Zach Levinson

CMS will decide which states to fund by the end of the year, and how to allocate the first year of funding across states. It is not yet clear how states will distribute funds across rural hospitals, other providers, and other state initiatives (9/9)

The analysis could not factor in the $12.5 billion that will be distributed based on CMS’s discretionary scoring of state policy, state initiatives, and other factors (8/9).

TX, CA, NM, MT, and AK are estimated to receive the largest amounts from the $37.5 billion. Most of the extra dollars they're estimated to receive are due to their large land area, one of several factors used to allocate funds based on state need (7/9).

Additionally, of the $12.5 billion based on measures of need, only 20% is directly based on total rural population (6/9).

This in part reflects the fact that estimated state awards vary much less than differences in rural populations, principally due to the equal distribution of the first $25 billion across all states with approved applications (5/9).

Estimated awards from the $37.5B are partially, but not closely, tied to rural population. E.g., TX has the most rural residents in the nation (4.3M) but is estimated to only receive about twice as much as RI, which has the fewest (about 25,000) (4/9)

Estimated awards from the $37.5B range from $550 million in Rhode Island to just over $1 billion in Texas over five years if all states are approved for funding (3/9).

The analysis examines $37.5B of the $50B fund: $25B to be distributed equally across states with approved applications (as required by law) and an additional $12.5B to be distributed based on measures of state need (as specified primarily by CMS) (2/9).

State Awards From Most of the Rural Health Fund Could Vary Only Modestly Despite Large Differences in Rural Needs | KFF This brief provides estimates of how $37.5 billion of the $50 billion rural health fund could be distributed across states if all states are approved for funding. Awards from the $37.5 billion could r...

The July 2025 reconciliation law created a $50B rural health fund to help offset the impact of the law on rural areas. Our brief suggests that state awards from most of the fund could vary only modestly despite large differences in rural health needs 👇(1/9): www.kff.org/state-health...

Key Takeaways from CMS's Rural Health Funding Announcement | KFF This brief describes five key takeaways from CMS's Notice of Funding Opportunity for the $50 billion Rural Health Transformation Program. It includes information about how CMS intends to review state ...

CMS's recent announcement includes many new details about the distribution of the rural health fund across states, but questions remain about which states will receive funding and how well awards will align with state need. More in our recent brief: www.kff.org/other-health...

Key Takeaways from CMS's Rural Health Funding Announcement | KFF This brief describes five key takeaways from CMS's Notice of Funding Opportunity for the $50 billion Rural Health Transformation Program. It includes information about how CMS intends to review state ...

States will receive more from the $50 billion rural health fund if they adopt certain Make America Health Again (MAHA) policies. This and more from a new KFF brief examining CMS's recent funding announcement:
www.kff.org/other-health...

Key Takeaways from CMS's Rural Health Funding Announcement | KFF This brief describes five key takeaways from CMS's Notice of Funding Opportunity for the $50 billion Rural Health Transformation Program. It includes information about how CMS intends to review state ...

New KFF brief examines CMS's recent rural health fund announcement. While the $50B fund could help rural areas in a number of ways, it's unclear the extent to which it will benefit rural hospitals and offset their losses under the reconciliation law. More from the brief: www.kff.org/other-health...

With today's announcement, it still remains to be seen how much of the $50 billion rural health fund will go to hospitals. According to CMS, payments to providers for care "cannot exceed 15% of the total" though other uses, like capital investments, could also benefit hospitals.

Five Things to Know About Medicare Site-Neutral Payment Reforms | KFF This brief examines key facts around proposals to align Medicare payments for outpatient services across care settings, otherwise known as “site-neutral payment reforms.”

CMS just released its 2026 proposed rule for hospital outpatient payments. Among its proposals: lowering reimbursement for drug administration services at hospitals to the physician reimbursement rate.

Check out our brief to learn more about site neutral policies. www.kff.org/medicare/iss...

How Might the Reconciliation Bill’s Medicaid Cuts Affect Rural Areas? | KFF This analysis estimates that the House-passed reconciliation bill could lead Medicaid spending in rural areas to decrease by $119 billion and a 1.5 million drop in enrollment over 10 years.

