5 - 1 5. Rural Health Care Support The portion of the 1996 Telecommunications Act that covers universal service support for rural health care providers states that “[a] telecommunications carrier shall . . . provide telecommunications services . . . to any public or non-profit health care provider . . . at rates that are reasonably comparable to rates charged for similar services in urban areas in that state.” 1 The Commission's universal service rules permit eligible health care providers 2 to receive support for any telecommunications service. 3 In 2003, the FCC significantly changed the universal service support mechanism for rural health care providers, effective in Funding Year 2004 (July 1, 2004 – June 30, 2005). Dedicated emergency departments of rural for-profit hospitals that participate in Medicare are now deemed “public” health care providers eligible to receive prorated rural heath care support. 4 Further, rural health providers may now receive support for any form of Internet access reasonably related to the health care needs of the facility. 5 Rural health care providers may also use “safe harbor” categories to compare the urban and rural rates for functionally similar services as viewed from the perspective of the end user. 6 Also, rural health care providers may compare their rural rates to urban rates in any city with a population of at least 50,000 in the state, as opposed to the nearest city with a population of 50,000. 7 Finally, rural health care providers may 1 47 U.S.C. § 254(h)(1)(A). 2 47 C.F.R. § 54.601. 3 A 1.544 Mbps (T1) maximum bandwidth cap was employed in Funding Years 1 and 2. See Federal-State Joint Board on Universal Service, CC Docket No. 96-45, Report and Order, 12 FCC Rcd 8776, 8952-94 (1997). The Commission removed the bandwidth cap for year three and beyond. See Federal-State Joint Board on Universal Service, CC Docket Nos. 97-21 and 96-45, Sixth Order on Reconsideration in CC Docket No. 97-21, Fifteenth Order on Reconsideration in CC Docket No. 96-45, 14 FCC Rcd 18756 (1999) (Fifteenth Order on Reconsideration). 4 See Rural Health Care Support Mechanism, WC Docket No. 02-60, Report and Order, Order on Reconsideration and Further Notice of Proposed Rulemaking, 18 FCC Rcd 24546 (2003) (Rural Health Care Order) at 13. 5 See Rural Health Care Order at 22. 6 See Rural Health Care Order at 33. 7 See Rural Health Care Order at 37. 5 - 2 receive discounts for satellite services even where alternative terrestrial-based services may be available. 8 In December 2004, the Commission released a Second Order 9 that further modified the Commission’s rules for rural health care support. In this Second Order, the Commission changed its definition of rural for the purposes of the rural health care support mechanism. Now a “rural area” is an area that is not located within or near a large population base. Specifically, a “rural area” is an area that (a) is entirely outside of a Core Based Statistical Area (CBSA); (b) is within a CBSA that does not have any urban area with a population of 25,000 or greater; or (c) is in a CBSA that contains an urban area with a population of 25,000 or greater, but is within a specific census tract that itself does not contain any part of a place or urban area with a population of greater than 25,000. This new definition was effective as of Funding Year 2005 (July 1, 2005 – June 30, 2006). Several other rules also were changed. The Commission expanded funding for mobile rural health care