Make Me Smart Congress set aside $50 billion to transform rural health care. Will it work?
Feb 19, 2026
Arielle Zients, KFF Health News rural health correspondent based in South Dakota, covers rural hospitals, Medicaid, and health policy. She explains the $50 billion Rural Health Transformation Program and its funding formula. Short-term Medicaid cuts versus long-term transformation, impacts on maternity and emergency care, telehealth and experimental tech, and local workforce and service solutions are discussed.
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Transformation Funding Isn't Revenue Replacement
- The Rural Health Transformation Program offers $50 billion over five years but is designed for system change, not to replace lost Medicaid revenue.
- Only 15% of funds may be used for direct provider payments so it won't directly prop up hospital operating margins.
Complex Formula Determined State Awards
- State allocations combined base money with measures like rural population and Medicaid enrollment to decide awards.
- States were also scored on policy alignment, producing concern but resulting allocations were mixed politically.
Prioritize Practical Projects For Grants
- Invest in workforce training, mobile and at-home care, telehealth, and alternative payment models to extend rural access.
- Focus grants on scaling community paramedics, remote monitoring, and payment reforms to improve outcomes.