In a largely criticized move, Guam is left out of the $50 billion rural health transformation program–a federal grant that’s opening up mid-September to rural hospitals across the nation. 

The grant was authorized by the GOP led One Big Beautiful Bill Act, to address the significant reductions to Medicaid spending. 

The congressional office budget estimates that those cuts will total $911 billion over ten years and 10 million people may lose coverage by 2034. 

In early August, Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz went before CBS News’ face the nation, talking about the grant and how it could help rural communities. 

“They’ll get the applications in early September. The money is designed to help you with workforce development, right-sizing the system and using technology to provide things like telehealth that can change the world,” said Oz. 

Department of Public Health and Social Services Director Theresa Arriola says she first heard of the grant through federal partners.

“Really they just said there was this grant that’s going to come out, and this NOFO, which is the notice of federal opportunity, will come out and everybody should look out. Then they started planning information webinars so that states and territories could get to know more about what the application requirements are going to be. And that was just late August,” said Arriola. 

It was through a source in DC, she recently found out only the 50 U.S. states are eligible. The District of Columbia and U.S. territories are not. 

Arriola shared her disappointment.

“My reaction was a deafening ‘oh, my God.’ Because really, this rural health transformation grant was what I saw as the make-up, if you will, for some of public health’s grants that were removed throughout the year from HHS. We were all, including the states and territories in those early morning meetings, were really looking forward to it because it was going to help us make whole what happened earlier in April and May when several grants were removed,” said Arriola. 

She immediately brought it to the administration’s attention during the labor day weekend. 

From there, Lt. Governor Josh Tenorio criticised Guam's exclusion at a federal-terriorial meeting in Washington D.C. last week. 

“This denies us access to programs that would support the acquisition of Electronic Health Records and Health Information Exchange systems that are essential for modern healthcare. We urge action to fix this exclusion and recognize, also, that there are pathways for closer collaboration among the territories in pursuing modern solutions for healthcare technology to maximize the provision of healthcare to all of our island residents,” said Lt. Gov. Tenorio. 

But in response to media reports and criticism from island leaders, Congressman James Moylan says Guam was not excluded from the grant due to “oversight or neglect.”

He says the grant was created, “To address medicaid reductions that apply only to the 50 states,” adding “Guam and other U.S. territories are not subject to those reductions—and therefore were not included in this specific funding stream.”

Moylan is working on drafting legislation to establish a parallel fund for territories, modeled on the rural health transformation program framework.

The delegate also highlighted the long-term development of a broader initiative to address medicaid equity for the territories– the Access To Medicaid For Our Territories (AMOT) Act. 

Meantime, the Public Health Director shared her disappointment that Guam was left out in the first place. 

“That’s a lot of millions. I would just be happy if I got a handful of those millions for Guam. It’s unfortunate that we were not included in this initial rural health transformation program. Guam is of course, all rural. We are considered rural with our federal partners and in many other ways. We’ve never been not rural as the federal government sees Guam,” said Arriola. 

Guam Memorial Hospital Authority Administrator and CEO Lillian Perez Posadas echoes her sentiments, speaking out on how it could help the island’s underfunded public hospital.

“The $50 billion, if we could benefit from that, that would help us move forward and even elevate the availability of health services for the people of Guam. But unfortunately, we’re not going to have any of that funding source. We’re going to have to find ways– other funding sources– to make sure we continue to provide and make care accessible and available to the people of Guam,” said Posadas.