providers by subsidizing the difference between the rate for the satellite service and the rate for an urban wireline service with a similar bandwidth. June 30 is now the final deadline for applications for support for health care providers seeking discounts for a specific funding year under the rural health care support mechanism. In addition, a rural health care provider in a state that is entirely rural may now receive support for advanced telecommunications and information services. USAC recently streamlined the application process for the Rural Health Care mechanism. USAC combined the information from two forms onto one, 10 allowed the new form to be filled out electronically, and, where possible, prefilled the form with that applicant’s information. 11 Now, an eligible rural health care provider seeking funding must first submit FCC Form 465 (description of services requested and certification form) to the Rural Health Care Division (RHCD). 12 If the 8 See Rural Health Care Order at 44. 9 See Rural Health Care Support Mechanism, WC Docket No. 02-60, Second Report and Order, Order on Reconsideration, and Further Notice of Proposed Rulemaking, 19 FCC Rcd 24613 (2004) (Second Order). 10 FCC Forms 466 and 468 were combined into the new FCC form 466. 11 See www.rhc.universalservice.org/whatsnew/062003.asp#2 12 The Rural Health Care Corporation merged into the Universal Service Administrative and became the Rural Health Care Division on January 1, 1999. See Changes to the Board of Directors of the National Exchange Carrier Association, Inc., Federal-State Joint Board on Universal Service, CC Docket Nos. 97-21 and 96-45, Third Report and Order in CC Docket No. 97-21 and Fourth Order on Reconsideration in CC Docket No. 97-21 and Eighth Order on Reconsideration in CC Docket No. 96-45, 13 FCC Rcd 25058, 25064-65, para. 12 (1998). 5 - 3 RHCD determines that the health care provider is eligible, it posts the Form 465 on its website. 13 Twenty-eight days thereafter, the rural health care provider may contract with the most cost- effective bidder. The health care provider then fills out FCC Form 466 (Funding Request and Certification Form) and/or 466-A (Internet Service Funding Request and Certification Form), and submits it to the RHCD. Upon receipt and approval of FCC Form 466, the RHCD sends a Funding Commitment Letter to the rural health care provider. The letter explains that the request has received preliminary approval, and provides an estimate of the amount of support that can be expected. The rural health care provider must respond by submitting FCC Form 467 (receipt of service confirmation form) to verify that the service has begun. RHCD then sends a Support Schedule to the carrier and the health care provider. The carrier provides service to the rural health care provider, and then invoices the RHCD for the support amount. Upon approval of the invoice, USAC reimburses the carrier. By rule, the Commission has established a $400 million per funding year cap for the rural health care mechanism. 14 For more information on the Universal Service Program for Rural Health Care providers, visit the RHCD website. 15 USAC supplied the Commission with funding commitments and disbursements information as of June 30, 2006. 16 Table 5.1 summarizes funding disbursements for all funding years by service speed. Tables 5.2 through 5.4 show details for Funding Years 2003 through 2005. For details on the preceding funding years, see the previous editions of the Monitoring Report. 