With hundreds of millions of federal dollars flowing into the commonwealth’s coffers for rural health, a coalition of stakeholders considered the potential funding opportunities Wednesday for nearly three hours in Harrisburg.
“Being from the rural, rural part of Pennsylvania, (healthcare is) something I hear about virtually every day,” said Sen. Gene Yaw (R-Lycoming), who chairs the Center for Rural Pennsylvania that hosted the meeting.
The state’s $193 million Rural Health Transformation Plan (RHTP) award, the first of five funding rounds, is designed to help offset the $20 billion Pennsylvania is expected to lose in Medicaid dollars between 2028 and 2038.
With tight deadlines — dollars must be committed by Oct. 30, 2026 — and a short time to prove itself before the next round of applications begins, the commonwealth is focusing on stabilization funding, establishing committees to direct regional priorities and a smattering of narrowly defined projects.
“(The Centers for Medicare and Medicaid Services) had a lot of constraints on this … there’s a cap on how much money can be spent on electronic health records. So we can spend some, but we can’t spend as much as we would like,” said state Secretary of Human Services Val Arkoosh.
State leaders will be focusing some dollars this year on a public awareness campaign for 988, the mental health crisis hotline, alongside a pilot program to add car seats for parents using transportation services to get to medical appointments.
“We heard (about this) from community members in every single place we went,” said Arkoosh about the car seat pilot program. “It’s a huge barrier for parents to get to doctor’s appointments, both for their child and for themselves.”
The state is rescored annually on whether it used its allotted dollars to meet the goals described in its project narrative, which includes: Aging and Access, Behavioral Health, Emergency Medical Services (EMS) and Transportation, Maternal Health, Technology and Infrastructure, and Workforce.
The last priority resonated with Yaw, who said every one of the five counties in his rural district is projected to lose population over the next few decades.
“It’s impossible to find a psychiatrist in the area I live in. Even dental care is becoming a real issue,” said Yaw. “People just don’t want to practice in rural Pennsylvania.”
Focus on EMS and behavioral health
One of three panels before the committee focused on expanding access for EMS and behavioral health, with an emphasis on the potential benefits of mobile integrated health (MIH).
“EMS is not just the front line of rural health care. It’s often the lowest barrier, front-door entry into the health care system. And in many areas of the commonwealth, EMS clinicians are the only healthcare professionals available 24 hours a day, seven days a week,” said Dr. Alvin Wang, who is Montgomery County’s Chief Medical Officer & Regional EMS Medical Director and a practicing physician.
The challenge in Pennsylvania, Wang said, is that transportation services are the primary source of reimbursement. But EMS does more than give rides to hospitals, he continued, such as home-based care.
In other states, EMS clinicians can be paid for home assessments, follow-up visits after hospital discharges, chronic disease or substance use management and more. One example, from Mason County in Washington, combines fire and medical services under one entity for the rural, high-poverty area.
“What we find is with our most challenging patients, who are constantly engaging the 911 system, it’s not just a medical issue; it’s not just a substance use; it’s not just a mental health issue. It’s usually a combination of all of those put together, so we try to be holistic in our care,” said North Mason County Regional Fire Authority Chief Beau Bakkan.
State law in Washington allows him to charge private insurance for MIH services like the above and nurse practitioners can operate without constraints. In the commonwealth, those providers must work under the supervision of a doctor and can’t be independent.
Bakken estimated that his MIH program had saved the local hospital and EMS system $12 million and reduced emergency calls by 10%.
“What we have done is we have centralized medicine outside and away from our rural communities,” Bakken added about healthcare access, generally speaking. “We’ve centralized that medicine so much that we have depleted the health resources that are available. The mobile integrated health team has tried to push back and combat that.”
Wang noted that the state has pursued global integrated health programs, which are somewhat similar. The one he oversees in Montgomery County focuses on substance use disorder.
“I think this is just an example of how funding that exists through RHTP can also support existing EMS agencies,” said Wang. “And then we can get the most for our money.”
An opportunity for school-based services
School-based health centers pitched themselves as another investment, though they aren’t mentioned in the state’s 68-page plan.
These clinicians can focus on at-risk youth facing “significant” health disparities, said Julie Cousler, the executive director of the Pennsylvania School-Based Health Alliance. Services can go beyond medical needs to include behavioral, dental and vision services.
“They do not replace the school nurse. It is a very, very different service,” Cousler continued.
Cousler said seven states included the centers as part of their federal rural health plans — but not Pennsylvania. Of the two dozen states with such organizations, Pennsylvania is one of three without any state funding.
Researchers found that students in rural New York counties bordering the commonwealth benefited from the centers, missing less school, staying up-to-date with vaccinations and making more healthcare visits than their peers.
“We know full well what works and the return on investment … we just need to implement them,” said Cousler. “The Rural Health Transformation dollars are a perfect way to do that.”
A study on Pennsylvania’s school-based health centers at the state’s Department of Human Services is underway, she noted. Most of the state’s 30 centers are operated by Federally Qualified Health Centers (FQHCs), which receive higher-than-average Medicaid reimbursement rates.
FQHC operator Jenny Englerth, the president and CEO of Family First Health, which has locations in both New York and Pennsylvania, said, “for children, the optimal location is in schools.”
School-based services negate transportation barriers and caregiver schedule conflicts, she said, translating into “earlier intervention, fewer missed appointments and reduced reliance on emergency departments for non-urgent needs.”
“This model offers a particularly promising path forward in rural areas with well-documented challenges, provider shortages, hospital closures, long travel distances and higher rates of chronic disease,” Englerth added. “Schools, however, remain one of the most stable institutions in all of these communities.”
Allocating RHTP dollars is underway, though the initial funds are for stabilizing existing resources and not expansion. The first annual report is due at the end of the summer and the next year of funding is slated to be awarded on Oct. 31.
Read more from our partner, the Pennsylvania Capital-Star.