States are Beginning to Grapple with Federal Medicaid Cuts Impact on Rural Health Care

Over the past week more national media outlets published articles on the effects of federal cuts to health care passed last year by Congress and signed into law by President Trump in H.R. 1, “The One Big Beautiful Bill.” The coverage shows how states are starting to grapple with the effects of the federal cuts…

March 31, 2026

By

Adam Searing

Blog

Maternal and Infant Health in State Rural Health Transformation Proposals Set Promising Priorities in an Uncertain Landscape

All 50 states applied for CMS’ Rural Health Transformation (RHT) program, a $50 billion fund borne from a need to reassure members of Congress during the final debate over H.R. 1 that Medicaid cuts would not decimate their states’ rural health systems. As previous blogs have detailed, the RHT program presents a unique opportunity for…

March 20, 2026

By

Tanesha Mondestin

and

Nancy Kaneb

Blog

Community Health Workers are a Focus of Rural Health Transformation Applications

Awards for the Rural Health Transformation (RHT) program were released on December 29, 2025, and state applications with proposals for the funds have been made public, covering a range of activities aiming to increase access to care, develop infrastructure, and enhance workforces. As we’ve written about previously, community health workers (CHWs) are a critical workforce…

March 18, 2026

By

Natalie Lawson

and

Adam Searing

Blog

The Rural Health Transformation Fund: Political Rhetoric Meets Bipartisan Concern as the Program Moves Forward

The Trump administration frequently highlights investments in rural health care. While the federal budget bill H.R. 1 (often referred to as the “One Big Beautiful Bill”) passed last year did establish the Rural Health Transformation Fund (RHTF) to inject much-needed capital into rural communities, the same legislation includes deep cuts to the Medicaid program—including billions of dollars…

March 6, 2026

By

Adam Searing

Blog

The Federal Rural Health Transformation Fund: “Likely to Treat Symptoms But Not Deliver a Cure”

The most recent annual analysis on rural health from the health care consulting company Chartis had some interesting insights on rural hospitals, rural health and the federal Rural Health Transformation Fund (RHTF), a part of the H.R. 1 budget bill passed by Congress last year. While the entire report is worth a read, here are some…

February 25, 2026

By

Adam Searing

Blog

Fact-Checking Dr Oz’ Claims About Rural Health Investments

CMS Administrator Mehmet Oz makes two statements in this short video that are not correct: Rural areas and small towns need assistance with health care affordability, quality and accessibility. The Rural Health Transformation Fund, despite its origin as a political maneuver to enable passage of the 2025 federal budget reconciliation law (HR1), means substantial help…

February 6, 2026

By

Adam Searing

Blog

Trump Administration Severely Limits Rural Health Transformation Funds for Rural Hospitals and Clinics – Capped at 15%

Passage of the budget reconciliation law signed into law by President Trump (HR1) will result in a gross reduction of $990 billion in federal Medicaid and CHIP spending over 10 years and an increase in the number of uninsured Americans of 10 million. These are the largest health cuts in Medicaid’s history, and passage of…

October 21, 2025

By

Adam Searing

Blog

How Can the Rural Health Transformation Fund Help Make Maternal Health Great Again?

The passing of the HR.1 bill has threatened the vitality of rural health in America. To soften the blow, the Trump administration included a $50 billion Rural Health Transformation Fund (RHTF). States are preparing their applications that are due on November 5th. There is a lot to unpack with the RHTF. My colleague Adam Searing…

October 9, 2025

By

Tanesha Mondestin

Blog

States Should Use Rural Transformation Fund to Focus on Children and Families

At this moment, states are seeking input and putting ideas on paper to develop priorities for their state applications for a piece of the $50 billion Rural Health Transformation Fund included in H.R. 1 (with applications due to the federal government by November 5th). Our colleague Adam Searing reminded readers that these funds will by…

September 26, 2025

By

Elisabeth Wright Burak

and

Anne Dwyer

Blog

Unpacking the Rural Health Transformation Fund Created by Congress to Soften Impact of Medicaid Cuts on Rural Hospitals

I grew up in North Carolina and often split my time between the urban center of the state and some of its most beautiful and rural areas on the back sounds “Down East.” This part of NC is so rural and was isolated for so long, generations of residents still speak with a distinctive Elizabethan…