17 Table 5.2 summarizes funding commitments and disbursements on a state-by-state basis. Funding Year 2003 was July 1, 2003, through June 30, 2004. USAC estimates Funding Year 2003 demand will be $26.25 million. 18 13 The forms may be viewed at www.rhc.universalservice.org/telecomcarriers/searchpostings/default.asp. 14 47 C.F.R. § 54.623(a). 15 See www.rhc.universalservice.org. 16 Because of the appeals process, funding commitments and disbursements may be made after the program year ended. 17 Earlier editions of the Monitoring Reports are available at this URL: www.fcc.gov/wcb/iatd/monitor.html. 18 Universal Service Administrative Company, Federal Universal Service Support Mechanisms Fund Size Projections for the Third Quarter 2006, at 15. 5 - 4 Funding Year 2004 was July 1, 2004, through June 30, 2005. USAC reports that 2,999 FCC Forms 465 have been posted and that it received 4,667 Form 466 and 466-A packets, including 801 packets from applicants seeking support for Internet access only. 19 Of the 4,667 packets, 133 were denied, 332 were withdrawn by the applicant, two were complete and ready to process, and the rest were completely processed. 20 As of June 30, 2006, over $35.5 million had been committed, and nearly $25.5 million had been disbursed. 21 Funding Year 2005 was July 1, 2005, through June 30, 2006. USAC reports that it posted 3,413 Form 465 packets, and received 2,985 Form 466 and 466-A packets. Of these packets, 1,281 have been completely processed, 295 are awaiting supervisory approval only, 39 are complete and ready to process, 158 have been withdrawn by the applicant, 15 have been denied, and 1,197 were incomplete or require clarification. 22 As of June 30, 2006, more than $22.6 million had been committed, and more than $7.7 million had been disbursed. 23 USAC estimates Funding Year 2005 demand will be approximately 36% higher than demand in Funding Year 2004, resulting in Funding Year 2005 demand of about $38.165 million. 24 Table 5.3 shows state-by-state disbursements by service speed for Funding Years 2003 through 2005. In some instances, such as with frame relay service, the service speed was not clearly identifiable. Whenever possible, the most likely speed for each service was assumed. For example, Frame Relay theoretically could be provided at voice grade speeds, but the vast majority of it is provided at broadband speeds (200K to 1.49Mb), so Frame Relay was assumed to be broadband at that level. Table 5.4 shows, for Funding Years 2003 and 2004, state-by-state disbursements from the Rural Health Care Support Mechanism, the population of the rural areas, and the disbursements per person in rural areas. 19 Universal Service Administrative Company, Federal Universal Service Support Mechanisms Fund Size Projections for the Third Quarter 2006, at 15. 20 Universal Service Administrative Company, Federal Universal Service Support Mechanisms Fund Size Projections for the Third Quarter 2006, at 16. 21 See Table 5.2. 22 Universal Service Administrative Company, Federal Universal Service Support Mechanisms Fund Size Projections for the Third Quarter 2006, at 16-17. 23 See Table 5.2. 