The Trump administration plans to turn rural health care into a high-stakes game after slashing nearly $1 trillion from Medicaid in the Republican spending bill, while dangling a $50 billion “prize” as a reward for states willing to compete.
Under the new rules, states must suddenly rush proposals to the Centers for Medicare and Medicaid Services (CMS) by early November. Half the funds are split equally among states, no matter their size, while the rest, billions in critical rural health funding, are left to the discretion of CMS Administrator Mehmet Oz, Trump’s loyal yes-man.
To qualify, states are nudged toward controversial policies, from food stamp restrictions to mandatory fitness programs. There is no avenue of appeal for rejected proposals, and funding can be yanked from underperforming states at any moment.
Experts at the National Rural Health Association have warned that cuts to Medicaid will result in rural hospital closures and a loss of access to care for families in rural America. Even in the best-case scenario, experts say the funding can’t paper over the damage done by billions in cuts to already struggling rural hospitals.
According to health consulting firm Manatt Health, on average, rural hospitals will lose 21 cents out of every dollar they receive in Medicaid funding, including both federal and state funds, totaling nearly $70 billion in losses over the next decade.
“By slashing Medicaid and tying what’s left to his political whims, Trump has put rural hospitals in a constant state of uncertainty. He’s turning rural health into a rigged game show where he picks winners and losers after hospitals beg for funding that can vanish at his political whim,” said American Bridge 21st Century spokesperson Brandon Weathersby. “Funding tied to political loyalty isn’t health care, it’s extortion. Rural families shouldn’t have to wonder if their health care depends on pleasing the president.”
Published: Sep 16, 2025