JFAC takes lead on Rural Health Transformation Program after previous bills stalled

BOISE — With past efforts to provide direction on the Rural Health Transformation Program floundering this session, the Joint Finance-Appropriations Committee took it upon themselves Tuesday to advance guardrails for spending hundreds of millions in health care grants.

The Rural Health Transformation Program (RHTP) was established last year following the passage of the One Big Beautiful Bill. The $50 billion in funding for the program is to be distributed to all 50 states in $10 billion increments from 2026 through 2030. Idaho was awarded $929 million over this time frame in $186 million increments, each available for 2 years before expiring. 

To prepare for the allocation of this funding, JFAC advanced legislation to establish the Idaho rural health transformation fund, composed of these distributed federal funds, according to recommendations from a new rural health transformation committee.

Though several bills to provide oversight on this funding have been presented by legislators this session, the key sticking point has been the makeup of this committee, which has grown from five members to nine members across a series of bills originating in both the House and the Senate.

The legislation approved by JFAC states the committee will consist of nine members, with four coming from the Senate and appointed by the Senate President Pro Tempore (current Sen. Kelly Anthon, R-Rupert), four members coming from the House and appointed by the Speaker of the House (currently Rep. Mike Moyle, R-Star) and one non-voting member elected by the governor. 

Alex Williamson, senior analyst for the Legislative Services Office, said the committee makeup mirrors what House Bill 916 intended to establish. Although the bill passed the House unanimously earlier this month, it did not receive a hearing before the Senate Health and Welfare Committee.

The Senate instead voted to support Senate Bill 1264, which included provisions that the nine-member committee include three representatives and three senators representing rural districts, defined as districts with a population center of no more than 20,000 people.

Although it does not include this rural representation stipulation, the legislation from JFAC includes a provision from the Senate bill requiring committee members to have access to data on RHTP, including awards received or created by the Idaho Department of Health and Welfare.

Sen. Kevin Cook, R-Idaho Falls, who was the floor sponsor for Senate Bill 1264, questioned why it won't be sent to the House after passing the Senate on Monday. 

Cook responded that removing the requirement for rural representation on the committee would result in legislators representing areas served by St. Luke’s and Saint Alphonsus making funding decisions for rural hospitals and rural health care.

“We don't have to have rural people represent them,” Cook said. “I think that is just really, really wrong … why would you want city people representing rural.”

After Cook voiced these objections, JFAC unanimously approved the legislation establishing the nine-member oversight committee without rural district requirements, which will go before both the House and the Senate for a wider floor vote.

In separate funding consideration for the first and second years of the RHTP, JFAC aligned with recommendations from Gov. Brad Little to allocate resources to 12 “limited service” full-time positions — which will be in place for the duration of the federal program — along with $3.7 million in federal funds for fiscal year 2026 for a portion of this year’s award. In a 14-4 decision, the committee voted to align with the governor and allocate these resources for the current fiscal year.

A subsequent request for $295.4 million — comprised of funds for the first and second year of federal awards and the aforementioned 12 employees — was approved for fiscal year 2027 in a 15-4 vote.

Williamson said the supplemental funding allows the department to begin moving forward on the federal program and start appropriating funds for various rural health objectives.

“The state does have an obligation to obligate those funds for year one by October of this year,” Williamson said. “So, allowing a supplemental would give them a bit longer of a runway on getting those dollars out the door.”