Alaska to seek federal reset of rural health program milestones

Alaska's Department of Health is working through possible adjustments to the milestone timelines in its Rural Health Transformation Program application, the agency told its advisory council Wednesday, after CMS signaled it is willing to work with states on timing changes.

Betsy Wood, director of the Office of Health Savings, said most milestones set completion targets by 2028, the program's midpoint. "This feels a little front-loaded if we were meant to accomplish most of the activities that we identified in our application by the midpoint," Wood said. CMS views milestones as reflective of progress spread across the full length of the program, she added, and the department has already begun reviewing which timing adjustments would make the most sense.

Deputy Commissioner Emily Ricci said any changes require justification and that the process is not a do-over. "It is not a do-over by any means," she said. Ricci added that Alaska has hired staff and issued contracts while some states have not. "I think we are in the top tier of states in terms of how we are moving," she said.

On the application front, Wood told the council that 365 implementation applications are under review following a submission window that closed June 22. The department expects to complete its review through late July and execute final award agreements in August.

A tribal health representative raised concern that no water projects appeared to have moved forward from the letter-of-interest stage, despite a fourth-quarter 2026 milestone for launching off-grid sanitation projects. Ricci said the department is seeking clarity from CMS on construction requirements and realistic timelines before funding those types of projects. The off-grid sanitation milestone is among those being examined for adjustment.