Millions of federal dollars are rolling into northern Michigan to transform rural health care, including improvements to workforce development and technology.
The program is intended in part to offset cuts to federal Medicaid spending, which could disproportionately impact rural areas — but it still may not be enough to make up for the impact of those changes.
Included in the One Big Beautiful Bill Act, the federal Rural Health Transformation Program is a $50 billion fund to be distributed to states over the next five years. Locally, organizations such as Munson Healthcare and public health departments, as well as tribes, received awards.
Michigan garnered $173 million to distribute in the first year of the program. Among the recipient organizations was District Health Department #10, which serves much of northern lower Michigan.
“This is a phenomenal opportunity for the state of Michigan and rural communities, so we were super excited,” District #10 Deputy Health Officer Sarah Oleniczak said.
That level of funding may be decreasing in the future. Michigan received about $2.5 million less in the second round of funding, announced this week. States are being scored by the Trump administration on whether they’ve implemented policies that align with the Make America Healthy Again movement, such as reestablishing the Presidential Fitness Test in schools.
Local leaders are also concerned about whether the funding is making it to counties with the highest rural population. State Representative Cam Cavitt, R-Cheboygan, wrote in a press release that the classification of Wayne County as partially rural was “an insult to everyone who lives north of Clare.”
According to the state’s website, partially rural counties will be prioritized based on the percentage of residents in rural areas as defined by the U.S. Census.
Regardless of how funding is distributed, it may not be enough to make up for looming Medicaid cuts. KFF, a nonprofit health policy research organization, estimates that the $50 billion would only partially offset an estimated $137 billion reduction in federal Medicaid spending in rural areas.
Local health departments plan to expand access to care
Local health departments in Michigan received about $6.7 million in direct grants. District Health Department #10, serving 10 counties in northern Michigan, led the funding with a combined $3 million to expand their reach of care and facilitate technology improvements.
Oleniczak said the department got the most funding because it encompasses the largest geographical area and all of its counties are rural.
“I've been in public health for 400 years — or 44, one of those numbers,” she joked. “I've been around a long time. This is the biggest investment in rural health communities [I’ve seen]. Is it perfect? No, no program is ever perfect.”
According to Oleniczak, funds will allow the health department to digitize medical records and install high-speed internet across all counties to better facilitate telehealth visits — crucial for supporting access to care in rural areas. The department also received funding to support a mobile clinic, which is already operating in Lake County.
Smaller health departments, like the Benzie-Leelanau District Health Department, received just under $200,000 in direct grants from the state. However, they still benefit from grants to organizations like the Northern Michigan Public Health Alliance, which received $3 million.
“Could we have used more funding to really bolster and improve the program and what we're doing? Yeah, of course,” Dan Thorell, health officer for the Benzie-Leelanau District Health Department, said. “However, the funding that we did receive, we are extremely grateful for, and we are using that as efficiently and effectively as we possibly can.”
New health workers to support Medicaid access, reduce barriers to health
Thorell said those funds supported 15 community health workers across northern Michigan, who can help address socioeconomic barriers to health care.
“That could be anywhere from needing to sign up for Medicaid, or maybe someone doesn't have transportation to get to their medical appointments, or maybe they have issues with paying their rent,” Thorell said.
Community health workers are uniquely qualified to help individuals navigate assistance programs, often coming from a place of lived experience themselves, Oleniczak said.
“We hire people who've survived their circumstances,” she said. “Who understand homelessness, who understand poverty, who understand mental health issues or substance use issues or food insecurity, who have struggled in that place where people have the greatest needs.”
This echoes a strategy being used by other local health leaders preparing to help individuals stay on Medicaid while grappling with uncertainty.
“There's so much need, and you know the real concern is not knowing what's going to happen next,” Oleniczak said. "But if the Medicaid changes do go into effect after the first of the year, there's going to be a lot more people in greater need than ever before.”