24 Universal Service Administrative Company, Federal Universal Service Support Mechanisms Fund Size Projections for the Third Quarter 2006, at 16-17. Table 5.1 Rural Health Care Funding Disbursements by Funding Year Voice Grade Broadband Other Service Funding 56K to 200K to 1.5Mb or Speed Year 199K 1.49Mb and faster Unknown Total 1998 $202,778 $880,375 $2,292,252 $0 $3,375,405 1999 452,992 1,073,816 2,719,619 58,132 4,304,559 2000 613,595 3,015,004 6,685,573 0 10,314,172 2001 319,539 8,110,537 10,125,267 0 18,555,343 2002 423,756 10,639,476 10,405,314 0 21,468,545 2003 474,651 11,027,242 13,095,924 7,559 24,605,376 2004 529,770 10,215,472 14,274,426 471,754 25,491,422 2005 18,375 3,381,790 4,121,309 234,404 7,755,878 Note: Disbursements through June 30, 2006. Because of the appeals process, funding commitments and disbursements may be made after the program year ended. Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. 5 - 5 Table 5.2 Rural Health Care Funding Commitments and Disbursements by State Funding Year 2003: July 1, 2003 through June 30, 2004 Total Providers Total Providers Funds Receiving Funds Receiving State Committed Support Disbursed Support Alabama $28,736 4 $28,736 4 Alaska 16,882,404 203 15,060,505 155 Arizona 1,182,242 62 786,478 55 Arkansas 113,247 36 103,347 32 California 378,376 77 351,385 70 Colorado 142,852 15 132,206 14 Connecticut 0 0 0 0 Delaware 0 0 0 0 District of Columbia 0 0 0 0 Florida 259,622 44 101,963 7 Georgia 70,580 5 69,731 4 Hawaii 211,966 20 211,966 20 Idaho 212,171 22 153,385 21 Illinois 91,725 25 76,544 21 Indiana 26,375 8 24,857 7 Iowa 186,674 41 146,264 36 Kansas 377,833 62 343,413 56 Kentucky 477,586 207 457,856 198 Louisiana 6,501 3 6,501 3 Maine 83,600 9 23,108 5 Maryland 0 0 0 0 Massachusetts 0 0 0 0 Michigan 570,029 50 518,918 46 Minnesota 1,006,345 102 865,528 95 Mississippi 113,354 14 111,454 11 Missouri 111,082 27 100,956 25 Montana 551,206 61 503,664 58 Nebraska 615,389 33 607,192 32 Nevada 66,767 18 57,757 15 New Hampshire 0 0 0 0 New Jersey 0 0 0 0 New Mexico 317,874 50 221,996 31 New York 14,252 3 13,651 2 North Carolina 149,423 16 146,147 16 North Dakota 460,135 58 440,865 58 Ohio 142,734 8 99,302 8 Oklahoma 106,114 35 97,233 30 Oregon 21,586 9 21,586 9 Pennsylvania 47,646 13 35,291 12 Rhode Island 0 0 0 0 South Carolina 7,323 3 6,355 2 South Dakota 421,819 49 398,292 45 Tennessee 31,717 14 26,166 12 Texas 139,929 28 130,034 25 Utah 687,450 28 646,542 27 Vermont 1,265 3 1,265 3 Virgin Islands 115,575 9 113,637 8 Virginia 166,495 28 166,464 28 Washington 68,592 28 63,336 25 West Virginia 123,204 29 87,577 19 Wisconsin 987,303 92 915,723 90 Wyoming 155,530 12 130,202 11 Totals $27,932,628 1,663 $24,605,376 1,451 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2006. Because of the appeals process, funding commitments and disbursements may be made after the program year ended. 5 - 6 Table 5.2 Rural Health Care Funding Commitments and Disbursements by State Funding Year 2004: July 1, 2004 through June 30, 2005 Total Providers Total Providers Funds Receiving Funds Receiving State Committed Support Disbursed Support Alabama $18,693 5 $16,608 4 Alaska 20,547,595 229 15,097,072 162 Arizona 1,207,764 73 628,858 55 Arkansas 163,213 34 100,445 27 California 564,724 76 340,384 36 Colorado 155,686 16 122,289 14 Connecticut 0 0 0 0 Delaware 0 0 0 0 District of Columbia 0 0 0 0 Florida 351,825 53 163,022 9 Georgia 216,861 21 194,413 15 Hawaii 305,536 21 242,690 19 Idaho 136,905 28 73,940 20 Illinois 597,529 68 394,696 45 Indiana 175,949 9 123,495 7 Iowa 218,683 53 175,606 42 Kansas 547,607 73 237,389 25 Kentucky 919,990 202 836,017 192 Louisiana 7,536 6 4,700 2 Maine 42,258 11 31,450 6 Maryland 0 0 0 0 Massachusetts 1,638 1 0 0 Michigan 835,089 75 532,569 52 Minnesota 1,031,874 140 857,430 116 Mississippi 175,424 25 129,477 