The Alaska Legislature is asking the federal government for some flexibility when it comes to implementing a massive program intended to improve rural healthcare across the state.
Alaska received $272 million from the federal Rural Health Transformation Program, part of the One Big Beautiful Bill that passed in the summer of 2025, putting it on track to receive nearly $1.4 billion over five years. It’s the largest per-capita grant for any state in the $50 billion federal program, and the second largest overall.
The Senate added the Rural Health Transformation Program to President Donald Trump’s signature tax- and spending-cut legislation to win support from moderates, including Alaska Republican Sen. Lisa Murkowski, concerned about the bill’s cuts to Medicaid.
The Department of Health says it received nearly 1,800 proposals for how to spend the first round of federal funding.
But that funding comes with limits to what it can be spent on and when, said state Sen. Forrest Dunbar, an Anchorage Democrat and chair of the Alaska Senate’s Health and Social Services Committee.
“It's not clear that that money can go where it's most needed,” he said. “It's not a huge amount of money relative to the challenges we face.”
One major limit is that the funding can’t be used to construct or expand healthcare facilities, like hospitals or badly needed housing for healthcare workers.
Another is the timing: The first round of funding has to be allocated by the end of September and fully spent within the following year.
The Legislature’s healthcare liaison told lawmakers that short timeline is challenging in rural Alaska, where a missed barge delivery or poor weather can lead to long delays.
Another source of heartburn is a series of commitments the state Department of Health made in its application to the federal government. It said the Legislature would pass a series of license compacts, which make it easier for healthcare providers from outside the state to practice in Alaska, and another measure allowing pharmacists to treat routine chronic conditions and minor illnesses.
A compact for nurses has been especially controversial, and it’s unclear precisely how much money could be clawed back or withheld from future grants if the Legislature doesn’t pass the series of bills by the end of 2027.
Rep. Genevieve Mina, an Anchorage Democrat and the main sponsor of House Joint Resolution 32 as chair of the House Health and Social Services Committee, said during a floor debate in March the Legislature needed more information as it weighed the pros and cons.
“We want more clarity on what these provisions would mean in terms of the award that we currently have and the money that we lose,” Mina said. “We don’t have that guidance right now.”
Lawmakers have yet to pass any of the license compact bills, and the end of the regular legislative session is fast approaching.
The resolution says the Legislature is committed to the goals of the program and calls on the governor and Alaska’s congressional delegation to push for clarity and flexibility.
As a resolution, it cannot be vetoed.
