COLUMBIA — Putting more medical care on wheels. Converting vacated buildings. Encouraging doctors and doctors-in-training to work in rural South Carolina.
Those are among the possibilities for up to $1 billion flowing to South Carolina over the next five years through the $50 billion federal Rural Health Transformation Program.
“It’s a massive amount of funding,” Eunice Medina, director of the state Department of Health and Human Services, told the SC Daily Gazette. “It’s truly a once-in-a-lifetime opportunity for the state.”
Exactly how much will be available for health care in rural South Carolina won’t be known until late December, when the Centers for Medicare and Medicaid Services will announce states’ awards. In the meantime, South Carolina health officials want providers to get their proposals ready.
“We want to stay on a schedule and get those grants awarded and money to flow into the system,” Medina said.
Her agency is hosting a webinar Tuesday to explain the state’s 60-page application to providers, advocates, and anyone else who’s interested. The state agency can keep a maximum of 10% of its total award for administration. The rest will be doled out as grants for initiatives that fall into five general categories — what Medina calls “buckets.” (See the info box below.)
All are about “creating more services, more providers, more overall access” with improvements that carry on once the federal money runs out, without putting state taxes on the hook, she said.
Prohibited uses of the one-time money include salaries. But grants can be used to pay bonuses for doctors who move to or do their specialty training in rural areas.
“Once you’re there, we want you to fall in love and stay,” said Medina, who’s been visiting agency offices statewide since becoming director a year ago.
And while the money can’t construct a new building, it can pay to refurbish abandoned spaces for patients. There are plenty of those in rural South Carolina.
Grants can also buy mobile doctors’ offices.
“If you’re trying to expand mobile health units that go out to schools, and you just need the cost of the van and equipment — done,” Medina said. “Let’s do that, as long as they have a sustainability plan.”
South Carolina is seeking $1 billion total from the program created by Republicans’ “big, beautiful” law signed July 4 by President Donald Trump. Congress created it in response to concern about the law’s impact on rural providers.
Every state is automatically eligible for $100 million annually through 2030 for applying by the Nov. 5 deadline — which every state did. Decisions on divvying up the other $25 billion will be based on states’ ruralness — South Carolina ranks 35th — their plans for the money, and their existing laws and policies.
For example, Medina said, South Carolina will get credit for the 2023 law repealing the Certificate of Need regulatory permission process for hospitals. And the state will score major points for aligning with the Trump administration’s “make America healthy again” initiative by banning the purchase of candy, sodas and other sugary drinks with federal food assistance. (With the federal government reopened, official approval of the state’s request, submitted in late September, could be imminent.)
Other policies in South Carolina’s favor include state support for telehealth and participation in regulatory agreements that allow nurses, emergency medical personnel, and psychologists to work across state lines, according to the health agency.
The state gets no credit for legislation proposing interstate agreements for physician assistants, expanding the authority of advanced practice registered nurses, or allowing pharmacists to delegate supervision. Those policies would be a plus if they were law. But the three bills — all introduced by GOP Sen. Tom Davis of Beaufort — have yet to get a vote. The agency couldn’t risk counting on them to pass, since the state faces federal penalties for anything that falls through. So, it didn’t include them in the application.
“We take very seriously the clawback restraints,” Medina said. “Whatever you put in that application, that is your commitment. And if you don’t do it, they’ll give you the money upfront and take it right back.”
Rural challenges
The program could be a huge boon for poor, rural parts of South Carolina, health association leaders said.
While it is overseen by the state agency that runs Medicaid, which provides health coverage to more than 1 million poor South Carolinians, it is not Medicaid, Medina stressed. Rather, it’s supposed to improve access for rural South Carolinians whether they’re covered by Medicaid or not, she said.
Roughly a third of the state’s population lives in rural areas with limited access to health care.
In 2021, there were nine doctors for every 10,000 people in rural counties, compared to 28 doctors per 10,000 people in urban areas, according to the 2024 Health Professions Data Book, compiled by the South Carolina Area Health Education Consortium. It shows that more than two-thirds of all doctors statewide were concentrated in six of the state’s 46 counties: Charleston, Greenville, Richland, Horry, Spartanburg, and York.
Eight rural counties didn’t have a single pediatrician. Fifteen lacked an OB-GYN; 17 lacked a psychiatrist, according to the latest data book.
“This could be one of the greatest blessings the state has ever had,” said Terri Jowers, executive director of the state Community Health Workers Association.
Her group was among providers submitting more than 350 proposals that helped the state health agency craft its application. Providers will still need to officially apply for a grant, which will be a contract with the state. The webinar will include an explanation of the grant cycle.
Jowers’ group plans to ask for money to connect doctors with health workers who may go into people’s homes and live in their community. The workers can provide valuable insight to assist patients’ medical care and increase their likelihood of returning for check-ups.
“How can we weave these together to really take care of our patients and our communities and help everybody live healthier lives?” Jowers said.
