Missouri’s new approach to rural health looks to CMH as example

A federal allocation aims to transform health care in rural areas of Missouri by expanding a program already familiar to Polk countians.

Through the federal Rural Health Transformation Program, Missouri Gov. Mike Kehoe has secured $216 million for the first year, with a potential for more than $1 billion over a five-year period. This year’s allocation includes a $100 million base allocation, with the remainder available as discretionary funding earned through a merit-based review process.

Missouri’s vision for using the funds is an expansion of the state’s Transformation of Rural Community Health Care initiative – called ToRCH – and Citizens Memorial Hospital in Bolivar is one of six rural hospitals participating in the program.

According to Dave Dillon, vice president of public and media relations for the Missouri Hospital Association, CMH has distinguished itself through its innovative approach to the ToRCH program, and its model is serving as an example of how the program might transfigure the state’s approach to rural health care.

“Citizens is an amazing hospital that is very forward-thinking on a lot of things,” Dillon said.

He cited CMH’s end-to-end thinking about health care, exemplified through the hospital’s creative use of paramedicine, health workers and social workers.

“That is what the local level could look like throughout the state,” he said.

A CMH official said CMH began its Mobile Integrated Healthcare program using paramedics in July 2023 and has done more than 2,500 visits with more than 600 patients.

“They will have a community paramedic go to patients’ homes and do vitals, make sure their medication is managed or do handoffs to other social service providers,” he said. “It’s cool and innovative stuff, and it represents the future of doing health well.”

An important new term used in the program is community health worker, he said.

“That doesn’t always look like a clinician,” he said.

The use of paramedics is one way to expand the reach of health services, according to Dillon.

“It isn’t going to solve every problem that exists in rural health, but it’s a great running start to make initial investments to help the system work effectively,” he said.

The rural health transformation funds were granted by the Centers for Medicare & Medicaid Services, the agency within the U.S. Department of Health and Human Services that administers the Medicare program and partners with state governments to administer Medicaid.

All states received some of the funding, but Missouri was in the top 10 of recipients by funding level. A Dec. 29 announcement by Gov. Kehoe and the Missouri Department of Social Services said the federal initiative aims to strengthen health care access, improve outcomes and support innovative care in rural communities.

Kehoe pointed out that the program leverages local efforts.

“Through Missouri’s Rural Health Transformation plan, we are supporting local partners who understand their communities and are positioned to deliver meaningful, lasting impact for future generations of Missourians,” he said in the announcement.

Program goals are to increase access to care while improving its quality, enhancing care coordination and incentivizing long-term sustainability to build a health care ecosystem for the state’s rural communities.

It will do this through collaboration among hospitals, clinics, community-based organizations and local leaders, the announcement states.

Shoring up rural health care is important not only to rural patients. According to John Myers, president of Mercy Springfield Communities, larger urban hospitals will also benefit. Springfield is a medical hub for the region, and when people can’t get the services they need from rural hospitals, they come here.

Myers said H.R. 1, the One Big Beautiful Bill Act – signed into law in 2025 – cut over $1 trillion from federal Medicare spending over the next decade.

“While the money Missouri will get from the Rural Health Transformation Program is helpful, it’s nowhere close to what hospitals across the state need, especially in rural communities where independent hospitals really find it difficult to stay in operation,” he said.

Mercy Springfield Communities will face reduced Medicaid reimbursement through the legislation, according to Myers, but because of its size, it will be able to survive. For rural hospitals where 25% of their revenue is from Medicaid, the loss will be significant.

“That leads to patients losing access to care,” Myers said.

He added that many Missourians are already postponing necessary care or deferring care altogether – and that can land them in an emergency department. While rural hospitals run excellent emergency departments, there is only so much they can do, Myers said.

“Obviously, if we see more rural hospital closures and see more patients deferring care, they come into the hospitals in Springfield with more acute issues,” he said. “We’re going to see more influx in emergency departments, where wait time will increase.”

For Jenna Hicks, director of quality and population health at CMH, a key goal is to keep people out of emergency departments.

“Health care is a basic need of everybody, and having access to health care is paramount,” she said.

Hicks noted providers have to build trusting relationships with patients and be attuned enough to recognize issues that arise. That’s not something that happens in an annual visit alone.

“In order to actually impact someone’s health, people have to have access to a health care provider, and regular access,” she said.

A rural person who doesn’t feel well may have to travel 45 minutes or more to receive care. Throw in a car problem, and that could put off their care for another week or more.

“By not engaging, they could suffer a stroke or heart attack or something else that truly disables them,” she said. “This is something that could have been prevented with easy local health care access.”

And the need is much larger than physical, Hicks said, including behavior and social factors like a safe living space or healthy family dynamics.

That type of comprehensive care is only found with easy access and multiple touch points to develop relationships, she said.

Hicks, too, worries about federal cuts to Medicaid.

“Rural health care is particularly dependent on public funding,” she said. “Anything that impacts public funding in a negative way directly hurts rural health care.”

But Hicks said CMH is thankful for the opportunities provided by the Rural Health Transformation Program, particularly now. She added that she is hopeful that in time the federal government will reconsider its funding decisions, but until then, the program will be helpful.

“Even if it’s not apples-for-apples, it still aligns with the needs of rural health care and provides support to bridge a gap for at least the most immediate future,” she said.

Hicks said the original ToRCH program, which serves Medicaid patients, has been effective in Polk County, where Bolivar is located, and the Rural Health Transformation Program will allow the benefits to expand, both in area and in the people served.

“It takes the best parts of ToRCH – what we’ve learned – and adds to it,” she said. “From my perspective and CMH’s perspective, we’re very, very excited about the Rural Health Transformation Program.”

Hicks said challenges breed innovation.

“We have to think of how to do things differently, more than just the ask of doing more with less,” she said.

The whole intention of the transformation program is to find ways to work smarter.

“Rural health care entities are uniquely suited for innovative strategies from the ground up,” she said.

She added that while concerns remain about Medicaid cuts, the Rural Health Transformation Program offers incredible opportunities.

“We’re thankful for it, and we’re well suited for it,” she said. “It aligns with what we’ve already implemented – systems of care that keep folks healthy and don’t just serve them when they’re sick.”