Georgia is asking Washington for $1.4 billion to reshape how medical care reaches its rural communities, betting big on experiments like telehealth pods, workforce incentives, and new transport links as hospitals struggle and budgets stay tight.
The proposal lands as federal officials prepare to hand out one-time grants meant to jolt rural health systems into new shapes, even as broader funding cuts loom in the background.
A high-stakes pitch ahead of a New Year deadline
Georgia’s request was filed just weeks before the Trump administration plans to announce which states will receive grants from a newly created Rural Health Transformation Program.
The application, submitted by Gov. Brian Kemp’s administration, runs 96 pages and carries a bold name: Georgia Rural Enhancement And Transformation of Health, shortened to GREAT Health.
At its core, the plan asks for $1.4 billion over five years, a sizable slice of a $50 billion federal fund that Congress approved last summer.
That money would support pilot projects meant to shake up how care is delivered far from metro Atlanta, where hospital closures, staff shortages, and long drives to doctors have become everyday problems.
Georgia officials say the scale matters.
Small tweaks, they argue, won’t be enough for places where emergency rooms close early or maternity wards disappear entirely.
Inside the GREAT Health proposal
The state’s application reads like a catalog of ideas pulled from years of policy debates and rural town halls.
Some are modest.
Others carry eye-popping price tags.
Together, they sketch a system less tied to brick-and-mortar hospitals and more dependent on networks, screens, and shared resources.
Plans highlighted in the application include:
-
Drop-in telehealth “pods” placed in rural towns so patients can connect with clinicians remotely.
-
Regional transportation systems to help residents reach appointments across county lines.
-
Financial incentives aimed at recruiting and retaining nurses and other frontline staff.
-
Investments in data systems to track patient outcomes and service gaps.
One section of the proposal focuses entirely on workforce issues, reflecting a blunt reality: many rural facilities can’t hire enough people, even when buildings and equipment are available.
Another section leans heavily on technology, with state officials arguing that virtual care can reduce costs and travel time for patients managing chronic conditions.
It’s an ambitious mix, and critics already say it risks spreading money too thin.
Supporters counter that experimentation is the whole point.
The federal fund behind the push
Georgia’s request targets money from the Rural Health Transformation Program, a $50 billion pool created under last summer’s One Big, Beautiful Bill Act.
Half of that fund is set to be split evenly among states, regardless of how many rural hospitals they have.
The other half will go to states selected through a competitive application process overseen by the Trump administration.
Congress approved the fund as part of a broader package that included about $1 trillion in health care cuts, a trade-off meant to win support from lawmakers uneasy about the impact on rural areas.
Federal officials have been clear that the fund is temporary.
It runs for five years, while many of the spending reductions in the law are permanent.
That contrast sits at the heart of the debate now unfolding.
“Invent tomorrow,” federal officials say
At a December event in Washington, Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services, framed the grants as a chance to rethink the system rather than prop it up.
Speaking at the Department of Health and Human Services, Oz said the goal is to move away from endlessly covering bills for structures that no longer work.
Photos from the event show Oz at a podium beneath the seal of HHS, signaling how closely the effort is tied to broader federal health policy goals.
The message from Washington is blunt.
This money is not meant to replace what rural hospitals are losing.
It is meant to push states to try something different.
That philosophy aligns closely with the language used throughout Georgia’s application, which emphasizes pilots, demonstrations, and scalable models.
The math behind rural health pressure
Rural hospitals across the U.S. have been under strain for years.
According to data from the Sheps Center for Health Services Research at the University of North Carolina, more than 140 rural hospitals have closed nationwide since 2010, with dozens more operating on razor-thin margins.
Georgia has felt that pain.
Several rural hospitals have shut their doors over the past decade, while others have eliminated services like labor and delivery.
Longer drives to care are common.
Ambulance diversions happen more often.
Patients delay treatment, sometimes until it’s too late.
Against that backdrop, $1.4 billion sounds large.
Spread across dozens of counties and multiple programs over five years, it shrinks quickly.
That tension shows up repeatedly in the GREAT Health proposal, which stresses efficiency and coordination as much as new spending.
Support, skepticism, and politics
State officials say the application reflects months of work with providers, consultants, and community leaders.
They describe it as pragmatic.
Critics, including some health policy analysts, see risks.
One concern is sustainability.
What happens when the five-year funding window closes?
Another is accountability.
With so many pilot projects running at once, tracking results could get messy.
There is also politics.
The fund itself exists because Congress and Donald Trump sought to smooth the passage of a controversial bill.
States selected for extra funding may face scrutiny over whether decisions were purely technical or partly political.
Georgia’s leaders say they are focused on outcomes, not optics.
Still, the timing and scale of the request ensure it will draw attention well beyond state borders.
Waiting on Washington’s call
By New Year’s Eve, states expect to learn whether their applications made the cut.
If Georgia secures the full $1.4 billion, GREAT Health would become one of the largest rural health experiments in the country.
If it falls short, officials say they will reassess priorities and adjust plans.
Either way, the request highlights a bigger truth.
Rural health care in Georgia, like much of the U.S., sits at a crossroads.
