The director of New Hampshire’s signature rural health overhaul is about to start spending federal money at a pace the state has rarely seen, even as deep cuts to Medicaid threaten the very communities the new program is supposed to lift up. In a wide-ranging interview with NHPR’s All Things Considered, GO-NORTH director Donnalee Lozeau laid out what the next four years of work will look like, where the dollars will land first, and how she intends to keep the lights on after the federal money runs out in 2030.
The numbers behind the program are staggering by Granite State standards. Roughly $200 million in federal funding will flow into New Hampshire this year alone, with the state expecting a total of $1 billion over five years through the Rural Health Transformation Program, a $50 billion national fund created inside the One Big Beautiful Bill that President Trump signed into law last year. The fund was specifically designed, by Congress, to compensate for the deep Medicaid and federal health cuts contained in the same legislation. As reported by New Hampshire Public Radio, Lozeau is now the person in Concord most responsible for translating that compensation into actual care.
A Reactive System That Has To Become Proactive
Lozeau, who serves as director of the Governor’s Office of New Opportunities and Rural Transformational Health, did not soft-pedal the underlying problem. New Hampshire’s healthcare system, she told NHPR’s Julia Barnett, is built to treat illness rather than to keep people well. It is fragmented, reactive, volume-based instead of value-based, and offers limited support for the daily life needs that keep rural residents healthy in the first place.
Layered on top of that structural mismatch are the specific pressures the North Country and other rural pockets feel most sharply: workforce shortages that worsen near every state line where competing employers can pay more, financial pressure on small providers, long drives to a primary care visit, and a rising tide of behavioral health and chronic disease cases that the existing system cannot keep up with.
GO-NORTH’s answer, Lozeau said, is built around four verbs the office is using almost as a mantra. Stabilize the providers that exist today. Strengthen the ones with room to grow. Transform the way care is delivered. Sustain whatever works once the federal grant ends. Each verb is meant to keep the office honest about whether the dollars it spends will still be producing results five and ten years out.
Where The Money Will Land First
The state has already organized its first wave of work around five regional hubs, partner organizations and provider networks that will carry GO-NORTH’s strategy into the field. That hub model, Lozeau said, is one of the reasons New Hampshire is ahead of many other states that received the same federal infusion. Granite State leaders did not wait for the money to arrive before deciding who would do the work.
Workforce remains the through-line. Federal rules cap the share of GO-NORTH dollars that can be spent paying providers for direct patient care at 15 percent, which means the program cannot just write checks to keep doctors and nurses in place. Instead, the strategy is to grow the supply. Manchester Community College is adding two faculty positions in its nursing program, the University of New Hampshire recently doubled enrollment in its nursing pipeline before having to pause new admissions, and the governor’s award program funded through GO-NORTH will cover tuition for students who commit to five years of work in priority shortage areas.
Lozeau also pointed to billing reform as a quieter but powerful lever. Certified behavioral health centers, for example, can bill for their services in ways that uncertified providers cannot, which improves their long-term financial picture without requiring more dollars from Concord. Telehealth and mobile access strategies will let providers stretch existing staff across more communities. And during a recent visit to Ammonoosuc Community Health Services, Lozeau highlighted “food for medicine” programs that treat nutrition and food insecurity as part of a patient’s clinical care plan rather than as a social services afterthought.
The Medicaid Question She Cannot Solve
The hardest part of the interview came when Barnett asked the question that hangs over every rural health conversation in New Hampshire right now. What can GO-NORTH actually do about the Medicaid losses that are squeezing rural hospitals and patients today, with new eligibility rules and federal funding cuts already biting?
Lozeau’s answer was honest and limited. Her experience, she said, is not in Medicare and Medicaid policy. Her strength is organizing, staying nimble, listening to communities, and implementing what is in front of her. She cannot reverse decisions the federal government has already made. What she can do is take the money Washington is sending and put it to work as efficiently as possible.
That answer reflects the political reality of the moment more than it reflects any failure of vision. Congress designed the Rural Health Transformation Program as the offset to Medicaid cuts. The money was always going to land in the laps of state-level administrators who were not in the room when the cuts were negotiated. Lozeau is being asked to play offense with funds that are themselves a defensive line drawn around vulnerable patients.
Sustainability After The Money Runs Out
The most consequential question for Granite Staters may be what happens in 2030. Federal grant money has a way of vanishing on schedule, and rural systems that build new capacity on a temporary infusion can find themselves worse off than before once the dollars stop. Lozeau is keenly aware of this trap.
When Manchester Community College proposed adding two nursing faculty, she said, her immediate response was to ask what happens to those positions when the GO-NORTH money runs out. The answer, she suggested, may be partnerships with the same hospitals that desperately need those nurses. If a regional hospital benefits from the new graduates, it has every reason to help underwrite the faculty who teach them. Multiply that logic across behavioral health centers, mobile clinics, and tuition reimbursement programs, and a path emerges to keep the work going on a mix of billing reform, employer co-investment, and ongoing state and federal support.
Success, Lozeau said, will be measured in the things rural Granite Staters can actually feel. Avoidable emergency department visits should drop. Avoidable hospitalizations should drop. Wait times to see a primary care provider should shrink. Provider turnover should slow. Patients should be in care before they are in trouble rather than after. The Centers for Medicare and Medicaid Services will measure New Hampshire’s performance against the goals the state set in its application, and Lozeau said her office will be “honest and transparent” about what works and what does not, including the willingness to pivot when an approach falls short.
What This Means For New Hampshire
For Granite State residents living in rural communities, GO-NORTH represents a meaningful chance to fix problems that have festered for decades. For policymakers, it is also a test of whether a state-run office can spend a billion federal dollars in a way that produces durable change rather than a five-year sugar high. The early signs that New Hampshire chose hubs and partners before the checks arrived suggest a serious effort to avoid the worst pitfalls.
The harder truth is that no rural health office can substitute for a stable Medicaid program. Congress chose to pair its cuts with this fund, and Lozeau’s task is to maximize what the fund can actually buy. That is the right work to do. It is also work that will be evaluated, fairly or not, against problems much larger than $200 million a year can solve.
Readers who want to follow this story should also see our coverage of how the GO-NORTH program plans to channel its full $1 billion federal allocation into rural transformation, the structural role Medicaid plays in propping up the state’s healthcare system, and the closures and care declines hitting hospitals like Exeter.
For related coverage, see our reporting on Federal Judge Greenlights Trial Over NH’s Choices For Independence Program.
For related coverage, see our reporting on A Vermont Lab Just Rewrote a Basic Assumption About the Flu.