8 Missouri 124,185 29 85,329 15 Montana 582,426 62 494,145 52 Nebraska 857,484 76 734,167 66 Nevada 64,099 10 0 0 New Hampshire 5,388 2 2,483 1 New Jersey 0 0 0 0 New Mexico 276,523 55 107,972 10 New York 41,782 8 7,274 1 North Carolina 199,975 22 129,854 11 North Dakota 577,294 89 484,338 70 Ohio 196,045 10 93,072 6 Oklahoma 168,105 35 69,508 5 Oregon 40,054 11 18,994 2 Pennsylvania 80,716 17 51,293 10 Rhode Island 0 0 0 0 South Carolina 45,433 11 38,528 9 South Dakota 574,325 76 443,024 55 Tennessee 97,352 29 52,874 5 Texas 451,913 37 6,669 3 Utah 661,538 36 558,595 28 Vermont 35,336 9 27,973 8 Virgin Islands 113,841 12 104,232 12 Virginia 364,973 50 307,182 39 Washington 88,533 31 44,713 8 West Virginia 131,324 20 68,750 12 Wisconsin 1,459,699 170 1,158,130 132 Wyoming 109,001 9 99,776 7 Totals $35,569,725 2,135 $25,491,422 1,423 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2006. Because of the appeals process, funding commitments and disbursements may be made after the program year ended. 5 - 7 Table 5.2 Rural Health Care Funding Commitments and Disbursements by State Funding Year 2005: July 1, 2005 through June 30, 2006 Total Providers Total Providers Funds Receiving Funds Receiving State Committed Commitments Disbursed Support Alabama $62,401 19 $35,319 10 Alaska 11,273,201 147 3,970,024 56 Arizona 942,121 49 387,458 12 Arkansas 59,698 12 788 3 California 224,644 28 92,911 9 Colorado 22,310 5 301 1 Connecticut 0 0 0 0 Delaware 0 0 0 0 District of Columbia 0 0 0 0 Florida 59,645 2 0 0 Georgia 264,698 32 122,741 9 Hawaii 217,524 19 148,277 14 Idaho 84,860 21 42,500 13 Illinois 405,990 34 70,297 7 Indiana 133,767 7 69,014 3 Iowa 168,619 29 102,806 14 Kansas 438,507 66 98,261 12 Kentucky 110,665 46 27,926 12 Louisiana 207,635 24 88,396 10 Maine 11,476 10 0 0 Maryland 0 0 0 0 Massachusetts 35,487 2 0 0 Michigan 291,103 30 22,853 4 Minnesota 898,465 96 294,583 38 Mississippi 181,496 11 31,208 5 Missouri 84,619 17 5,094 8 Montana 255,523 27 22,225 4 Nebraska 1,396,985 79 749,046 50 Nevada 0 0 0 0 New Hampshire 4,816 1 0 0 New Jersey 0 0 0 0 New Mexico 277,405 32 22,857 2 New York 25,204 8 12,419 1 North Carolina 7,041 2 2,934 1 North Dakota 561,777 71 234,615 40 Ohio 80,087 2 17,930 1 Oklahoma 82,927 5 0 0 Oregon 0 0 0 0 Pennsylvania 47,805 5 0 0 Rhode Island 0 0 0 0 South Carolina 55,102 12 31,268 8 South Dakota 783,607 46 555,802 38 Tennessee 106,077 13 3,064 3 Texas 637,711 46 2,475 1 Utah 246,459 22 233,466 18 Vermont 78,704 12 65,688 11 Virgin Islands 79,786 10 498 1 Virginia 129,983 24 24,540 5 Washington 29,646 10 11,232 4 West Virginia 45,281 12 0 0 Wisconsin 1,447,543 118 155,063 16 Wyoming 42,354 4 0 0 Totals $22,600,754 1,267 $7,755,878 444 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2006. Because of the appeals process, funding commitments and disbursements may be made after the program year ended. 5 - 8 Table 5.3 Disbursements by Service Speeds Acquired by Rural Health Care Providers Funding Year 2003: July 1, 2003 through June 30, 2004 Voice Grade Broadband Other Service 56K to 200K to 1.5Mb or Speed State 199K 1.49Mb and faster Unknown Total Alabama $0 $2,146 $26,591 $0 $28,736 Alaska 22,766 8,838,145 6,199,594 0 15,060,505 Arizona 0 120,169 666,308 0 786,478 Arkansas 0 31,001 72,346 0 103,347 California 176,002 84,707 90,676 0 351,385 Colorado 15,114 9,476 106,578 1,037 132,206 Connecticut 0 0 0 0 0 Delaware 0 0 0 0 0 District of Columbia 0 0 0 0 0 Florida 0 5,225 96,737 0 101,963 Georgia 0 0 69,731 0 69,731 