This edition examines the Rural Health Transformation Program (RHTP) in the context of Medicaid and rural health, comparing the timeline of federal Medicaid reductions with RHTP investments and assessing how state-proposed initiatives align with key rural health indicators.
- The RHTP represents a new influx of federal investment as states contend with H.R. 1’s Medicaid cuts. While RHTP funding roughly equates to the estimated rural Medicaid losses over 2026-2030, the Medicaid cuts and RHTP funds will often affect different rural residents and providers, given differences in timelines, mechanisms, and RHTP limitations.
- Medicaid plays an outsized role in rural health systems, covering nearly one in four rural residents, nearly half of rural births, and about one-fifth of rural hospital discharges. Nearly 70% of rural hospital closures between 2014 and 2024 occurred in non-expansion states.
- Per-resident RHTP funding varies widely relative to state-level need across key health system indicators, including rural Medicaid enrollment, Medicaid-financed births, maternal mortality, and rural hospital closure vulnerability. States took different approaches in how directly their proposed RHTP initiatives address those challenges.