动。
据负责该项目的联邦机构医疗保险和医疗补助服务中心（CMS）消息，各州必须在8月底前提交进度报告，并在10月30日前完成所有第一年拨款的拨付。根据CMS的资金机会公告，如果各州未能遵守联邦要求，其拨款可能随时被削减或终止。
截至4月初，怀俄明州、科罗拉多州和佛蒙特州等部分州的预算尚未获得CMS批准，或仅获得部分批准，据州政府官员透露。CMS发言人凯瑟琳·豪登拒绝透露哪些州仍需提交修订后的预算审批，她表示该机构不会提供“各州具体更新信息”。
阿拉斯加州的预算已获批准，但该州尚未公布发布完整拨款申请和奖项的时间，阿拉斯加农村医疗转型项目协调员特丽西娅·富兰克林说道。
“原定目标是初夏，”富兰克林说。但供应商和申请者的响应“远超预期”，因此可能需要更长时间。
专注于州级医疗政策的非营利组织米尔班克纪念基金的全国人口健康主管摩根·麦克唐纳表示，各州与咨询公司合作是“快速高效”满足联邦时限、发放拨款的成熟方式。
升级技术，重塑农村医疗
财富500强政府承包商科学应用国际公司（SAIC）牵头组建了“推进农村医疗联盟”。SAIC业务涵盖网络安全和工程支持等多种技术服务。该联盟还包括沃尔格林药房和将房车改造为初级医疗诊所的“使命流动医疗”公司。此外，一家数据分析公司、一家远程医疗软件公司，以及一家协助医学生进入医疗系统的企业也加入了该联盟。
SAIC农村医疗转型项目负责人、曾担任弗吉尼亚州卫生厅首席信息官的苏雷什·桑达拉拉詹表示，SAIC联盟提供了一个可协调各州既定工作的“企业生态系统”。他说，每家公司都有专门负责该农村医疗项目的代表。
两党政策中心的桑达洛指出，数字基础设施的缺失——例如不同诊所和医院的电子健康档案无法互通——一直是农村医疗团队面临的持续障碍。
“农村地区一直缺乏必要资金，无法搭建起能够全面采用远程患者监护、远程医疗和人工智能的基础设施，而这些技术才能真正提供支持，”桑达洛说，“这需要更新基础设施、调整工作流程等投入。”
桑达洛的最新报告显示，缅因州和犹他州正投资于网络安全；印第安纳州、密苏里州和新墨西哥州计划升级电子健康档案；俄克拉荷马州计划采购硬件和软件、补贴订阅服务，并为农村医疗服务提供者提供技术支持；亚利桑那州和南卡罗来纳州等州将利用资金创建远程医疗中心或采购远程患者监护设备。
联邦监管机构在制定农村医疗项目的支出规则时还规定，各州总拨款中用于更换已符合联邦标准的电子病历系统的资金不得超过5%。桑达洛表示，这意味着各州将专注于对现有系统进行增强和升级。
为数十个州的医疗补助计划运营系统的盖恩威尔技术公司，牵头组建了另一个企业联盟。盖恩威尔高级副总裁鲁希尔·德赛表示，各州详细的支出计划“正在实时变化”。
缅因州的医疗补助计划与盖恩威尔签订了合同，该州最初的申请列出了四份价值超过1600万美元、为期五年的合同。该州证实，仅获得了第一年开支的联邦批准，其中包括一份25万美元的合同，用于实施该州医疗补助索赔系统的变更。
马萨诸塞州农村地区的老年护理倡导者、非营利组织“尊严联盟”的詹姆斯·洛马斯特罗表示，他担心大型供应商和医疗系统会拿走该州的转型资金。
他说，那些“实际在社区提供日常护理服务的诊所、家庭护理机构和养老院，大多被排除在州政府讨论资金使用方式的会议之外”。马萨诸塞州卫生与公众服务执行办公室发言人奥利维亚·詹姆斯表示，州政府官员将“通过培训、经济激励和直接投资，确保每个人都有参与权”。
亚利桑那州第一年的农村医疗基金预算为1.67亿美元，其中约3000万美元将用于医疗诊断设备和技术升级，包括专门针对农村医疗机构的电子健康档案升级。
但皮马县公共卫生主管特蕾莎·卡伦表示，该预算还优先向县公共卫生部门发放拨款。获批预算中包含最高400万美元的拨款，用于支持社区医疗工作者。
“在这些农村社区，你必须深入其中，”卡伦说。
CMS农村医疗转型办公室主任阿丽娜·切卡伊表示，其团队计划走访全美50个州。她在2月于华盛顿举行的全国农村健康协会政策会议上发表讲话时告诉听众，她的团队希望“资金流向农村社区、农村医疗服务提供者和农村患者”。该协会的成员包括农村医院和诊所，这些机构预计将因医疗补助计划的削减而遭受重大损失。
在加利福尼亚州，“开放社区健康中心”的斯塔尔表示，他曾为该州的初始申请提供意见，该申请获得了2.34亿美元的第一年拨款，但他不清楚如何才能从该项目中获得资金。
斯塔尔说，对于他的患者而言，资金需要用于技术升级。毕竟，升级后的电子健康系统可以无缝运行，并存储维持患者医疗补助参保资格所需的文件。
斯塔尔表示，升级后的技术可能正是“开放社区健康中心”和该地区其他诊所“帮助留住参保患者”所需要的。
_KFF健康新闻高级记者菲尔·盖尔维茨和农村医疗通讯员阿里尔·齐恩茨对本文亦有贡献。
_KFF健康新闻是一家专注于健康问题深度报道的全国性新闻编辑部，也是独立健康政策研究、民调与新闻机构KFF的核心运营项目之一。
Big companies position themselves for payday from $50B federal rural health fund
April 27, 2026 5:00 AM EDT / KFF Health News
Tory Starr is worried about the people who get medical care at Open Door Community Health Centers along California’s North Coast.
“They’re the folks that work at restaurants. They’re the teacher’s aides,” said Starr, a registered nurse who became Open Door’s chief executive more than six years ago. Those patients, he said, are “really the heart and soul of rural America.”
He said if his remote health centers don’t get a share of the billions of dollars Congress earmarked to transform health care in rural America, patients may soon lose services. About 50% of Open Door’s 60,000 patients are on Medicaid, the joint state and federal insurance program that, together with the related Children’s Health Insurance Program, covers about 76 million people with low incomes or disabilities.