Hawaii 0 0 211,966 0 211,966 Idaho 0 90,534 62,852 0 153,385 Illinois 0 25,359 51,185 0 76,544 Indiana 0 2,859 21,998 0 24,857 Iowa 0 41,456 104,808 0 146,264 Kansas 26,207 225,069 92,136 0 343,413 Kentucky 1,795 222,255 233,805 0 457,856 Louisiana 0 5,303 1,198 0 6,501 Maine 21,529 1,580 0 0 23,108 Maryland 0 0 0 0 0 Massachusetts 0 0 0 0 0 Michigan 6,301 18,993 493,625 0 518,918 Minnesota 6,133 220,774 638,621 0 865,528 Mississippi 0 17,961 93,493 0 111,454 Missouri 0 50,151 50,805 0 100,956 Montana 0 9,356 494,308 0 503,664 Nebraska 22,517 79,245 505,430 0 607,192 Nevada 0 23,486 34,271 0 57,757 New Hampshire 0 0 0 0 0 New Jersey 0 0 0 0 0 New Mexico 0 138,212 83,784 0 221,996 New York 1,975 0 11,676 0 13,651 North Carolina 0 13,296 132,851 0 146,147 North Dakota 12,054 63,947 364,864 0 440,865 Ohio 179 1,332 97,791 0 99,302 Oklahoma 956 70,959 25,318 0 97,233 Oregon 0 18,434 3,152 0 21,586 Pennsylvania 2,669 35 32,587 0 35,291 Rhode Island 0 0 0 0 0 South Carolina 4,320 0 2,035 0 6,355 South Dakota 5,435 102,848 290,009 0 398,292 Tennessee 5,547 0 20,619 0 26,166 Texas 2,560 40,340 87,135 0 130,034 Utah 0 118,862 527,679 0 646,542 Vermont 0 1,265 0 0 1,265 Virgin Islands 0 0 113,637 0 113,637 Virginia 0 4,319 162,145 0 166,464 Washington 0 13,414 49,922 0 63,336 West Virginia 0 47,661 39,915 0 87,577 Wisconsin 140,592 203,731 564,877 6,521 915,723 Wyoming 0 63,338 66,864 0 130,202 Totals $474,651 $11,027,242 $13,095,924 $7,559 $24,605,376 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2006. Because of the appeals process, funding commitments and disbursements may be made after the program year ended. 5 - 9 Table 5.3 Disbursements by Service Speeds Acquired by Rural Health Care Providers Funding Year 2004: July 1, 2004 through June 30, 2005 Voice Grade Broadband Other Service 56K to 200K to 1.5Mb or Speed State 199K 1.49Mb and faster Unknown Total Alabama $0 $724 $15,883 $0 $16,608 Alaska 1,325 8,689,366 6,362,388 43,993 15,097,072 Arizona 0 90,905 529,703 8,249 628,858 Arkansas 3,160 20,166 73,303 3,817 100,445 California 170,734 10,467 154,687 4,495 340,384 Colorado 16,168 0 105,280 841 122,289 Connecticut 0 0 0 0 0 Delaware 0 0 0 0 0 District of Columbia 0 0 0 0 0 Florida 0 4,380 158,642 0 163,022 Georgia 0 30,150 160,953 3,310 194,413 Hawaii 0 0 236,103 6,586 242,690 Idaho 0 26,402 43,221 4,317 73,940 Illinois 0 14,624 346,125 33,947 394,696 Indiana 0 0 123,495 0 123,495 Iowa 22,266 21,800 125,639 5,900 175,606 Kansas 23,000 19,685 189,453 5,251 237,389 Kentucky 0 244,245 493,620 98,152 836,017 Louisiana 0 0 4,700 0 4,700 Maine 21,565 6,189 2,802 894 31,450 Maryland 0 0 0 0 0 Massachusetts 0 0 0 0 0 Michigan 5,741 21,479 482,713 22,636 532,569 Minnesota 2,952 109,302 690,741 54,435 857,430 Mississippi 0 3,980 124,830 667 129,477 Missouri 0 6,768 70,141 8,419 85,329 Montana 0 33,072 459,794 1,279 494,145 Nebraska 0 45,704 673,568 14,895 734,167 Nevada 0 0 0 0 0 New Hampshire 0 0 2,483 0 2,483 New Jersey 0 0 0 0 0 New Mexico 0 41,346 64,379 2,248 107,972 New York 1,975 0 4,099 1,200 7,274 North Carolina 0 3,707 124,543 1,604 129,854 North Dakota 10,715 191,236 276,123 6,264 484,338 Ohio 0 0 73,512 19,560 93,072 Oklahoma 0 58,868 10,640 0 69,508 Oregon 0 0 18,994 0 18,994 Pennsylvania 5,237 147 35,746 10,163 51,293 Rhode Island 0 0 0 0 0 South Carolina 0 23,990 14,538 0 38,528 South Dakota 4,859 27,827 409,676 662 443,024 Tennessee 0 37,029 14,905 940 52,874 Texas 0 0 4,574 2,095 6,669 Utah 0 120,497 437,576 522 558,595 Vermont 0 6,377 13,492 8,104 27,973 Virgin Islands 1,987 0 94,481 7,763 104,232 Virginia 0 118,384 186,915 1,882 307,182 Washington 0 0 43,113 1,600 44,713 West Virginia 4,095 12,457 51,243 955 68,750 Wisconsin 233,991 134,348 706,395 83,396 1,158,130 Wyoming 0 39,852 59,214 711 99,776 Totals $529,770 $10,215,472 $14,274,426 $471,754 $25,491,422 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2006. Because of the appeals process, funding commitments and disbursements may be made after the program year ended. 