RIVERTON—Clad in a hard hat and neon safety vest, Corte McGuffey walked across floors coated in drywall dust, pointing out what’s to come in this unfinished building. A radiology lab here, clinical exam rooms over there, a walk-up pharmacy near the back and on the second floor, hospital beds and two labor and delivery bays.
McGuffey was leading a tour of Riverton’s new hospital, which is the result of a seven-year effort to fundraise, design, build and staff a community-owned health facility in this western Wyoming town of roughly 11,000.
Construction broke ground in late 2024. Over the past year, a 70,000-square-foot building has risen on a plot of land on the north edge of town. Crews recently installed exterior walls and most of the windows. The hope is to finish construction by September, and begin accepting patients before year’s end.
The hospital spawned from local displeasure with consolidation and loss of services under SageWest, which operates its own hospital in Riverton. It represents a rare area of growth in Wyoming’s health care landscape, which has experienced widening service gaps in recent years as hospitals and clinics struggle to retain workers and maintain financial stability.
The Riverton Medical District Board still needs to complete construction, hire staff and implement billing and record systems — and would like to raise additional money. Once open, the facility will face financial realities that make hospital viability so challenging in Wyoming. Things like low volume and high fixed costs.
Overcoming those challenges may become more feasible for Riverton’s and other health care facilities now that Wyoming will receive $205 million in federal Rural Health Transformation Funds in 2026 — and up to $800 million beyond that over the consecutive five years.
As part of its plans to deploy the funds, Wyoming proposes to spend a big chunk on supporting hospitals. The Riverton Medical District Board pooled its own rural health recommendations with fellow Billings Clinic affiliates in Wyoming and submitted them to the state, and has been closely following the process. Though there are few details at this early stage about fund deployment, Riverton hospital officials see promise not only for their facility to benefit, but also the broader state health care network.
“Wyoming has a real opportunity to use these funds, and hopefully not just a one-time shot, hopefully to create a way to use the money for a long period of time,” McGuffey, who chairs the Riverton Medical District board, said amid the din of construction.
Rapidly unfolding
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.
The application and award process unfolded rapidly this fall. Wyoming Department of Health staff gathered input through stakeholder conferences and public meetings starting in September. The state received 1,300 responses to an online survey. Staff prepared an 84-page application and submitted it in early November.
The application proposed an array of initiatives to bolster health care. Those include 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 boost the industry. There were also programs designed to promote healthy habits, expand technology like telehealth and bolster EMS services.
Wyoming applied for an initial budget of $200 million. When awards were announced Dec. 29, the state was given $5 million more than it requested and received the second-largest award per capita, behind Alaska.
Now, the work begins. It will entail drafting contracts, hiring staff, crafting bills and gaining legislative approval. The vision is that initiatives will be available to an array of health care services, providers and programs.
Staying inside the lines
On Thursday, the Joint Appropriations Committee considered a draft bill to establish the perpetuity investment fund, create an advisory panel and launch programs for implementing many of the state’s Rural Health proposals.
Though many of Wyoming’s state lawmakers are small-government conservatives wary of growing agencies, appropriations members appeared to support the bill — a necessary step in receiving the Trump administration funds.
One notable initiative not in the bill is the state-run insurance plan, which appropriations committee members previously frowned upon.
Wyoming does anticipate some amount of flexibility to opt out of the application’s approved initiatives, Wyoming Health Department Director Stefan Johansson told the board. However, “adding programming to this effort is likely not allowable at the federal level.”
Anything outside of the approved purposes in the application risks clawback from the federal government, according to the Wyoming Department of Health.
“I don’t want it to be a situation where we color outside the lines, to the point where we find ourselves without lines and maybe without a fund,” said Rep. Jeremy Haroldson, R-Wheatland.
The bill will play a key role in the rollout of the rural health fund proposals.
“This is, in my view, a generational opportunity to make some very smart, conservative, but practical investments in our rural and frontier communities when it comes to their health and their health care,” Johansson said. “I think this is a very good opportunity for us to take full advantage of the Trump administration’s program in this area.”
The committee did not vote on the draft, which it tabled until February.
Obstacles
Back in Riverton, McGuffey reflected on nearly eight years of efforts, like feasibility studies and fundraising, to get to the current hospital construction phase.
“The amount of work that goes into pulling something like this off is … crazy,” he said.
That included securing a $37.1 million USDA Rural Development loan, $15 million in federal grant funding facilitated by the state and the 4-acre building site. The district is partnering with the Billings Clinic to be an affiliate of the larger health care company, which it hopes will help leverage resources.
“We worked for so long just looking at a lot,” McGuffey said from a second-floor balcony in the new building. “To see [the building] actually go up is really exciting.”
The hospital will provide more than 100 local jobs and present the kind of essential health care that draws families to communities, Riverton Medical District Board members say. That will include, eventually, limited labor and delivery — a service that SageWest Riverton and several other state hospitals have closed down in recent years.
Once the doors open, the facility will have to navigate the unique challenges of operating a hospital in the largely frontier state.
The infusion of federal funds and Wyoming’s plan will help overcome those challenges, Gov. Mark Gordon said during a press conference last week.
“The bottom line is, this program will protect hospitals, strengthen emergency care, grow our rural health care workforce and bring care closer to home,” Gordon said.
The governor also acknowledged the Legislature’s role in securing the federal funds.
“I think we have the opportunity here with the Legislature to be able to really move forward in a way that’s going to help their constituents,” Gordon said. “I think all of Wyoming is looking very carefully at what this plan means.”