Mississippi providers are nearing the first deadline to apply for a share of hundreds of millions of dollars of federal grant funding to improve rural healthcare. But questions remain about how the state crafted its funding application and who influenced its plan.
Mississippi is one of two states where the governor’s office is directly overseeing the money. Republican Gov. Tate Reeves spearheaded the state’s application for the funding last fall and is now coordinating distribution of the $206 million allotted to Mississippi in December for the first year of the five-year, national $50 billion Rural Health Transformation Program.
During a June 4 legislative hearing, Richard Grimes, who directs the Rural Health Transformation Program Office, told lawmakers that the governor’s office gathered stakeholder input through an online survey, received presentations from select stakeholders and consulted with state agency leaders while drafting the state’s proposal.
Lawmakers have said they are concerned the proposal was shaped through survey responses from stakeholders and closed-door conversations rather than broader engagement with people living in rural communities. They also requested more information about the stakeholders who participated in the survey.
Applications for the state’s first three initiatives to support rural healthcare, which focus on facility improvements, upgrading technology systems and increasing telehealth capacity, must be submitted by July 15.
Through a public records request, Mississippi Today obtained the survey responses submitted to the Mississippi Division of Medicaid during development of the state’s application. Here are three things the responses reveal about the public engagement process.
1. Respondents had two weeks to submit responses, though some did not meet that deadline. The compressed timeline mirrored a quick federal deadline for states to apply for the funds.
Mississippi moved quickly to gather stakeholder input after President Donald Trump signed a sweeping tax and spending bill into law July 4, 2025. The legislation reduced Medicaid spending by nearly $1 trillion over a decade and created the Rural Health Transformation Program to help offset the strain vulnerable rural hospitals were expected to face.
States were required to submit applications for the funds by Nov. 5, leaving roughly four months to collect feedback and develop proposals.
“There was a very, very short turnaround,” said Jamila McLean, the director of health equity for Princeton University’s State Health and Value Strategies Program. The program has studied states’ approaches to the application process and implementation of the initiative.
The Mississippi Division of Medicaid launched an online survey on July 31, including more than 40 questions about the challenges impacting access to rural healthcare and potential solutions. The survey closed two weeks later, on Aug. 14.
By that deadline, the survey yielded 122 responses, with about two dozen additional submissions arriving by the end of October for a total of 145. Eight respondents submitted multiple entries, and five did not answer any of the survey’s questions about improving healthcare in rural areas.
Grimes told legislators on June 4 that the governor’s office received 145 responses from stakeholders.
Consulting firm HORNE, now part of BDO, was selected through an emergency procurement process to prepare the state’s application for the program. Potential vendors had less than a week to submit a quote.
Mississippi did not hold public meetings or hearings as a part of the application process. Thirteen stakeholders were invited to a closed-door forum on Aug. 28 at HORNE’s Ridgeland offices to present their ideas to the governor’s office.
Other states, including Louisiana and Arizona, held in-person outreach meetings to collect feedback from stakeholders and rural residents. Several states, including Georgia, Alaska and Washington, released survey responses or a summary of themes collected as a part of their efforts to engage stakeholders.
Senate Public Health Chairman Hob Bryan, a Democrat from Amory, criticized the lack of broader engagement for the program, saying rural residents had no opportunity to weigh in beyond the online survey and that the survey was not widely publicized.
“That is the one and only opportunity that any just general member of the public has had to do anything,” Bryan said.
In recent months, after the application was submitted and funds were awarded, Mississippi has hosted online and in-person forums to share information about the program and available grant opportunities. The program office held a webinar and in-person outreach meetings in Pearl, Cleveland, Ellisville, Summit and Tupelo in early June.
McLean said the tight timeline to apply for the funds created a lag in the public engagement process for some states. She said that much of the stakeholder input is occurring now, after the application process has concluded.
“There’s a little bit of a mismatch, in that the stakeholder (engagement) process is happening now, but at the same time the state is moving forward with implementation,” McLean said.
2. Survey respondents spanned the U.S., with most Mississippi participants concentrated in five counties.
The people who responded to Mississippi’s survey — excluding duplicates and people who did not answer questions or provide an address — represented 19 states and the District of Columbia.
Nearly 80% of the responses came from people in Mississippi. The Mississippi responses covered 39 counties. More than half of the Mississippi responses were concentrated in five counties: Lee, Hinds, Madison, Forrest and Sunflower.
On June 4, Grimes noted that the responses covered nearly half of Mississpipi’s 82 counties. Bryan countered that interpretation, arguing it also meant that residents from more than half of the state’s counties did not participate in the planning process.
“That glass is half empty, I’ll have you know,” Bryan said on Mississippi Today’s political podcast “The Other Side” on June 23.
Under Mississippi program guidelines, providers receiving funds do not have to be located in a rural area to be eligible but must demonstrate that their proposal will provide meaningful benefits to rural communities.
The program office, however, classifies all Mississippi counties as rural because each falls below the threshold of 500 people per square mile. The state’s average population density is about 63 people per square mile, according to census data, while DeSoto County, the most densely populated county in the state, has roughly 389 people per square mile.
3. Most respondents were affiliated with a hospital or private company.
Roughly a third of survey responses came from hospital administrators and staff. More than 25 hospitals were represented, including rural facilities across the state. Tupelo-based North Mississippi Health Services staff alone accounted for 20 of the 49 hospital responses.
Hospital staff members said healthcare workforce shortages are limiting access to care in rural Mississippi. They also said there are many patients must travel long distances for care and lack transportation, high rates of people do not have health insurance, ambulance systems are overburdened, patients have limited access to specialty care and they are concerned about financial instability given the budget cuts passed into law last summer that will reduce Medicaid payments to hospitals beginning in 2028.
“Physician shortages are a challenge and will be a challenge,” wrote one northeast Mississippi hospital administrator. “Mississippi is not a state providers are rushing to.”
Private companies made up about one-fifth of all responses. The companies included managed care organizations, technology firms, ambulance providers, patient monitoring and telehealth companies and home-delivered meal services. Many referenced their products and services as solutions to the healthcare issues facing Mississippians.
Clinics and other healthcare providers represented a range of services, including community mental health centers, family medicine practices, nursing homes and long-term care facilities, pharmacists, senior services organizations, urgent care clinics and youth mental health programs.
Professional organizations included state-based organizations representing hospitals, nursing homes and community health workers, as well as national organizations representing pharmacies and advanced practice providers. Advocacy organizations included groups supporting families with children who are deaf or hard of hearing, people living with Alzheimer’s disease and promoting telehealth policy.
Three elected officials – two state and one local – also responded. Among them was House Public Health Chairman Sam Creekmore, a Republican from New Albany. He told Mississippi Today he believed lawmakers should have been more involved in the application process, especially those regularly engaged with health policy and providers, like himself.
“We weren’t included in any of this,” he said. “We deal with this just about every day. Hospitals and nurses and doctors come to us all the time for solutions. We thought the Legislature should have been part of the process.”
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