General Discussion

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 the bill was delayed by worries that rural hospitals across the United States would be put at further risk of closing because so many of their patients rely on Medicaid. KFF estimates that HR1 will reduce federal Medicaid spending in rural areas across all states by $137 billion over 10 years.
To ensure passage, Congress included a $50 billion “Rural Health Transformation Fund” (or RHTF).


In the end, what was characterized by many as a “rural hospital fund” is really nothing of the sort. The vast majority of RHTF funding is actually prohibited from directly benefiting health care providers, including rural hospitals. Members of Congress may have had different motivations for passing HR1, but the implementation of the law around the RHTF is different than the assurances around help for rural hospitals many policymakers gave the public.


https://ccf.georgetown.edu/2025/10/21/trump-administration-severely-limits-funding-for-rural-hospitals-and-clinics-from-rural-health-transformation-fund-capped-at-15/