Health care advocates are celebrating Monday’s announcement that Wyoming will be awarded $205 million in federal Rural Health Transformation Project funds in 2026.
But the announcement is only step one in a process that will require drafting contracts, hiring staff, crafting bills and gaining legislative approval. State workers, contractors and healthcare providers will have to hustle to lay the groundwork for programs they hope will shore up health care for the long term.
“There’s real potential for this money to meaningfully improve health care in Wyoming, I think, as long as the other pieces come together and our state works as a team to implement the varying aspects,” Wyoming Medical Society Executive Director Sheila Bush said. “We have a lot of work in front of us, but it’s exciting work.”
The state’s highly rural nature and large land area create steep challenges: Ambulance response times can be long, clinics struggle to hire and retain medical professionals and hospitals fighting to stay viable have shed services like labor and delivery.
Even if the federal award doesn’t live up to its promise of “transforming” Wyoming’s health care system, it presents a huge opportunity for improvements, advocates say.
Wyoming’s application sketches out what those improvements might look like. They incentives for small rural hospitals to provide basic services and cut extraneous ones that can be performed at regional facilities; grants for clinical workforce training programs and five-year commitments from grads; a state-run insurance plan for catastrophic events; and permanent, investment-generated revenue to prop up the industry.
The opportunity
The Rural Health Transformation Program is a new federal initiative created by President Donald Trump’s One Big Beautiful Bill Act. The program will funnel $50 billion to states over five years to stabilize and strengthen rural hospitals and providers. It aims to offset a portion of the federal funds for health care that were cut by the same legislation.
The application process for states unfolded rapidly. In Wyoming, Department of Health staff held stakeholder conferences and 11 public meetings starting in September to gather input. The state received 1,300 responses to an online survey it circulated. The application was then drawn up and submitted by the Nov. 5 deadline.
“Our biggest challenge lies in access to basic medical care,” Wyoming’s 84-page application stated.
It went on to identify the state’s priorities of building the state’s health care workforce, improving residents’ metabolic, cardiovascular and behavioral health and using technology to improve chronic disease management and bring care closer to home. Some of the initiatives proposed to address those priorities include:
- Build cooperative agreements for EMS agencies to work together on a regional basis, using regional dispatch to coordinate things like interfacility transfers.
- Establish a state-operated public insurance plan, dubbed “BearCare,” that would cover health care emergencies, such as car crashes or bear attacks, for dues-paying members.
- Fund, in perpetuity, annual awards to cover educational costs for individuals interested in joining one of four clinical pipelines: nursing, EMS, behavioral health and physician.
- Implement the Presidential Fitness Test in Wyoming’s primary and secondary schools.
- Limit the state’s SNAP benefits to healthy food purchases by excluding things like sodas and candy.
- Stand up a grant process for technology to improve care delivery closer to home or build systems that can work across providers.
- Establish a system of investments that can generate revenue for health care programs in perpetuity.
Wyoming applied for an initial budget of $200 million. The Centers for Medicare and Medicaid Services announced Monday that all 50 states will receive awards in 2026 under the program. Texas claimed the biggest prize, $281 million, while New Jersey received the smallest at $147 million. Wyoming got $5 million more than it asked for.
“The State of Wyoming has a smart and targeted plan to address our unique healthcare challenges,” said U.S. Sen. John Barrasso. The Wyoming doctor and Republican Majority Whip has championed the Rural Transformation Fund as a sensible solution while railing against expansion of the Affordable Care Act subsidies that expired Wednesday, leaving thousands of Wyoming residents facing significant spikes in insurance premiums.
Work ahead
Implementing the application’s ambitious vision will require more staff, organization, many hours of work and the collaboration of several parties. With almost 1,400 employees in four divisions, the Wyoming health department is a “superagency” that’s well-equipped to helm the challenge, the application states. Still, it anticipates hiring around 13 contractors to address the additional load.
The agency’s first task is to revise its budget to incorporate the award amount, said Wyoming Department of Health Deputy Director Franz Fuchs.
Then, next week, the Joint Appropriations Committee, which holds the state’s purse strings, will consider draft legislation related to the Rural Health Transformation Program proposals. Based on the committee’s initial reaction to some of the application’s components, that could present challenges.
When the committee discussed the application during a December meeting, several lawmakers frowned on the state-run catastrophic health insurance plan.
“I’m not inclined to want to compete in the private sector. I don’t think it’s the proper role of government to do so,” said Rep. John Bear, R-Gillette. Bear was also skeptical of the proposed investment fund’s ability to keep pace with ever-rising health costs and to remain effective.
Along with hiring staff and getting related bills passed by skeptical lawmakers, health department staff also need to issue requests for proposals for various initiatives and draw up the attending contracts.
For providers interested in applying for the program initiatives, Fuchs said, those opportunities will likely come later in the spring.
If states do not spend the initial tranche of money within a certain time frame, Fuchs said, the feds will claw it back and redistribute it. Since the program is designed to divvy out $50 billion over five years, Wyoming could receive close to $1 billion when it’s all said and done.
‘A heavy lift’
Wyoming Hospital Association President Eric Boley’s organization has been involved and closely following the process.
“The workforce part of it holds a lot of promise for us as we look at the shortages we’re already facing and the projected shortages in our country coming up in the next decade,” Boley said. He is also encouraged by the technological improvements that could be realized, hopes emergency services can be stabilized and said struggling hospitals will jump at opportunities to help realize financial viability.
“It’s gonna be a heavy lift, but I think our folks are ready to sit down at the table and see how we can make it work,” he said. “The devil’s in the details now.”
Wyoming Primary Care Association Executive Director Jen Davis is “cautiously optimistic” about the massive grant. “The reason I say that is because it’s a great opportunity to really do some amazing things in Wyoming, but I think we need to be really intentional, and I think we really need to focus on infrastructure for long-term sustainability and not just put out money to put out money.”
That will likely involve some hard conversations, she said. “I hope that now that it’s been awarded, there’ll be opportunities for a lot more participation as we go forward and figuring out how that looks.”
The award opens doors to opportunities Wyoming has never been able to fully consider before, said Bush of the Wyoming Medical Association. “However, these opportunities will only become a reality if the state comes together to pursue a unified vision.”