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March 29, 2024

New Rural Health Program Directs Resources to Rural Communities to Improve Health

JEFFERSON CITY, MO – Today, the Missouri Department of Social Services (DSS), MO HealthNet Division (MHD), which administers Missouri’s Medicaid program, announced the approval of a 1915(b) waiver amendment from the Centers of Medicare and Medicaid Services (CMS). The waiver amendment allows for the full deployment of the Transformation of Rural Community Health (ToRCH) pilot project.

ToRCH, which MHD began designing and developing in late 2021, will address critical social care challenges that compromise individuals’ ability to maintain their health and effectively manage chronic conditions.

DSS Director Robert Knodell has called the project “a groundbreaking initiative that empowers and encourages rural communities to collaborate to address healthcare-related social needs among their Medicaid population, with a focus on driving better health outcomes.”

Healthcare providers across the country recognize the impact of Social Determinants of Health (SDOH) on patient outcomes and are seeking ways to address these needs. According to the U.S. Department of Health and Human Services, these needs, or SDOH, encompass the environmental conditions where individuals are born, grow, learn, work, play, worship, and age. These factors impact various health outcomes, functioning, and overall quality of life. Some examples of SDOH include safe housing, transportation, access to nutritious foods, and physical activity opportunities.

"For too long, our payment systems have failed to reward hospitals for efforts to address some of the root causes of poor health,” said Kirk Mathews, MHD Chief Transformation Officer, “The ToRCH program allows hospitals to receive payment for proactively addressing issues that contribute to poor health outcomes. Under this model, hospitals are empowered to truly be in the 'healthcare' business in addition to the 'sick care' business.”

MHD Director Todd Richardson added, “This model perfectly aligns with our overarching goals for the Medicaid program. We believe this innovative approach will empower our partner communities to focus on improving health outcomes, and in doing so it will lower overall costs to the program.”

The ToRCH model is based on strong collaborations among three essential entities in rural communities: the hospital, primary care and behavioral health clinics, and community-based organizations (CBOs) offering social services. These partners will utilize the Community Information Exchange (CIE) software from Unite Us, a secure digital platform. This software will enhance care coordination by sharing resources, sending referrals, and ensuring the completion of referrals, thereby reducing barriers between individuals and the services meant to assist them.

In June 2023, six rural hospitals were selected to participate in the first cohort of the pilot:

  • Salem Memorial District Hospital - Salem, Missouri (Dent County)
  • Golden Valley Memorial Healthcare - Clinton, Missouri (Henry County)
  • Bothwell Regional Health Center - Sedalia, Missouri (Pettis County)
  • Phelps Health - Rolla, Missouri (Phelps County)
  • Citizens Memorial Hospital - Bolivar, Missouri (Polk County)
  • Ray County Memorial Hospital - Richmond, Missouri (Ray County)

ToRCH funding enables hospitals to act as community hubs, collaborating with partners to address SDOH and reduce preventable hospital admissions and emergency department (ED) visits. The model incentivizes improved population health through:

  • Lower rates of avoidable hospitalization, including readmissions
  • Decreased rates of avoidable ED use
  • Reduced all-cause hospital utilization for all Medicaid recipients in the community, regardless of hospital location

The ToRCH model is a Primary Care Case Management model focusing on addressing SDOH at the community level. It introduces potential new funding opportunities for rural hospitals leading in its implementation.

“Missouri is filled with innovative hospitals whose missions and capabilities make them essential to health and quality of life in their regions. These wise investments by MHD recognize the value and leadership of those great hospitals and provide support for them to expand their functions as hubs for health improvement. By expanding the assets available to community-based partners and better coordinating care, ToRCH will help hospitals improve lives and strengthen communities,” said Jon Doolittle, President/CEO of the Missouri Hospital Association.

How ToRCH Works

A local leadership board at the hospital "hub" will oversee the ToRCH model, prioritizing health-related social needs through community knowledge and clinical expertise.

Communication among partners for services like transportation and food will be facilitated through the Unite Us CIE platform. ToRCH funding will cover staff and project support, including convening the Leadership Board, monitoring data, engaging with community organizations, and seeking additional funding sources. CBO Capacity Building Funds will enhance smaller partners' capacity. The model aims to improve health management for rural Medicaid participants, achieve cost savings, and sustain operations through shared savings.

For more information about the ToRCH pilot project, contact Baylee Watts at


Media Contact

Baylee Watts