When Congress approved the One Big Beautiful Bill Act last summer, it cut nearly $1 trillion from Medicaid over the next decade. Now, Starr hopes the $50 billion Rural Health Transformation Program, which was part of the same bill, will help keep his patients covered.
Yet, small community health care providers, such as Open Door, may find they are sharing the billions with an army of corporate giants before it reaches their patients.
Tory Starr is a registered nurse and the chief executive officer of Open Door Community Health Centers. Open Door has 13 clinical sites in two counties in Northern California, and about 50% of its patients are on Medicaid, the state and federal insurance program for low-income people. Open Door Community Health Centers
Months after federal leaders announced that all 50 states won first-year awards, ranging from $147 million for New Jersey to $281 million for Texas, state plans reveal that a heavy dose of prescribed spending will go to companies that can increase the use of electronic health records, strengthen cybersecurity, and improve state and health system technology platforms.
And at least four large-scale coalitions of companies are now pitching multipronged services to the states. Many of the companies already work with regional health systems and states through Medicaid contracting or mobile and telehealth operations.
How those services will help improve the health care of rural Americans at places such as Open Door remains an open question.
States stare down reporting deadlines
Federal regulators were “really interested in seeing digital health investments” when they crafted the five-year rural health program rules last year, said Maya Sandalow, an associate director at the Bipartisan Policy Center, a think tank based in Washington, D.C. She co-authored a recent report on how the 50 states plan to invest in technology, including modernizing health care infrastructure and expanding virtual care options such as telehealth and remote patient monitoring.
“The rural health fund isn’t really designed to directly replace or offset the lost Medicaid funding,” Sandalow said, noting that the federal staffers in charge of the program capped provider payments — money that could help rural hospitals and clinics pay for patient care — at 15% of the total funding awarded to a state.
Federal regulators also established tight reporting deadlines, forcing states to move quickly.
States must file progress reports by the end of August and obligate all first-year funding by Oct. 30, according to the Centers for Medicare & Medicaid Services, the federal agency overseeing the program. States could see their awards decreased or terminated at any time if they fail to follow federal requirements, according to the CMS notice of funding opportunity.
As of early April, CMS had not approved or had only partially approved some state budgets, including those of Wyoming, Colorado, and Vermont, according to state officials. CMS spokesperson Catherine Howden, who declined to say which states still needed revised budgets approved, said the agency does not provide “state-by-state updates.”
