Rural Health Policy Update

January 2024

Update provided by Andrew Coats, NOSORH Legislative Liaison 

Congress Returns for 2024: 
Congress returned this week to begin the second session of the 118th Congress. Unlike most years where Congress slowly dips its feet back in the water, lawmakers face an immediate deadline to keep the government funded. The current stopgap continuing resolution (CR) expires on January 19th for four of the twelve spending bills (which includes FDA funding). The remaining eight funding bills, including the measure that funds HHS and its agencies, come due on February 2nd. 

On January 7, Congressional leadership and the White House announced an agreement on a “topline” spending number for FY 2024. Nondefense discretionary spending will remain flat in fiscal year (FY 2024) at $772.7 billion. The new agreement also rescinds $6.1 billion in “unused” Covid-relief funds. Although this agreement is a first step, appropriators and leadership must now work over the next two weeks to implement it through legislation and discuss potential policy riders on an agreement.  

Congress faces a January 19th expiration date for key healthcare programs such as funding for community health centers, pandemic preparedness, and the delay in $8 billion in Medicaid payment cuts to DSH hospitals. These are the most likely healthcare provisions to be addressed in the upcoming spending package.  

Another area to watch this year is telehealth. The Consolidated Appropriations Act of 2023 extended some telehealth flexibilities through the end of 2024 (shortlist found here). Stakeholders expect at least a one-year extension of these flexibilities, with some floating around a three-year extension, to be included as a policy provision in a larger bill this year.   


FY 2024 Appropriations Update: 
Congress still has not passed an FY 2024 spending bill funding rural health programs. With a new deadline of February 2, we should know the fate of FY 2024 rural health funding in the coming weeks. Speaker of the House Johnson (R-LA) has repeatedly said he does not want another short-term CR. As a reminder, below are the FY 24 funding levels for rural health programs that have been passed through the committee level in each chamber:   

 Medicare Rural Hospital Flexibility program  

  • House:  $74,277,000 of that amount, $25,942,000 for the Small Rural Hospital Improvement Grant Program  
  • Senate: $64,277,000 of that amount, $20,942,000 for the Small Rural Hospital Improvement Grant Program 

Rural Emergency Hospital Technical Assistance  

    • House: $5,000,000 
    • Senate: $5,000,000 

    State Offices of Rural Health grant program  

    • House: $12,500,000 
    • Senate: $12,500,000 

    Rural Residency Programs  

    • House: $12,700,000 
    • Senate: $12,500,000 

    Rural Communities Opioids Response Program   

    • House: $0 
    • Senate: $155,000,000