5 - 10 Table 5.3 Disbursements by Service Speeds Acquired by Rural Health Care Providers Funding Year 2005: July 1, 2005 through June 30, 2006 Voice Grade Broadband Other Service 56K to 200K to 1.5Mb or Speed State 199K 1.49Mb and faster Unknown Total Alabama $0 $0 $0 $35,319 $35,319 Alaska 0 3,048,695 889,586 31,743 3,970,024 Arizona 0 0 380,411 7,047 387,458 Arkansas 0 0 0 788 788 California 0 0 91,859 1,052 92,911 Colorado 0 0 0 301 301 Connecticut 0 0 0 0 0 Delaware 0 0 0 0 0 District of Columbia 0 0 0 0 0 Florida 0 0 0 0 0 Georgia 0 0 122,741 0 122,741 Hawaii 0 0 144,824 3,454 148,277 Idaho 0 10,732 29,136 2,633 42,500 Illinois 0 0 66,015 4,283 70,297 Indiana 0 0 69,014 0 69,014 Iowa 0 0 97,960 4,846 102,806 Kansas 3,300 0 92,747 2,214 98,261 Kentucky 0 317 27,609 0 27,926 Louisiana 0 0 0 88,396 88,396 Maine 0 0 0 0 0 Maryland 0 0 0 0 0 Massachusetts 0 0 0 0 0 Michigan 0 0 21,206 1,647 22,853 Minnesota 0 24,311 266,878 3,394 294,583 Mississippi 0 0 28,930 2,278 31,208 Missouri 0 0 0 5,094 5,094 Montana 0 0 22,225 0 22,225 Nebraska 0 22,160 722,540 4,347 749,046 Nevada 0 0 0 0 0 New Hampshire 0 0 0 0 0 New Jersey 0 0 0 0 0 New Mexico 0 4,164 18,348 345 22,857 New York 4,354 0 7,988 78 12,419 North Carolina 0 0 2,934 0 2,934 North Dakota 970 95,258 138,143 244 234,615 Ohio 0 0 0 17,930 17,930 Oklahoma 0 0 0 0 0 Oregon 0 0 0 0 0 Pennsylvania 0 0 0 0 0 Rhode Island 0 0 0 0 0 South Carolina 0 13,959 15,753 1,556 31,268 South Dakota 0 3,597 552,026 180 555,802 Tennessee 0 0 0 3,064 3,064 Texas 0 0 0 2,475 2,475 Utah 0 112,153 121,313 0 233,466 Vermont 0 13,662 45,794 6,232 65,688 Virgin Islands 0 0 0 498 498 Virginia 0 0 22,890 1,650 24,540 Washington 0 0 11,232 0 11,232 West Virginia 0 0 0 0 0 Wisconsin 9,752 32,781 111,211 1,320 155,063 Wyoming 0 0 0 0 0 Totals $18,375 $3,381,790 $4,121,309 $234,404 $7,755,878 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2006. Because of the appeals process, funding commitments and disbursements may be made after the program year ended. 5 - 11 USAC Disbursements Disbursements State or on Behalf of Rural Population in Per Person in Jurisdiction Health Care Providers Rural Areas 1 Rural Areas Alabama $29 1,407 $0.020 Alaska 15,061 367 41.076 American Samoa 0 57 0.000 Arizona 786 954 0.825 Arkansas 103 1,435 0.072 California 351 2,521 0.139 Colorado 132 777 0.170 Connecticut 0 334 0.000 Delaware 0 157 0.000 District of Columbia 0 0 NA Florida 102 1,427 0.071 Georgia 70 2,520 0.028 Guam 0 155 0.000 Hawaii 212 335 0.632 Idaho 153 862 0.178 Illinois 77 1,878 0.041 Indiana 25 1,691 0.015 Iowa 146 1,600 0.091 Kansas 343 1,193 0.288 Kentucky 458 2,069 0.221 Louisiana 7 1,111 0.006 Maine 23 854 0.027 Maryland 0 385 0.000 Massachusetts 0 335 0.000 Michigan 519 1,769 0.293 Minnesota 866 1,594 0.543 Mississippi 111 1,821 0.061 Missouri 101 1,799 0.056 Montana 504 705 0.715 Nebraska 607 811 0.748 Nevada 58 305 0.189 New Hampshire 0 380 0.000 New Jersey 0 0 NA New Mexico 222 856 0.259 New York 14 1,537 0.009 North Carolina 