Pennsylvania has big plans for its $193 million award from a federal rural health fund, including investments in telehealth, recruiting health care workers and supporting ambulance services.
But the nine-figure infusion from the Rural Health Transformation Program, announced last month by the Centers for Medicare and Medicaid Services, is overshadowed for some experts and Democratic officials by President Donald Trump’s Medicaid cuts, which are expected to threaten access to care in these communities.
“Rural providers are going to have a lot of ground to make up,” said Brock Slabach, chief operating officer for the National Rural Health Association. “What will happen, and what we’re hearing reports of from all over the country, is closure of services in hospitals.”
The nation’s more remote hospitals serve a high number of Medicaid patients, and as a result could see an influx of uninsured patients when the program’s work requirements kick in next year.
The federal government is cutting back its Medicaid contributions by about $1 trillion over a decade-long period. Health policy nonprofit KFF estimates rural Pennsylvania will miss out on $5.5 billion in Medicaid dollars over 10 years, starting in 2027.
From 2028 to 2037, the changes will remove $20 billion from Pennsylvania’s Medicaid program, according to the state Department of Human Services.
Nearly a quarter of Pennsylvanians are on Medicaid, the joint federal-state program that covers medical costs for poor people along with nursing home and personal care home expenses.
Questions of fairness have also emerged around the rural health fund — a late add to Republican’s summer megabill meant to make slashing Medicaid more politically palatable.
The $50 billion pot will be distributed to states between 2026 and 2030 with the aim to “Make Rural America Healthy Again,” according to the Centers for Medicare and Medicaid Services.
Texas had the biggest first-year award, at $281 million, while New Jersey pulled up the rear with $147 million.
Litmus tests?
The amount of money each state gets is influenced by objective measures, like the size of its rural population and total square mileage. But loyalty to the Trump administration mattered, too.
States could earn more funding if they agreed to restrict the use of food stamps on unhealthy products, a policy pushed by Health Secretary Robert F. Kennedy Jr. and Agriculture Secretary Brooke Rollins.
Agreeing to reinstitute the Presidential Fitness Test in schools, a pet issue of Trump’s, could also bolster a state’s application, as could requiring medical professionals to receive continuing education on nutrition — another Kennedy proposal.
These terms are highly unusual, according to Slabach.
“We’ve never seen funding that’s contingent upon states implementing policies that are clearly within state purview,” he said.
Pennsylvania promised none of these measures in its 67-page application. Their absence may explain why the state received the 17th smallest award and the fourth fewest dollars per rural resident.
“Pennsylvania’s rural communities deserve health care investments that are driven by need, not by political litmus tests imposed by the Trump administration and its allies in Washington,” U.S. Rep. Summer Lee, D-Swissvale, said in a statement.
The state’s relatively small allotment is “further proof that this program was never intended to truly counteract Republicans’ deep cuts to Medicaid or protect rural health systems from collapse,” she added.
U.S. Rep. Chris Deluzio, D-Fox Chapel, called for Pennsylvania to get its fair share of rural health funds. He also said the state’s $193 million windfall is far short of what’s needed to offset damage caused by Medicaid cuts.
In a statement, Kush Desai, a White House spokesman, argued new limits on Medicaid will hardly impact rural hospitals. Only 7% of the program’s hospital spending goes toward rural facilities, Desai said, citing an estimate from the Centers for Medicare and Medicaid Services.
U.S. Rep. Guy Reschenthaler, R-Peters, lauded the fund as the country’s largest investment ever in rural health care. He did not address questions about the funding criteria or harms caused by Medicaid cuts.
U.S. Sens. John Fetterman, D-Braddock, and Dave McCormick, R-Squirrel Hill, did not return requests for comment. Neither did U.S. Rep. Mike Kelly, R-Butler.
Pennsylvania’s plan
Pennsylvania’s rural residents tend to be older and sicker than their urban counterparts and face higher barriers to accessing care, according to the state Department of Human Services.
Specific goals in the state’s rural health fund application include:
• Reducing rural hospital staff vacancy rates by 10%
• Decreasing the number of pregnant women living in rural areas without adequate prenatal care by 20%
• Bringing telehealth services to at least 85% of rural hospitals
• Allowing at least 85% of rural patients to get a routine primary care appointment within four weeks and an urgent appointment within a week.
“With nearly $200 million from the federal government, we are moving forward with our plan to improve rural health care, attract and retain a skilled workforce, promote long-term, sustainable access; support the growth of innovative care and foster technological innovation,” Gov. Josh Shapiro said in a statement.
To guide these initiatives, Pennsylvania will work with economic development groups to establish eight Regional Care Collaboratives across the state.
Southwestern Pennsylvania’s collaborative will encompass Allegheny, Armstrong, Beaver, Butler, Fayette, Greene, Indiana, Washington and Westmoreland counties.
Lisa Davis, director of the Pennsylvania State Office of Rural Health at Penn State, welcomed these hubs as a way to tailor health care initiatives by region.
For example, Southwestern Pennsylvania has a relatively strong maternal care network, but these services are much harder to come by in the northwestern corner of the state, according to Davis.
The state will offer rapid response grants to rural health care providers to address urgent needs while the collaboratives take shape.
Despite the boost from the federal government, the state’s rural health care system is in for a bumpy ride, Davis said — and not just because of changes to Medicaid.
The expiration of enhanced Affordable Care Act subsidies at the end of last year will also swell the ranks of the state’s uninsured.
“It’s a little bit like death by 1,000 cuts,” Davis said.