BISMARCK, N.D. – U.S. Senator Kevin Cramer (R-ND) sent a letter today to U.S. Health and Human Services (HHS) Secretary Robert Kennedy, Jr. and Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mehmet Oz requesting a reasonable glidepath and collaborative partnership regarding North Dakota’s Medicaid expansion program and implementation of the Rural Health Transformation Program (RHTP). CMS is currently reviewing the state’s Medicaid expansion reimbursement program per a proposed rule relating to state directed payments. CMS is also partnering with North Dakota to administer the RHTP to support rural hospitals and transform healthcare delivery.
Cramer’s letter highlighted the state’s unique healthcare delivery challenges, including a large rural population and long travel distances, and the importance of Medicaid reimbursement in sustaining a reliable delivery system. Abrupt changes to existing payment arrangements could create disruption for providers, patients and communities. Cramer requested a phased approach that will provide stability while creating opportunities for RHTP investments to expand innovation and enhance access, especially in the state’s more rural areas.
“I have heard from many stakeholders across the state with concerns about proposed changes to Medicaid expansion reimbursement and the impact of such changes on healthcare delivery,” said Cramer. “To help address these concerns, I requested Secretary Kennedy and Administrator Oz work with North Dakota on a phased approach to implementing any changes and partner on harnessing the RHTP to transform healthcare in our state. This glidepath approach paired with the RHTP investment would support the pioneering work already underway in our state and create generational changes to our rural healthcare ecosystem.”
Cramer stated that without a phased approach, providers could face a fiscal cliff, and a reasonable glidepath would provide the state and affected providers sufficient time to adjust to new requirements and mitigate any disruptions to the state’s healthcare delivery system. Cramer requested the agency work closely with North Dakota to establish an appropriate glidepath and phased implementation schedule for any identified changes.
The RHTP, a $50 billion investment created through the Working Families Tax Cut Act, reflects Congress’ commitment to protecting taxpayers and ensuring the long-term sustainability of federal healthcare programs broadly. The legislation also included a tiered pathway to reduce certain approved state directed payments beginning Jan. 1, 2028, with rates reducing annually until the target is reached.
Click here to read the full letter.