Rural hospitals lose about $137 billion in Medicaid funding against a $50 billion fund
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The law's Medicaid cuts fall on rural areas in proportion to how much their residents rely on Medicaid, which is more than urban areas. KFF estimates about $137 billion of the $911 billion in federal Medicaid cuts over ten years lands in rural areas. The Rural Health Transformation Program offers $50 billion over five years, distributed to all 50 states in December 2025.
Republican senators Josh Hawley of Missouri and Thom Tillis of North Carolina warned before the vote that the Medicaid cuts would close rural hospitals; Senator Susan Collins voted no in part for that reason. The University of North Carolina's Sheps Center identified more than 300 rural hospitals already at risk of closure or service cuts. When a rural hospital closes, the nearest emergency room can be an hour away for everyone in the county, insured or not, and it is often the largest employer.
- Your state decides how its share of the rural fund is spent. State hospital associations track this; ask yours.
Rural Health Transformation Program
Passed by Congress and signed. Opens the enacted text at that section.
- Nonpartisan How might federal Medicaid cuts affect rural areas? (KFF)
- Nonpartisan A closer look at the $50 billion rural health fund (KFF)
- Nonpartisan GOP budget bill could put 338 rural hospitals at risk of closure (Becker's Hospital Review (Sheps Center data))
- Nonpartisan Medicaid cuts threaten hundreds of hospitals, new report finds (NBC News)
- Conservative Don't cut Medicaid (op-ed, New York Times) (Sen. Josh Hawley (R-Mo.))
- Conservative Tillis: Medicaid cuts "will betray the very promise" Trump made (NPR (Sen. Thom Tillis, R-N.C.))
- Conservative Tillis denounces Trump's Big Beautiful Bill hours after retirement announcement (Fox News)
- Conservative Sen. Collins votes no, citing Medicaid cuts and rural hospitals (WGME (Sen. Susan Collins, R-Maine))