The state of South Dakota has submitted its proposal to tap into millions of dollars the federal government has allocated to transform rural health care.
For nonprofits and other health care entities, that means the clock is ticking to get a slice of the pie. One nonprofit is looking to help Native American health care in South Dakota but worries about the lack of awareness within tribal communities.
The Rural Health Transformation Program is a product of President Donald Trump's One Big Beautiful Bill Act that Congress passed earlier this year. The fund was added to appease some concerns over worries that Medicaid cuts would further deepen disparities in rural health care across the country. Half of the $50 billion will be divided equally among all states whose applications are approved. The rest is divided based on rural geographic makeup and scores from state proposals.
South Dakota’s request for the Rural Health Transformation Program has four key priorities: Connecting technology and data, advancing rural workforce, keeping health care local and strong and transforming systems for sustainability. The state's proposal totaled $500 million over the next five years, the minimum amount guaranteed if the application is approved.
South Dakota Urban Indian Health, or SDUIH, is a nonprofit that provides care and services to both tribal and nontribal people using Indigenous lifeways and cultural practices. At an SDUIH and the USD Sanford School of Medicine Team meeting, stakeholders combed through the state’s 63-page proposal.
Although the SDUIH's Title V funding is tied to treating Urban Indians, Grants Director Erika Iverson said they also treat rural Indians so they could help create more equitable access to rural areas.
"Before we were able to bill Medicaid, our cultural health representatives that were based on the clinic side were primarily providing education while doing transportation and doing trips every other week to Wagner and Fort Thompson so that we could do medical pickup," Iverson said. "But also, people who needed to see, or get IHS services we provide them transportation to those IHS clinics and then bring them back."
She said they're working to "go beyond just the transportation."
"This is where, since we've thought through some of these things that we can do, should do, that the tribes were already doing that a whole national system was developed on, learn from that so that we can be ready to expand as these funds become available," Iverson said. "So we are connecting folks in rural areas, but there's a lot more we could do."
Colette Keith is the Executive Director of SDUIH. She said the time to start is now.
“The reason why I’m so pants on fire about this is because in January they’re going to start looking at proposals,” Keith said. “That doesn’t give anyone much time at all to write grants.”
With Stage Zero of the state’s proposal set for January 2026 through March 2026, groups have about two months from now to gather the necessary information to respond to request for proposals.
During the meeting, Keith told her team they need to work now on outreach to other tribes and nonprofits to team together to secure some of the funds for underserved areas. She pointed to many areas outlined in the state's proposal that she thought SDUIH could help, such as community health worker and community health representative training and strengthening chronic disease management.
She mentioned continuing the partnership with USD to advance rural workforce for tribal members but says they shouldn’t limit themselves.
“You know again, this might at some point look like a six-group partnership to put something really strong together,” Keith said.
DenYelle Kenyon is the Associate Dean of Community Health & Engagement for USD-SSOM. She said she could see some partnerships forming across the state to fill gaps, including by helping to sustain rural healthcare workforce.
"When we see the gaps in healthcare professionals and the needs in our rural areas, as well as the health disparities that are faced in the state, like that's the angle that we're trying to impact," Kenyon said.
She added that she'd love to see if the state is funding anything in prevention in public health. Kenyon said a lot of the other departments at USD that could be pulled in, including behavioral health.
However, Keith added there’s an issue right now for her relatives.
“Tribal health people just don’t know enough about this,” Keith said.
Keith said a fear of hers is that the tribes and Native people don’t get access to these dollars, adding it keeps her up at night.
“Holy, people don’t know that this money is coming down the pike, and the tribes that need it so badly are going to miss the boat. And that’s my biggest worry,” Keith said. “Literally, I’ve woken up in the middle of the night literally in a sweat like, ‘Wow. Our people are going to miss out on all of that money. That’s the other thing, if we don’t get that proposal in in January, February and March for this money do you think we get to compete for it next year? Nope. We don’t. That’s it. That money will be allocated. And it scares the whatever out of me.”
She said Native people and tribes not having extensive knowledge of the opportunity before them puts them at a disadvantage to fight for the funding.
Keith said her mind goes to words from Native American Rights Activist Lionel Bordeaux, when he received money from the American Indian Higher Education Consortium.
"He said, 'No. We're not going to take that money unless everybody gets that money. Keep your money. We want that money, but we won't take it just because you've identified us,'" Keith said about Bordeaux. "In this instance, we would probably take the money, and some people are going to be left behind. And that's very heartbreaking for me and goes against WoLakota values. But that's where we're at."
The group talked about inviting additional stakeholders, including tribal representatives, if possible, to a future meeting before January.
