Mississippi lawmakers uneasy about transparency around money for Rural Health Transformation Program

By Gwen Dilworth | Originally published by Mississippi Today

As Mississippi prepares to open applications for grants to improve rural healthcare, lawmakers on Thursday voiced concerns about transparency and whether the hundreds of millions of federal dollars awarded to the state will reach and benefit rural communities. 

The federal government allocated Mississippi nearly $206 million in December as part of the Rural Health Transformation Program. States will receive payments over five years as part of a one-time, national $50 billion program.

Republican Gov. Tate Reeves spearheaded the state’s application for these dollars last fall and is overseeing distribution of the funds through the newly established Mississippi Rural Health Transformation Program Office. Mississippi’s plan includes a statewide rural health assessment and other initiatives focused on coordinating care, strengthening the workforce, creating a statewide health information exchange, expanding telehealth opportunities and improving infrastructure.

During a joint meeting of House and Senate Public Health committees Thursday, lawmakers asked Mississippi Rural Health Transformation Program Office Project Director Richard Grimes how the state devised its funding plan, whether any private stakeholder meetings were held regarding the funds and how his office would ensure transparency.

Grimes, whom Reeves appointed to this position on April 29, said he was unable to answer lawmakers’ questions about events that occurred before he was hired. He also disputed claims that Mississippi has been less transparent than other states in distributing the federal funds. 

“We are where we are,” Grimes said. “We’ve got five months to obligate these funds. We can talk about the past or we can…” 

Senate Public Health and Human Services Chairman Hob Bryan, a Democrat from Amory, cut Grimes off. 

“No, we’re here to talk about the past,” Bryan said. 

Bryan said he was concerned that the state’s plan for the program was constructed using survey responses from stakeholders and conversations with agency heads rather than meeting with people in rural communities. 

“This closed process has been very disturbing, not just to those of us in the Legislature — this is not an argument between the Legislature and the governor — it is a frustration that is being expressed through us from people on the ground,” Bryan said. 

Jamila McLean, the director of health equity for Princeton University’s State Health & Value Strategies Program, told legislators at a May 28 hearing that Mississippi is an outlier in the limited availability of information about its rural health program. She also noted that nearly every other state held public meetings to gather input about how to spend the money and that Mississippi is one of two states where the governor’s office directly oversees the distribution of the money.

Grimes pushed back on these claims, saying that releasing information before the Centers for Medicare and Medicaid Services approved the state’s program budget on April 20 would have been premature. 

“April 20th was when the budget was approved,” Grimes said. “CMS approves all the communications. There’s really not a lot to talk about until that’s ready. There just wasn’t.”

The Rural Health Transformation Program office held a webinar Monday to discuss three grants that will soon open through the program. It also held an in-person outreach meeting Thursday at the Pearl Community Center. Additional community outreach meetings are scheduled in Cleveland, Ellisville, Summit and Tupelo for Friday through June 10. 

Grimes dismissed as “semantics” the argument that Misisssippi is one of only two states with its program administered directly by the governor. He said many states are administering their programs through other executive agencies. He pointed to Arkansas and Alabama as examples, noting that their programs are being overseen by the Arkansas Department of Finance and Administration and the Alabama Department of Economic and Community Affairs. 

Lawmakers passed oversight legislation in March requiring the program’s funding to be directed toward rural communities and spending to be reported to the Legislature. Reeves vetoed the bill, arguing it could jeopardize the state’s access to the money by slowing down its distribution and potentially result in a loss of up to $1 billion over five years. Lawmakers failed to override his veto. 

Responding to a request from House Public Health and Welfare Chairman Sam Creekmore, a Republican from New Albany, Grimes said his office will share required federal reports on the funding to the state Legislature. 

Mary Helen Abel, a program manager for BDO Government Services, formerly HORNE, said during the Monday webinar that applicants do not need to be located in rural areas but must demonstrate their proposal will benefit rural Mississippians. The governor’s office in January entered into a seven-year, $10.2 million contract with BDO for consulting and accounting services to administer the program. 

Abel added that funds have not been awarded or promised to any providers.

Grimes said program budget amounts will not be made public or shared with the Legislature because attorneys have advised the state not to. He said releasing that information to the public could affect the fairness of the grant process or inflate applicant’s proposed budgets. The state’s project narrative is available online but estimated funding amounts are redacted. 

During the webinar, Grimes and BDO staff announced Mississippi will begin accepting applications for three rural health grant programs June 15. These initial funded grant programs, which will flow through state agencies, will help providers:

• Make facility renovations, increase service capacity and efficiency and reduce travel burdens.
• Upgrade technology systems and strengthen cybersecurity infrastructure. 
• Increase telehealth capacity and educate providers and patients on uses of telehealth services. 

Applications must be submitted by July 15. Awards will be made in August and recipients will have less than a year – until July 2027 – to complete their projects.

“Many of these efforts will take place over multiple years, and we want people to be planning big, bold, multi-year initiatives, but we can only really think about how to structure things in one-year increments,” David Long, a senior manager at BDO, said to a full room of over 100 participants at the Thursday community outreach meeting in Pearl. During the event, BDO staff took questions from participants about how to apply for and use the funding. 

Rural Health program funding can not be used for new construction or major building expansion, according to federal guidelines. 

Applications will be scored with a rubric, which will be made public and is meant to objectively send money to providers doing the most good for people in rural Mississippi, BDO staff said. Grant recipients will be required to pay for most projects upfront and then be reimbursed, though there may be some exceptions. 

Bryan told Mississippi Today he has concerns about whether applications will be scored fairly and whether the funded projects will benefit rural Mississippi. 

Without more opportunities for public input while the state wrote its application for the funding, he said it’s too late to change how the funding will be used.

“All these decisions have been made,” Bryan said. “The train has already left the station.”

This article was originally published by Mississippi Today and is republished here under a Creative Commons license.

Source: Original Article