These Medicaid cuts, combined with ACA Marketplace changes, will result in significant coverage losses - at least 7.7 million individuals will lose health insurance according to the Congressional Budget Office. Drastic changes to these major public payers will further limit access to care for all rural patients by closing rural facilities and ending health care coverage for rural residents nationwide.
As a reminder, the initial provisions relevant to rural health in the package include:
- Medicaid:
- Freezing states' provider taxes at current rates and prohibiting states from implementing new provider taxes
- Limiting future state-directed payments to Medicare payment rates
- Sunsetting eligibility for increased FMAP (+5%) for new expansion states
- Work requirements: 80 hours per month of work, community service, participation in a work program, OR enrolled in educational program at least half-time
- Exceptions for children, seniors, pregnant women, caregivers of dependent children, individuals with disabilities, those already meeting work requirements for TANF/SNAP, members of Tribes
- Compliance determined 1-month preceding Medicaid enrollment and during redetermination. States can choose to do so more frequently
- Limiting retroactive coverage to 1 month prior to individual's application date (currently 3 months)
- Increasing frequency of eligibility redeterminations to every 6 months (currently 12 months) for expansion adults
- Reducing the FMAP for expansion states to 80% that provide coverage for undocumented immigrants
Rural Americans rely on Medicaid coverage more so than their urban counterparts with almost one quarter of adults and 40% of children living in rural areas enrolled in Medicaid/CHIP. Cuts to Medicaid would shift health care costs onto rural families, many of whom already struggle with financial instability. Without Medicaid, families would face higher out-of-pocket expenses, leading many to delay or forgo necessary treatments. This burden would worsen health outcomes, especially for those managing chronic conditions like diabetes, heart disease, and cancer.
Medicaid is not just a healthcare program—it plays a significant role in sustaining the viability of rural healthcare systems, including hospitals, clinics, and community health centers. A strong relationship exists between Medicaid coverage levels and the financial viability of hospitals. Medicaid expansion is associated with improved hospital financial performance and substantially lower likelihoods of closure, especially in rural markets and counties with large numbers of uninsured adults before Medicaid expansion. Drastic cuts could force many rural facilities to reduce or cut service lines, or close their doors entirely, leaving residents to travel further for care.
For more information on how reforms of Medicaid spending can impact your state, please use the 2023 Rural Medicaid coverage by county, the 2024 Medicaid Enrollment Data, Percent of Total Population, by state or Congressional District, and KFF’s Maps on State-by-State Estimates from Eliminating the Medicaid Expansion Federal Match Rates.
For more information on the rural impact of proposed Medicaid cuts, please find NRHA’s Medicaid Talking Points here and our leave-behind here. Additionally, please NRHA’s statement on the House passing the reconciliation bill here.
NRHA will be reviewing your campaign messages and may use your story to utilize in our advocacy efforts! If you have any questions, please contact NRHA’s Government Affairs and Policy Coordinator, Sabrina Ho (sho@ruralhealth.us).