146 2,612 0.056 North Dakota 441 367 1.200 Northern Mariana Islands 0 69 0.000 Ohio 99 2,139 0.046 Oklahoma 97 1,378 0.071 Oregon 22 977 0.022 Pennsylvania 35 1,893 0.019 Puerto Rico 0 3,859 0.000 Rhode Island 0 55 0.000 South Carolina 6 1,205 0.005 South Dakota 398 503 0.792 Tennessee 26 1,827 0.014 Texas 130 3,280 0.040 Utah 647 531 1.218 Vermont 1 448 0.003 Virgin Islands 114 109 1.043 Virginia 166 1,503 0.111 Washington 63 1,136 0.056 West Virginia 88 1,043 0.084 Wisconsin 916 1,757 0.521 Wyoming 130 354 0.368 Totals $24,605 58,795 $0.418 1 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2006. Because of the appeals process, funding commitments and disbursements may be made after the program year ended. Population in entirely rural counties as of April 1, 2000 from the Census Bureau. Some commitments were allowed in non-rural counties in areas affected by the Goldsmith Modification. See 47 C.F.R. § 54.5. For those counties, the 2000 rural population has been estimated. Table 5.4 Disbursements per Person for Rural Health Care Support Mechanism, by State Values in Thousands, Except Disbursements per Person in Rural Areas Funding Year 2003: July 1, 2003 through June 30, 2004 5 - 12 USAC Disbursements Disbursements State or on Behalf of Rural Population in Per Person in Jurisdiction Health Care Providers Rural Areas 1 Rural Areas Alabama $17 1,407 $0.012 Alaska 15,097 367 41.176 American Samoa 0 57 0.000 Arizona 629 954 0.659 Arkansas 100 1,435 0.070 California 340 2,521 0.135 Colorado 122 777 0.157 Connecticut 0 334 0.000 Delaware 0 157 0.000 District of Columbia 0 0 NA Florida 163 1,427 0.114 Georgia 194 2,520 0.077 Guam 0 155 0.000 Hawaii 243 335 0.724 Idaho 74 862 0.086 Illinois 395 1,878 0.210 Indiana 123 1,691 0.073 Iowa 176 1,600 0.110 Kansas 237 1,193 0.199 Kentucky 836 2,069 0.404 Louisiana 5 1,111 0.004 Maine 31 854 0.037 Maryland 0 385 0.000 Massachusetts 0 335 0.000 Michigan 533 1,769 0.301 Minnesota 857 1,594 0.538 Mississippi 129 1,821 0.071 Missouri 85 1,799 0.047 Montana 494 705 0.701 Nebraska 734 811 0.905 Nevada 0 305 0.000 New Hampshire 2 380 0.007 New Jersey 0 0 NA New Mexico 108 856 0.126 New York 7 1,537 0.005 North Carolina 130 2,612 0.050 North Dakota 484 367 1.318 Northern Mariana Islands 0 69 0.000 Ohio 93 2,139 0.044 Oklahoma 70 1,378 0.050 Oregon 19 977 0.019 Pennsylvania 51 1,893 0.027 Puerto Rico 0 3,859 0.000 Rhode Island 0 55 0.000 South Carolina 39 1,205 0.032 South Dakota 443 503 0.881 Tennessee 53 1,827 0.029 Texas 7 3,280 0.002 Utah 559 531 1.053 Vermont 28 448 0.062 Virgin Islands 104 109 0.956 Virginia 307 1,503 0.204 Washington 45 1,136 0.039 West Virginia 69 1,043 0.066 Wisconsin 1,158 1,757 0.659 Wyoming 100 354 0.282 Totals $25,491 58,795 $0.434 1 Source: USAC data. Rollups performed by the Industry Analysis and Technology Division, Wireline Competition Bureau, FCC. Note: Disbursements through June 30, 2006. Because of the appeals process, funding commitments and disbursements may be made after the program year ended. Population in entirely rural counties as of April 1, 2000 from the Census Bureau. Some commitments were allowed in non-rural counties in areas affected by the Goldsmith Modification. See 47 C.F.R. § 54.5. For those counties, the 2000 rural population has been estimated. Table 5.4 Disbursements per Person for Rural Health Care Support Mechanism, by State Values in Thousands, Except Disbursements per Person in Rural Areas Funding Year 2004: July 1, 2004 through June 30, 2005 5 - 13