Department of Health Director Stefan Johansen told the Appropriations subcommittee that Wyoming submitted its Rural Health Transformation application to the Centers for Medicare and Medicaid Services and posted the proposal publicly.

"We submitted that plan on Tuesday of this week to the Centers for Medicare and Medicaid Services," Johansen said, summarizing four priority categories: increasing sustainable access to right-sized rural medical care (ED, EMS, OB), building a durable rural health workforce pipeline, improving metabolic/cardiovascular/behavioral-health outcomes at the population level, and expanding technology adoption for telehealth and other digital tools.

Johansen said the department prioritized hearings in small communities, received more than 1,300 survey responses, and narrowed its requests to basic, high-fixed-cost services that are hard to sustain at low volume. He described a sustainability concept the agency calls the rural health transformation "perpetuity," a financing approach meant to reduce the risk of a post-grant fiscal cliff.

Deputy Director Franz Fuchs answered committee questions about definitions: critical access hospitals typically have fewer than 25 licensed inpatient beds and must be the only hospital within a 35-mile radius, while PPS (prospective payment system) hospitals operate on a fee schedule rather than cost-based Medicare reimbursement.

The application also included several state-policy actions to improve the state's scoring and implementation, Johansen said, citing a SNAP-waiver application and an initiative with the Department of Education on physical fitness. The plan proposes pilot grants and incentive payments for critical-access hospitals and EMS agencies, workforce scholarships or retention incentives tied to service in Wyoming, and a technology-adoption challenge for multi-site pilots.

Why it matters: If approved, federal Rural Health Transformation funds could be used to meet structural gaps—subsidizing readiness for low-volume, high-fixed-cost services, supporting training pipelines for nurses and direct-care staff, and seeding technology pilots that could be scaled across rural communities.

The application is now with CMS. Johansen said the department anticipates negotiations with the federal government and detailed procurement and implementation work in 2026 if funding is awarded.