Last year, Republicans passed Trump's budget bill. It cuts Medicaid, and a big piece of those cuts comes out of rural America. To soften the blow, the same law created a $50 billion fund for rural health care — and Republicans spent the fall campaigning on it.
Now the Trump administration has missed its own deadline to tell states how much of that money they get next year.
States were supposed to learn their 2027 awards by October 31, according to the original federal notice. Instead, at 4:05 p.m. on October 30, they got a 12-sentence mass email saying federal officials had "discovered an additional administrative process requirement," KFF Health News reported. The email didn't say when the money would come.
What the fund is supposed to do
The Rural Health Transformation Program hands states shares of $10 billion a year for five years. Trump called it an "unprecedented" investment to "revitalize hospitals in our cherished rural communities."
This year, every state got between $147 million and $281 million. Part of each award is a flat base amount. The rest is a competitive share, scored by federal officials and different from state to state. That share is re-scored every year.
States are counting on it because of what the same law takes away. KFF estimates the budget bill cuts about $137 billion from rural Medicaid over ten years — so the $50 billion fund makes up for only a little over a third of it. Kentucky, which won nearly $213 million this year, said the money was meant to "lessen the impacts" of the Medicaid cuts headed its way.
What the email said — and didn't
The October 30 email came from Alina Czekai, who runs the federal Office of Rural Health Transformation inside the Centers for Medicare & Medicaid Services (CMS). According to KFF Health News:
- Each state's $100 million base payment for next year is available.
- The competitive share — the part that varied so much from state to state — is delayed.
- No new date was given. But states' revised budgets, which depend on the new amounts, are still "due back to CMS" by November 30.
"We are working to resolve this as quickly as possible," Czekai wrote. She did not answer KFF Health News's questions. The CMS press office wouldn't answer on the record either.
State officials told KFF Health News how it felt on their end. One called the email "cryptic." Another said there had been "plenty of surprises along the way." A Midwestern state health association leader said her staff was "in the dark over here." They spoke on the condition that they not be named, because they feared retribution.
The deadline that landed right before the election
The announcement was scheduled for just days before the midterms. In the weeks before Election Day, Trump officials toured battleground states and put out a flurry of press releases calling the program a Republican success, KFF Health News reported. Health Secretary Robert F. Kennedy Jr. announced an $11 million grant in New Hampshire. CMS chief Mehmet Oz promoted rural hospital money in Ohio.
Republican candidates did the same. We documented eight Republicans campaigning on the fund in the final weeks of the race, and three Virginia Republicans taking credit for $189 million from it. In Kentucky, Andy Barr said the fund would save the state's hospitals, while the governor said its rules forbid spending it on the hospitals at risk.
The checks were the campaign message. The deadline for the next ones came and went.
Who got the competitive money
The delayed part — the competitive share — is the part federal officials hand out by their own scoring. A KFF Health News review of this year's awards found that states with Republican governors tended to receive more of it, and states controlled by Democrats crowded the bottom quarter.
The scoring gave states points for things like growing their rural health workforce — and for adopting the presidential fitness test for schoolchildren, according to Michael Baker of the American Action Forum, a center-right think tank.
What CMS won't show
The program's first yearly progress reports were due to CMS at the end of August. They show how each state spent its money. CMS has refused repeated requests to make them public.
So KFF Health News collected more than half of them itself, through emails and public records requests. Among its findings: many states hired management and tech consultants, and six states — Arizona, Connecticut, Kansas, Louisiana, Rhode Island and South Carolina — reported consulting contracts that together topped $60 million.
Some of the money did reach rural care. Nevada gave $1.4 million to Esmeralda County to build three rural clinics in a region where people regularly travel 70 to more than 200 miles for routine care.
States had already been complaining about the program's tight deadlines and paperwork. In public comments, officials from five states, including Republican-led Tennessee, wrote that the yearly report would take about 120 hours — not the time federal officials had estimated. CMS never answered the states directly. In August, it said it had worked to cut the burden, and estimated the first reports would take 80 hours.
What we know
Trump's budget bill, passed by Republicans, cuts an estimated $137 billion from rural Medicaid, and offers states a $50 billion fund to make up part of it. Republicans campaigned on that fund right up to Election Day. Then the Trump administration missed its own October 31 deadline to tell states how much they get next year, told them in a mass email with no new date, and still won't release the reports showing how this year's money was spent.
Source
Trump Administration Delays Awards Slated To Improve Rural America's Health — KFF Health News, republished by the Pennsylvania Capital-Star