September 19, 2025

By

Adam Searing

Blog

Untangling the Current Debate Around Federal Medicaid Cuts, the “Rural Health Transformation Program” and State Medicaid Budgets

The Congressional Budget Office estimates that the budget reconciliation law signed into law by President Trump (HR1) will result in a gross reduction of $990 billion in federal Medicaid/CHIP spending over 10 years and an increase in the number of uninsured Americans by 10 million. This is the largest cut to Medicaid in the history…

September 2, 2025

By

Adam Searing

Blog

States’ Maternal Mental Health Efforts Show Improvement as Need for Support Grows, Especially in Rural Areas

The Policy Center for Maternal Mental Health recently released state-by-state maternal mental health report cards that provide a snapshot of state progress addressing maternal mental health. Using measures across three domains—providers and programs, screening, and coverage—these report cards pinpoint areas of opportunity for states to improve maternal mental health. Overall, the report shows modest progress…

July 14, 2025

By

Tanesha Mondestin

Presentations

Webinar and Report Release: Medicaid Key to Maternal and Infant Health in Rural America

Georgetown University CCF shared a new report with state-by-state data on Medicaid coverage of women of reproductive age and how cuts could impact their access to obstetric care in small towns and rural areas. Medicaid plays a larger role in providing health coverage to people living in small towns and rural communities than it does…

May 19, 2025

Research & Reports

Medicaid Plays A Key Role for Maternal and Infant Health in Rural Communities

Key Findings: Introduction This paper examines the role of Medicaid in covering women of childbearing age (19 through 44 years old) living in small towns and rural areas. Previous research in this series found a higher reliance on Medicaid as a coverage source for children and all non-elderly adults living in small towns and rural…

May 15, 2025

By

Joan Alker

and

Aubrianna Osorio

Presentations

Webinar: What Medicaid Cuts Would Mean for Indian Country

The Georgetown University Center for Children and Families (CCF) and the National Council of Urban Indian Health (NCUIH) hosted a webinar on the potential impacts of proposed federal Medicaid cuts on American Indian and Alaska Native communities. This webinar was open to the press, tribal leaders, health advocates, policymakers, and anyone interested in understanding the…

February 6, 2025

Blog

Cuts to Medicaid Will Shift Costs to Families, Providers and Will Be Especially Harmful to Rural Communities

Medicaid is the backbone of many aspects of our health care system including paying for the majority of nursing home residents, covering 40 to 50 percent of children and births depending on where you live, people with disabilities and other low-income people. Medicaid covers almost 80 million people in total – roughly four times as…

January 15, 2025

By

Joan Alker

Research & Reports

Medicaid’s Role in Small Towns and Rural Areas

Key Findings Background One-fifth of people in the United States live in areas that are classified as non-urban. Residents of rural areas and small towns face additional challenges accessing needed health services compared to residents of metro areas for a variety of reasons including acute provider shortages, limited connectivity, and long distances to travel to…

January 15, 2025

By

Joan Alker

,

Aubrianna Osorio

and

Edwin Park

Data

Medicaid Coverage in Metro and Small Town/Rural Counties, 2023

Click on a state below to view rates of Medicaid coverage in Metro and Small Town/Rural counties. Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New…

January 14, 2025

Blog

Medicaid’s Role in Rural Areas Has Grown: Families Have Much at Stake in the Unwinding

In 2017 we published our first report examining the role of Medicaid in rural areas. We’ve updated the data a few times and our newest look is based on Medicaid coverage in 2020-2021. The data underscores the outsize importance of Medicaid as a source of health insurance coverage in rural areas and small towns –…

August 17, 2023

By

Joan Alker

Research & Reports

Medicaid’s Coverage Role in Small Towns and Rural Areas

Medicaid’s vital role as an insurer for low-income families, people with disabilities and chronic health conditions, and individuals in need of long-term services and supports in the nation’s health care system has continued to grow over the past decade. According to federal administrative enrollment data, one-quarter of all residents of the United States and more…

August 17, 2023

By

Aubrianna Osorio

,

Joan Alker

and

Edwin Park

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