As well as the implications of the reconciliation bill for spending and coverage, including in rural areas (7/7):
www.kff.org/medicaid/iss...
www.kff.org/affordable-c...
www.kff.org/policy-watch...

What are the Implications of the 2025 Budget Reconciliation Bill for Hospitals? | KFF On May 22, 2025, the U.S. House of Representatives passed a budget reconciliation bill that includes significant reductions in federal Medicaid spending to help offset the cost of tax cuts, along with...

Recent work from KFF provides a deeper dive on rural hospitals, Medicaid and hospitals, and the implications of the reconciliation bill (6/7):
www.kff.org/health-costs...
www.kff.org/medicaid/iss...
www.kff.org/medicaid/iss...

The Implications of Federal SNAP Spending Cuts on Individuals with Medicaid, Medicare and Other Health Coverage | KFF Proposed changes in eligibility rules in both SNAP and Medicaid may jeopardize some people’s access to both adequate food and health care if various provisions of the bill take effect, in part because...

While the fund could help prop up rural hospitals, it doesn't address concerns about the millions of individuals who could lose Medicaid or ACA Marketplace coverage in rural and other areas, many of whom would also be at risk of losing SNAP benefits (5/7)
www.kff.org/medicaid/iss...

Urban hospitals that serve a large share of Medicaid patients have been left out of the conversation and without support from the fund, though many are already in the red. These hospitals could also have a hard time absorbing any losses under the bill (4/7)

The relief for hospitals and other providers would also be temporary, while major Medicaid and ACA cuts would be permanent (3/7).

It's unclear:
* How much of this fund would be used for hospitals,
* Which hospitals would be targeted, and
* Whether the fund would be enough to offset any losses for hospitals and other providers under the bill. (2/7).

One of the biggest flashpoints for the "One Big Beautiful Bill Act" has been its impact on roughly 1800 rural hospitals, which is why Senate Republicans are proposing a new $15 billion rural health fund. However, there are still questions and concerns about the bill 👇 (1/7)

Medicaid Covers at Least One in Five Hospital Inpatient Days in Nearly Every State | KFF This analysis examines the share of inpatient hospital days that are covered by Medicaid nationally and by state at a time when Congress is considering potential cuts to the program. It finds that Med...

A new @KFF analysis finds that Medicaid covers at least one in five hospital inpatient days in nearly every state as Congress considers potential cuts to the program. The data illustrate the importance of Medicaid to hospitals. www.kff.org/medicaid/iss...

New: New: Many rural hospitals are struggling. But, less so in states that have expanded Medicaid under the ACA.

www.kff.org/health-costs...

5 Key Facts About Medicaid and Hospitals | KFF We explain the role of Medicaid for hospitals, including how much spending on hospital care comes from Medicaid, the share of births covered by the program, and how Medicaid expansion has impacted hos...

Federal cuts to #Medicaid could have implications for hospitals - check out new brief: www.kff.org/medicaid/iss...

Medicaid covers about one-fifth of all hospital spending. There's a hospital in pretty much every Congressional district, and it's often one of the biggest employers.

www.kff.org/medicaid/iss...

Hospital Margins Rebounded in 2023, But Rural Hospitals and Those With High Medicaid Shares Were Struggling More Than Others | KFF This data note examines trends in hospital margins from 2018 through 2023 and how operating margins varied across different types of hospitals in 2023. It shows the industry overall experienced a rebo...

Evaluating options to reduce spending on hospital services will require weighing the benefits of cost savings with the possibility of reduced access to care, with effects that could vary widely across hospitals and across the country. Link to full report: www.kff.org/health-costs...

Operating margins varied across states, which could reflect a variety of unique circumstances facing hospitals across the country, such as demographics, hospital ownership and cost structure, commercial reimbursement rates, and state and local health and tax policy.

Policymakers have explored options to rein in commercial prices. This analysis suggests that hospitals with the highest prices and largest commercial shares as a group are in a better position to absorb restraints on prices, though the impact would vary across hospitals.

Operating margins were also higher than average among hospitals with high prices, especially among those that also had high commercial shares.

In contrast to rural and high Medicaid share hospitals, operating margins were higher than average among hospitals with a relatively large share of commercial patients, system-affiliated hospitals, and (especially) for-profit hospitals.