Sign for emergency medical service. (Photo: David DeWitt, Ohio Capital Journal.)
Announced $202 million award to Ohio to combat hospital closures and lack of access to health care in rural areas. The funds have been welcomed by national leaders and supporters alike, but are seen as… transient solution to the problem made worse by federal cuts.
Five years ancient Rural Health Transformation Program — approved under a package of mega-taxes and spending cuts by Republican lawmakers signed by Trump in 2025 — aims to offset the rural budget impact of dramatic cuts to Medicaid.
In Ohio, Medicaid reduces the amount of the federal spending bill to a loss of $33 billion over the next decade, according to an analysis by the well policy organization KFF.
A total of $50 billion has been distributed nationally under the Rural Health Transformation Program.
Ohio Gov. Mike DeWine said the state is “grateful for the allocation of these funds so that more Ohioans will have greater access and better quality to the health care they need.”
Republican state Rep. Kellie Deeter, co-chair of the Ohio House Country Hospital Caucus, said Ohio’s award “is consistent with the proposal submitted by the state, so this announcement largely reflects expectations.”
“However, this is still not enough to offset broader federal cuts and therefore will not significantly help our rural hospitals,” Deeter said.
“The focus now needs to be on how this money will be used to deliver real, lasting improvements to rural health care — particularly for rural hospitals that lack access to some publicly funded revenue streams.”
Alaska, Montana and Oklahoma rank in the top five for rural hospital allocations
Democratic state Rep. Anita Somani expressed similar criticism, saying the funding was appreciated but “is the equivalent of treating a severed artery with a bandaid.”
“These funds will not stop the bleeding caused by other federal cuts, and any attempt to suggest otherwise is misleading,” Somani said.
The governor’s office said the state’s proposal focused on removing health barriers in rural parts of the state, such as access to specialty care, poorer health outcomes and higher rates of chronic disease.
The money will be used to invest in school-based health centers in rural communities, expand a state pediatric eye care program called OhioSEE to rural communities and further address Ohio’s infant mortality rate, according to DeWine’s office.
The state included costs in its funding proposal, estimating the cost of the program and initiative to range from $181.8 million to $252 million.
“Urgent health and socio-economic needs”
In a “project description” developed by the Ohio Department of Health as part of its funding application, state data showed that 4.4 million Ohioans live in 73 counties that are considered entirely rural or have a “significant rural footprint.”
The narrative mentions Ohio’s 74,000 farms and more than 200 commodities grown in the state, including corn, soybeans, dairy, hogs and poultry.
Rural counties also support manufacturing and forestry, as well as tourism and recreation.
Appalachian counties received special mention for “resource extraction,” an umbrella term used for fossil fuel drilling, logging and other similar sectors.
“For many rural Ohioans, the land is not just scenery, it is a source of livelihood,” the document stated.
Application documents submitted by the state also outline challenges facing rural communities in access to health care, infrastructure support, income, housing, education and access to well food.
“The story is consistent that rural Ohioans have strong ties to land and community, but also have pressing health care and socioeconomic needs,” according to the state’s application.
The state’s “Chronic Disease Atlas” released last summer found significant differences in health status and outcomes depending on the region of Ohio where people with chronic diseases live.
The study found that chronic diseases were more common in the state’s southern counties, including 32 counties in the Appalachian region.
Chronic diseases in the area included arthritis, asthma, chronic kidney disease, coronary heart disease, and chronic obstructive pulmonary disease.
“High mortality rates for all chronic diseases combined, Alzheimer’s disease, cancer and chronic lower respiratory diseases are also concentrated in southern counties,” the report said.
Diabetes, high cholesterol, obesity, heart disease and Parkinson’s disease were common in rural counties outside Appalachia.
According to the state, these disease rates are linked to a lack of regular doctor visits, physical activity, health insurance and insecurity when it comes to food and transportation.
There are 57 hospitals in rural Ohio counties, 33 of which are classified as: critical access hospitals.
The name was established by Congress decades ago when hundreds of rural hospitals faced closure in the 1980s and 1990s.
According to Centers for Medicare and Medicaid Serviceshospitals qualify for critical access if they currently participate in Medicare or are clinics or health centers that have ceased to function as hospitals.
Medicare-participating hospitals can become critical access hospitals if they are located in a rural area, are more than 55 miles from the nearest hospital, have no more than 25 inpatient beds, and have an average length of stay per patient of less than 96 hours.
Rural health was struggling before the latest federal budget law went into effect last July, but Medicaid cuts and up-to-date rules in this budget have devastated hospitals preparing for even greater challenges and the possibility of closure.
Three rural hospitals have closed since 2010, and the state says 10 more are at risk of closure.
“As of 2023, one in four rural hospitals in Ohio were financially impaired and 18% were considered vulnerable to closure,” reads the project narrative of the state’s Rural Health Transformation Fund.
Doctors and advocates, seeing the looming threat to rural health care facilities, were of course concerned about emergency care and daily care, but the impact on the number of maternity wards is already decreasing it could also mean complex times for rural communities.
But according to an analysis by the Robert Wood Johnson Foundation, only a miniature portion of the money states receive from the rural health fund – no more than 15% – can be used to make direct payments to facilities such as hospitals and clinics.
Rules on how to apply the money “can significantly limit how states can distribute allocated funds,” the foundation’s analysis said.
Additionally, the fund is intended to offset cuts in rural health care financing, but its amount does not match the rate at which the country’s rural hospitals and clinics are losing funding due to the federal budget bill.
“The fund does not offset cuts (in Medicaid funding and rural communities),” the foundation said. “$50 billion (nationwide) for rural health care is modest compared to $137 billion in funding cuts for rural communities and nearly $1 trillion in cuts to Medicaid funding.
YOU MAKE OUR WORK POSSIBLE.
