The Missouri Independent, on Friday, reported that the state had won a $216 million federal grant to close the rural health gap, but that it would not be enough to offset Medicaid cuts that were passed last summer as part of the One Big Beautiful Bill Act.
The Centers for Medicare & Medicaid Services (CMS) announced Monday, December 29th that all 50 states would get $50 billion combined under the Working Families Tax Cuts legislation. States will receive first-year awards from CMS averaging $200 million in 2026 with a range of between $147 million and $281 million.
The CMS listed the following objectives of the program:
Bring More Care Within Reach
States will advance Make Rural America Healthy Again goals by expanding preventive, primary, maternal, and behavioral health services and creating new access points that bring care closer to home and help preserve strong local health systems. Many states are implementing evidence-based, outcomes-driven strategies—such as physical fitness and nutrition programs, food-as-medicine initiatives, and chronic disease prevention models—to address root causes of diseases and manage chronic conditions. States will also strengthen rural emergency care through improved emergency medical services (EMS) communication, treat-in-place options, and coordinated transfers.
Strengthen and Sustain the Rural Clinical Workforce
States will support clinical workforce training, residencies, recruitment and retention incentives, and new pathways that help students begin health care careers in their own communities. States are also investing in programs to train and support the existing clinical workforce and build futures close to home.
Modernize Rural Health Infrastructure and Technology
Investments will modernize rural facilities and equipment; strengthen cybersecurity and interoperability; and expand telehealth, remote patient monitoring, and digital tools that enable timely access to care. States are also exploring the use of technology such as AI scribes and clinical workflow improvement tools to reduce burdens on clinicians.
Driving Structural Efficiency & Empowering the Community Providers
States will prioritize streamlining operations, empowering providers to enhance coordination of care and resources, and building partnerships across the state with the goal of keeping care local. This includes establishing specialized hub-and-spoke models, rural regional centers of excellence, comprehensive data-sharing platforms, and rural clinically integrated networks.
Advance Innovative Care Models and Payment Reform
States will test new primary care and value-based care models, strengthen partnerships among rural and other providers, and promote regional collaboration that improves health sustainability and patient outcomes.
On July 24th, Kaiser Family Foundation released a study showing that cuts under the Federal Reconciliation Package would reduce federal Medicaid spending in rural areas by $137 billion over ten years, of which the $50 billion Rural Health Fund would only partially offset. This figure does not account for the full change in total Medicaid spending or the ACA Marketplace coverage that expired recently, which Kaiser says represents the “biggest rollback in federal support for health coverage ever.”
Kaiser notes that federal spending cuts could mean increases in uncompensated care. The great majority of civil lawsuits filed in Worth, Gentry, Harrison, Nodaway, and Daviess Counties involve either medical debt or credit card debt.
Several years ago, Missouri voters voted to expand ACA coverage. The Kaiser study found that the greatest Medicaid spending cuts in rural areas will occur in states that have expanded Medicaid and have higher shares of rural residents. Missouri is estimated to lose $4.53 billion in federal Medicaid spending money over the next ten years according to Kaiser’s figures, which places it just outside of the top ten.
The Missouri Independent reported that Missouri is seeking to establish 30 community hubs across 104 counties which the state says will help hospitals, clinics, and community organizations identify local priorities and coordinate care. Missouri has already used one pilot program, called Transformation of Rural Community Health, to partner with community organizations to use Medicaid funding to address underlying causes of illness.
The Independent quotes a study from Washington University which found that while the amount of funding for Missouri seems high, at above the average of $200 million, Missouri actually ranked 36th for the amount of funding allotted per rural resident.
And while the federal and state initiatives seek to modernize rural health infrastructure and focus more on outcomes, they overlook facility needs. For instance, the Independent interviewed Lori Wightman, the CEO of Bothwell Regional Health Center in Sedalia. The facility participated in the Missouri pilot health program. As quoted by the Independent, Ms. Wightman stated that her hospital only had 14 days cash on hand and that the hospital was dealing with a leaky roof which forces them to shut down two operating rooms when it rains.
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