Federal cuts hang over Pennsylvania’s state budget, except in the area of rural health.

Pennsylvania is due to receive $193 million in federal dollars this year to help implement its Rural Health Transformation Plan (RHTP). Total federal aid for the plan could reach $1 billion during the next five years.

The $50 billion in rural health money for the states over five years is part of the federal spending package enacted last summer. Pennsylvania’s plan to spend the money got approval from Washington last November.

Gov. Josh Shapiro’s budget office said the plan’s aid won’t offset the $20 billion in federal cuts to the state Medicaid program over 10 years starting in 2028.

The Shapiro administration plans to use the rural health money to establish eight regional care collaboratives to improve access to health care, expand the rural health care workforce, find innovative ways to deliver care and invest in technology delivering care.

Specifically, the plan calls for expanding training programs for physicians, nurse practitioners, EMS personnel, physician assistants and dentists to target gaps in care. Providing scholarships, mentors, short-term housing and stipends are mentioned.

The plan calls for steps to “right-size” rural hospitals to shift care to lower cost settings and look at more digital delivery of health care.

Rural health issues received greater attention in recent years as hospitals closed or ended service in areas such as maternity care. Shortages of health care professionals is a growing problem.

The current state budget provides $10 million in one-time payments to help rural hospitals. Pennsylvania has the third highest rural population in the nation, officials said.