Advocacy

On April 30 the Department of Education released its Reimaging and Improving Student Education final rule which implements provisions from H.R. 1 that change federal student loan programs. These changes include establishing new loan limits for graduate students, professional students, and parents, and phasing out the Graduate PLUS Program. Additionally, the final rule adopts a limited definition of “professional degrees” for the purpose of accessing higher federal student loan borrowing limits.

On April 29, the 2026 Farm Bill passed the House on a bipartisan basis. NRHA applauds the House for passing the Farm, Food, and National Security Act and urges the Senate to quickly advance its own bipartisan Farm Bill to support rural communities. The bill now awaits action in the Senate. Please find NRHA’s letter of support for the bill and full bill summary.

On April 22, 2026, the Senate Finance Committee held a hearing, The President’s Fiscal Year 2027 Department of Health and Human Services Budget, with HHS Secretary, Robert F. Kennedy Jr., testifying on the Department’s priorities and the President’s FY 2027 Budget Request. NRHA submitted a statement for the record to address and clarify the role of the Rural Health Transformation Program and rural hospital sustainability.

On April 21, 2026, the House passed H.R. 2493, the Improving Care in Rural America Reauthorization Act. This bill reauthorizes the Rural Health Care Services Outreach Programs, which expand health care service delivery and improve population health for rural communities through community engagement and evidence-based models.

On April 3, 2026, President Trump released his Fiscal Year 2027 Budget Request. The budget request calls for de-funding longstanding, proven, and bipartisan rural health programs and reorganizing the Department of Health and Human Services.

On Feb. 3, 2026, the House voted to pass a full-year funding package that includes the Labor, Health and Human Services (L-HHS) appropriations bill and rural health extenders. The Senate passed this package last Friday, which means that it now heads to the President's desk for signature, ending the 3-day partial government shutdown.

On January 20, 2026, the House Appropriations Committee released a bicameral, bipartisan fiscal year (FY) 2026 Labor, Health and Human Services (L-HHS) funding bill that also includes critical rural Medicare extenders. This bill is expected to pass the House later this week and the Senate next week.

On January 13, 2026, the Substance Abuse and Mental Health Services Administration (SAMHSA) sent letters of termination for thousands of federal grants for behavioral health and substance use disorder programs administered by agency. On January 15, 2026, SAMHSA reinstated grants following pushback from stakeholders and advocates.

On Jan. 8, 2026, 17 Republicans joined Democrats in the House to pass a clean three-year extension of the Marketplace enhanced premium tax credits (ePTCs) that expired on January 1st. The extension passed with a 230-196 vote, restoring access to these subsidies for three years without any changes.

On December 29, 2025, the Centers for Medicare and Medicaid Services (CMS) announced Rural Health Transformation Program (RHTP) funding awards for fiscal year 2026. This initial first-year distribution of awards to all 50 states within an annual range of $147- $281 million.

NRHA is proud to share our new Rural Health Transformation Program State Application Summary Guide to provide a picture of how states are designing and budgeting their initial transformation strategies. This guide serves as a resource on states’ intended use of RHTP funds. All information in this document is drawn from state applications and other publicly available sources. The proposals in these applications are pending CMS funding decisions that will be released no later than December 31, 2025.

The National Rural Health Association (NRHA), along with 28 other organizations, sent a letter to congressional leadership urging Congress to extend enhanced premium tax credits (ePTCs) before they expire on December 31, 2025.

The National Rural Health Association (NRHA) welcomes the release of the Rural Health Transformation Program Notice of Funding. This unprecedented federal investment in rural health directs $50 billion toward prevention, access, workforce, technology, and care innovation, mirroring NRHA’s priorities.

The National Rural Health Association (NRHA) applauds Congress for passing a continuing resolution (C.R.) that will fund the federal government and reauthorize critical rural Medicare extenders until January 30, 2026.

Medicaid serves as a vital source of health insurance coverage for Americans living in rural areas, including children, parents, seniors, individuals with disabilities, and pregnant women. The One Big Beautiful Bill Act (OBBBA), enacted into law on July 4, 2025 made sweeping changes to Medicaid and the ACA Marketplaces that will result in coverage losses for rural Americans.

The National Rural Health Association (NRHA) is deeply alarmed by the President’s Fiscal Year (FY) 2026 Budget Request, which proposes the elimination of core rural health programs previously administered by the Health Resources and Services Administration (HRSA), including the Rural Hospital Flexibility (Flex) Program, State Offices of Rural Health (SORH), and the Rural Hospital Stabilization Program. These targeted eliminations come at a time when nearly half of all rural hospitals are operating at a financial loss, and communities across rural America continue to experience persistent workforce shortages, limited access to care, and disproportionate rates of chronic illness.

The National Rural Health Association released the following statement in response to the President’s FY 2026 draft budget proposal: "The National Rural Health Association (NRHA) is extremely concerned about the devastating cuts proposed in the President’s fiscal year 2026 draft budget proposal. The draft budget proposal calls for the elimination of bipartisan, fundamental, and longstanding rural health programs, such as the Medicare Rural Hospital Flexibility program and State Offices of Rural Health, which are essential to ensuring access to care for rural Americans. This will upend rural health care by ending proven programs, leading to a critical underfunding of rural health care and ultimately threatening rural provider stability and patient access. We are urging our rural champions on Capitol Hill to reject these proposed cuts and fully fund the rural health safety net.” – Alan Morgan, Chief Executive Officer

The National Rural Health Association issued the following statement in response to a federal district court in Texas vacating the Minimum Staffing Standards for Long-Term Care Facilities rule.

The decision to rescind over $11.4 billion in Centers for Disease Control and Prevention public health funding presents an urgent crisis for rural America, where the public health infrastructure is already underfunded and overstretched. These cuts come as rural communities prepare for a worsening measles outbreak and battle the ongoing threat of avian influenza, two crises that demand a well-supported, robust public health response.