In Alaska, the budget is approved but the state has not announced when it will release full grant proposals and awards, said Tricia Franklin, program coordinator for Alaska’s rural health transformation.
“Early summer was the target,” Franklin said. But the response from vendors and applicants has been “much greater than expected, so it may take us a little longer.”
Working with consulting companies is an established way for states to “quickly and effectively” meet federal deadlines and roll out grant money, said Morgan McDonald, national director for population health at the Milbank Memorial Fund, a nonprofit focused on state health policy work.
Upgrading technology, modernizing rural health
Science Applications International Corp., a Fortune 500 government contractor, pulled together the Alliance for Advancing Rural Healthcare. SAIC does a variety of technology work such as cybersecurity and engineering support. The alliance also includes Walgreens and Mission Mobile Medical, which turns RVs into primary care clinics. A data analytics company, a telemedicine and software company, and a company that helps place medical graduates in health systems are also part of the coalition.
The SAIC alliance offers “an ecosystem” of companies that can coordinate the work states have promised, said Suresh Soundararajan, SAIC’s Rural Health Transformation Program lead and a former chief information officer for the Virginia Department of Health. Each of the companies has representatives focused on the rural program, he said.
A lack of digital infrastructure — such as electronic health records at different clinics and hospitals that can talk to one another — has been a consistent barrier for rural medical care teams, said the Bipartisan Policy Center’s Sandalow.
“The funding hasn’t always been there in order for rural areas to create the infrastructure that’s needed to fully adopt remote patient monitoring, telehealth, artificial intelligence in ways that will really be supportive,” Sandalow said. “It takes things like updating infrastructure, changing workflows.”
Sandalow’s recent report found that Maine and Utah are investing in cybersecurity; Indiana, Missouri, and New Mexico plan to modernize their electronic health records; Oklahoma plans to buy hardware and software, subsidize subscriptions, and give technical support to rural providers; and states such as Arizona and South Carolina will use funds to create telehealth hubs or buy remote patient monitoring equipment.
Federal regulators, when creating the rural program’s spending rules, also said no more than 5% of a state’s total funding awarded could be used to replace electronic medical records systems that already meet federal standards. Sandalow said that means states will focus on enhancements and upgrades to their current systems.
Gainwell Technologies, which operates the systems for dozens of state Medicaid programs, is spearheading another coalition. Rushil Desai, a Gainwell senior vice president, said states’ detailed spending plans are “changing in real time.”
Maine’s Medicaid plan contracts with Gainwell, and the state’s initial application listed four contracts worth more than $16 million over five years for the company. The state confirmed it has received federal approval for only its first year of spending, which includes a $250,000 contract to implement changes to the state’s Medicaid claims system.
James Lomastro, a senior-care advocate in rural Massachusetts with the nonprofit Dignity Alliance, said he worries that large vendors and health systems will get the state’s transformation dollars.
Clinics, home care agencies, and nursing homes that “actually provide day-to-day support in the community are mostly on the margins” of state discussions about how to spend the money, he said. A spokesperson for Massachusetts’ Executive Office of Health and Human Services, Olivia James, said state officials would “ensure that everyone has a seat at the table” with training, financial incentives, and direct investments.
Arizona’s rural fund budget, which is $167 million for the first year, allocates up to about $30 million for medical diagnostic equipment and technology upgrades, including to electronic health records, specifically for rural health care facilities.
But it also prioritizes grants for county public health departments, said Pima County Public Health Director Theresa Cullen. The approved budget includes up to $4 million for grants to support community health workers.
“In these rural communities, you need to be present,” Cullen said.
Alina Czekai, director of the CMS rural health transformation office, said her team plans to visit all 50 states. She spoke at the National Rural Health Association’s policy conference in Washington, D.C., in February and told the audience that her team wants “the money to go to rural communities, rural providers, rural patients.” The association’s members include rural hospitals and clinics, which are expected to suffer big losses under the Medicaid cuts.
In California, Open Door’s Starr said he provided input on his state’s initial application, which won $234 million in first-year funding, but he is not clear on what the next steps will be for getting money from the program.
For his patients, Starr said, money is needed for technology upgrades. After all, he said, updated electronic health systems could operate seamlessly and store the documentation needed to keep a patient enrolled in Medicaid.
Updated technology could be exactly what Open Door and other area clinics need to “help keep people covered,” Starr said.
KFF Health News senior correspondent Phil Galewitz and rural health care correspondent Arielle Zionts contributed to this report.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.