Better coordination among health care providers could also help improve access to care, she said.
One of the category “buckets” for the money is using technology to create “connections to care.” That can include tying rural hospitals and other providers into an electronic health records system.
If doctors can go online to see patients’ medical history with other providers, treatment could become faster, easier and cheaper, Jowers said.
Rural hospitals’ requests include partnerships with the state’s technical colleges to grow the health care workforce, said Karlin Gill, spokesperson for the South Carolina Hospital Association.
Supporting small hospitals will be especially important as Medicaid rates decrease over the coming years. The program won’t fill all the gaps from that loss, she said.
“There are huge benefits” to the program, Gill said. “That amount is not a small amount. But I don’t think it will cover everything that will be affected as we see those reimbursement cuts year over year.”
In 2028, South Carolina will start losing its ability to pay hospitals for treating Medicaid patients at similar rates as private insurance through what’s known as the state directed payment program, which the law signed in July phases out. South Carolina has used it since 2023 to hike Medicaid payments to hospitals by a whopping 70% on average.
For the 60 general care hospitals in the Palmetto State, that collectively means a looming loss of roughly $150 million annually over 15 years, according to the hospital association.
South Carolina is among 10 states that never expanded Medicaid coverage to all adults up to 138% of the federal poverty level, as intended under the 2010 law commonly known as Obamacare. For that reason, other Medicaid changes in Republicans’ tax policy package don’t apply to the Palmetto State.
But the state also has a higher percentage of uninsured residents, giving hospitals much less wiggle room to absorb the impact of payment reductions.
And the number of uninsured will rise with the Dec. 31 expiration of enhanced federal subsidies for people buying private insurance through the online marketplace created by the 2010 law. The enhanced subsidies, initially approved by Congress during the pandemic, save South Carolinians between $500 and $700 monthly on premiums.
Losing that will make health insurance too expensive for many, which will also impact providers, said Maya Pack, director of the South Carolina Institute of Medicine and Public Health, a nonpartisan research organization.
“I don’t know that this fund will be able to offset all of the more negative outcomes that could be triggered by those things, but it will certainly help to mitigate that,” Pack said.
How much the program helps will depend on what the state health agency decides to fund, she said.
Another “bucket” for grants is called “leveling up,” which means expanding successful pilot programs.
“We have a lot of great programs in our state that meet the needs of rural residents as well as urban residents, but oftentimes, those programs or services are isolated to one community or one county,” Pack said.
Goals for SC’s award
South Carolina’s Rural Health Transformation plan consists of five general categories. Providers will apply for grants that fund the following initiatives:
Source: S.C. Department of Health and Human Services
Seanna Adcox is a South Carolina native with three decades of reporting experience. After covering the S.C. Legislature and state politics for 18 years. she launched the SC Daily Gazette in November 2023 as the 37th state affiliate under the States Newsroom umbrella. Her previous employers include The Post and Courier and The Associated Press.
Skylar Laird covers the South Carolina Legislature and criminal justice issues. Originally from Missouri, she previously worked for The Post and Courier’s Columbia bureau.
SC Daily Gazette is part of States Newsroom, the nation’s largest state-focused nonprofit news organization.
Shortage of rural doctors won’t end anytime soon, report says
BY: NADA HASSANEIN - NOVEMBER 20, 2025 9:26 AM
For at least the next dozen years, rural areas will continue to have only about two-thirds of the primary care physicians they need, according to a report released Monday.
The nonprofit Commonwealth Fund based its analysis on federal health workforce data. Its report comes just days after states applied for portions of a $50 billion rural health fund included in the broad tax and spending law President Donald Trump signed in July. Some states want to use the federal money to expand their rural residency programs, as physicians who complete their residencies in rural areas are more likely to practice in one.
About 43 million people live in rural areas without enough primary care physicians, according to the report. Across the country, nearly all — 92% — of rural counties are considered primary care professional shortage areas, compared to 83% of nonrural counties. Forty-five percent of rural counties had five or fewer primary care doctors in 2023. Roughly 200 rural counties lacked one altogether.
Nationally, the report found there was an average of one physician per 2,881 rural residents. States in the South had 3,411 patients per physician, whereas states in the Northeast had 1,979 residents per physician.
Rural residents are less likely to use telehealth for primary care, largely because of limited broadband internet access. About 19% of rural respondents said they received health care from a primary care physician via telehealth over the past year, compared with the national average of 29%.
The report also took the pulse of states’ participation in national programs for rural areas, such as a federal loan repayment and scholarship program for physicians working in areas with a shortage of health care providers. In 2023, 40% of rural counties had at least one primary care clinician participating in the program — compared to 60% of nonrural counties.
While the demand for primary care physicians will surpass the supply, the study estimates that the supply of rural nurse practitioners will exceed demand over time, as nurse practitioners are the fastest-growing type of clinician in the U.S., regardless of geography, the authors wrote.
Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.
Nada Hassanein is a health care reporter for Stateline with a focus on inequities.
