Advocacy

The roll-out of the federal Rural Health Transformation (RHT) funds over the next 5 years represents a historic opportunity for states to make meaningful inroads into addressing the access issues faced by rural communities. It also presents an unprecedented challenge in terms of targeting resources and evaluating program impacts in rural areas. Many states have, rightfully, elected to focus on primary care provider availability, accessibility, and distribution within their planned initiatives.

Growing up in Kentucky and West Virginia, I learned early that where you are born shapes what care you can access. There were counties without a single primary care physician, towns where the nearest specialist was an hours-long drive on a two-lane road, and communities where people rationed insulin because they couldn’t afford not to. When I chose medicine, I chose it because of those places. H.R. 1, or the One Big Beautiful Bill Act, signed into law on July 4, 2025, changes how future health professionals will finance their training. For rural America, the consequences deserve close attention.

The Regional Offices at the Centers for Medicare and Medicaid Services (CMS) play a critical role in ensuring the implementation and administration of Medicare, Medicaid, and other health programs across the country. CMS Regional Staff duties include monitoring compliance with federal regulations, providing support and guidance to state governments and healthcare providers, and addressing concerns or complaints from beneficiaries. Additionally, these offices work to promote public understanding of CMS programs by engaging with local communities and stakeholders. By maintaining a regional presence, they are better positioned to address specific needs and challenges unique to their respective areas, ensuring a more localized and efficient approach to healthcare administration.

The State Office of Rural Health (SORH) program helps to ensure access to quality health care for our rural residents. The SORH concept was an innovation created by rural states. In 1973, North Carolina started the first State Office of Rural Health, with other states following during the 70’s and 80’s, including Oregon, Wisconsin, Nevada, North Dakota, Arizona, and Georgia. In the late 80’s, existing SORHs worked with the Federal Office of Rural Health Policy to develop a State Office of Rural Health grant program that was authorized and funded in 1991. Today, every state has a SORH working to strengthen rural health care delivery systems.

Cuts to health research and the infrastructure to support important health data will prevent researchers from addressing the important rural health challenges in chronic disease, maternal health, mental health, and other health concerns disproportionately affecting rural populations. Additionally, it will have a domino effect impacting rural communities’ higher education opportunities, access to clinical trials, and data needs that may inform organizational decision making within local public health departments and healthcare facilities. NRHA calls on the executive and legislative branches of government to fund and sustain the research resources and infrastructure to ensure the health of our rural communities.

A defining theme in early 2025 has been reducing federal government expenditures, with the health care sector not being spared from the discussions. The withdrawal or reduction of federal support for Medicaid will have potentially devastating impacts on access to essential healthcare services, particularly for vulnerable rural populations such as the elderly, low-income families, and those with chronic conditions. Thus, the National Rural Health Association (NRHA), along with multiple partners both at the federal and state levels have been advocating for maintaining the federal support for Medicaid.