Inside Wyoming’s Bid for up to $800M to Fix Rural Health Care — and Why it’s a Big Gamble

The original story by Katie Klingsporn for WyoFile.

Wyoming is taking a big swing at one of its biggest problems: rural health care. The state has applied for up to $800 million in federal funding over five years, money that could reshape everything from emergency response times to how people pay for insurance in a place where distance and workforce shortages define daily life.

WyoFile dug into the 84-page application Wyoming submitted for the new Rural Health Transformation Program, a $50 billion federal initiative created under President Donald Trump’s One Big Beautiful Bill Act. Wyoming turned in its proposal in November and expects to hear back by the end of the year.

There’s no guarantee the state will get everything it asked for — or anything close. But the application lays out a sweeping, data-heavy vision for stabilizing hospitals, growing the health care workforce and making care more affordable across the most sparsely populated state in the nation.

Wyoming’s health care challenges are no secret. Patients routinely drive hours for care. Small hospitals struggle to stay staffed. Emergency response times in some areas stretch past 30 minutes. And costs are high — even for people with insurance.

Nearly 44% of Wyoming residents live in “frontier” areas, according to the application, compared to 30% in rural areas and just 26% in urban centers. Those frontier populations are older on average and face fewer nearby services, compounding the strain.

“Our biggest challenge lies in access to basic medical care,” the application states.

The proposals are broad — and sometimes controversial. Among the ideas included:

• Regional EMS cooperation, with shared dispatch systems to improve response times and interfacility transfers.
• Incentives for small hospitals to focus on core services like emergency rooms, ambulances and maternity care — instead of cutting delivery units while keeping more profitable procedures.
• Workforce investments, including grants for training programs and long-term commitments from graduates in nursing, EMS, behavioral health and medicine.
• Expanded residency slots in Wyoming to keep new doctors in-state.
• A state-run catastrophic insurance plan, nicknamed BearCare, designed to cover major emergencies like car crashes or severe injuries for members who pay monthly dues.
• Permanent education awards to cover training costs for future health care workers.
• Technology grants to bring care closer to home through telehealth and shared systems.
• A controversial proposal to limit SNAP purchases to healthy foods, excluding soda and candy.
• Even a plan to bring back the Presidential Fitness Test in Wyoming schools.

At the center of it all is a long-term funding idea called the Wyoming Health Transformation Perpetuity — an investment fund modeled after the state’s Permanent Mineral Trust Fund that would generate ongoing revenue for health care.

Healthy Wyoming Executive Director Jenn Lowe, often a critic of state health policy, called the application unusually strong.

“The Department of Health did a superb job,” Lowe said. “It is analytically strong. It is data driven, and it is grounded in community input.”

Still, she flagged a major concern: time.

Rolling out programs of this size — while coordinating lawmakers, agencies and providers — would be tough even with years to plan. Wyoming could have only a short window to execute if the money comes through.

Lawmakers are already signaling friction. During recent budget hearings, members of the Joint Appropriations Committee questioned several proposals — especially BearCare.

“I’m struggling with how we should go into the free market,” said Rep. John Bear, R-Gillette. “I don’t think it’s the proper role of government.”

Some Freedom Caucus lawmakers derisively dubbed the proposal “GordonCare,” tying it to Gov. Mark Gordon, who has supported the application.

Gordon, for his part, framed the effort as essential.

“Families, seniors, and communities are stronger when they are healthy,” he said in a recent budget message. “We must maintain access to safety net services for all Wyoming communities.”

The application process started fast — and stayed fast. Health officials held eight in-person and three virtual meetings, gathered 1,300 survey responses, and consulted hospitals, tribal leaders and care providers before submitting the plan by the Nov. 5 deadline.

Federal officials with the Centers for Medicare and Medicaid Services are expected to announce funding decisions by Dec. 31. They can approve pieces of the application without greenlighting the whole thing.

Even then, nothing moves without the Wyoming Legislature. Lawmakers must appropriate the funds, and major ideas — like BearCare or the perpetuity — would require separate approvals and possible changes to state law.

Health analysts estimate Wyoming could realistically receive around $750 million — close to the maximum. But Lowe worries political infighting could derail the moment.

“There’s so much discord in the state Capitol these days,” she said. “We have this once-in-a-lifetime opportunity, and I’m afraid we’re going to squander it a little bit.”

For now, Wyoming waits — hopeful that its bold, sometimes controversial vision convinces federal officials that the smallest state deserves a big investment in its health care future.