Rural Health News is a weekly segment of Rural Health Today, a podcast by Hillsdale Hospital.
Welcome back to Rural Health News, the segment of Rural Health Today where we fill you in on the latest in rural health headlines. We’ll cover three headlines in today’s episode: what’s most urgent, a rural health damage report, and a success story to send us into the week.
Most Urgent
More hospitals are dropping government payers, quietly turning away new patients with Medicaid, exchange and Medicare Advantage. Mount Sinai, a New York City-based health system, shared last week that their new policies will only affect new patients, not current ones with government-backed coverage, with some exceptions. For hospitals still relying on government payers like those in rural areas, patients continue to steadily drop ACA coverage due to increased premiums, placing a heavier lift of hospital finances as care goes uncompensated. Hospitals across the country are approaching this issue proactively, including here in Michigan, by establishing ongoing outreach programs to help patients identify and maintain the coverage that’s best for them. Even in the height of these challenges, rural health continues to advocate for its patients and long-term hospital sustainability.
Damage Report
State Medicaid programs have been using waiver projects to expand access to coverage for low-income individuals and families since 1962 under the Social Security Act. Each state can propose its own waiver rules to ensure unique populations in need can receive healthcare, but all waiver proposals must be “budget neutral”, meaning they cannot cost the federal government more than what Medicaid would cost without it. Waiver programs have included expanding social services like food and housing, expanding eligibility for coverage, and helping with job training to ensure program compliance. Health attorneys predict that H.R. 1 will limit states’ ability to propose and implement new waiver policies, decreasing the expansion of care and restricting access to coverage for low-income populations.
Arkansas has already run into this hurdle. The state has a waiver expiring at the end of 2026 that must face the new budget neutrality rules established by H.R. 1. Although budget neutrality already existed before H.R. 1, waiver programs are expected to shrink under the new rules, undercutting the foundation of Medicaid expansion programs.
Success Story
Rural tribal communities across the US face healthcare workforce shortages, leading to poorer health outcomes for tribal community members. The University of Arizona and Gila River Health Center recently launched the first MD-granting medical school branch within a tribal nation, educating future physicians right where they’re needed the most. Rather than conducting clinical training in academic medical centers, medical students in the program will be trained at health centers in Native communities. The goal for this program is to encourage medical students to stay in rural tribal healthcare after medical school. Stories like these are meaningful because they show the importance of education in solving healthcare access for rural communities.
Sources
Elizabeth Casolo, “Mount Sinai quietly stops accepting some new patients with government-backed plans,” August 19, 2026, https://www.beckershospitalreview.com/finance/mount-sinai-quietly-stops-accepting-some-new-patients-with-government-backed-plans/, Becker’s Hospital Review.
Elizabeth Casolo, “450,000 New Yorkers risk losing health coverage in wake of $7.5B federal funding cut,” September 10, 2025, https://www.beckerspayer.com/payer/450000-new-yorkers-risk-losing-health-coverage-in-wake-of-7-5b-federal-funding-cut/, Becker’s Payer Issues.
Sydney Halleman, “Hospitals feel the pinch as more patients lose insurance,” August 4, 2026, https://www.healthcaredive.com/news/hospitals-feeling-pinch-patients-lose-insurance/826764/, Healthcare Dive.
Centers for Medicare and Medicaid Services, “CMS’ program history,” https://www.cms.gov/about-cms/who-we-are/history.
Nicole Huberfeld & Matthew Lawrence, “Why It Matters: HR1’s Change to Medicaid Waiver Budget Neutrality Rules,” February 19, 2026, https://petrieflom.law.harvard.edu/2026/02/19/why-it-matters-hr1s-change-to-medicaid-waiver-budget-neutrality-rules/, The Petrie-Flom Center.
Phil Galewitz, “Trump Team’s Use of Arcane Budget Rule Threatens Medicaid Coverage,” August 14, 2026, https://kffhealthnews.org/medicaid/trump-cms-medicaid-expansion-1115-waivers-budget-neutrality-arkansas/, KFF Health News.
The University of Arizona News, “U of A and Gila River Health Care (an entity of the Gila River Indian Community) launch nation’s first MD-granting medical school branch within a Tribal Nation,” August 18, 2026, https://news.arizona.edu/news/u-and-gila-river-health-care-entity-gila-river-indian-community-launch-nations-first-md.
Rural Health Today is a production of Hillsdale Hospital in Hillsdale, Michigan and a member of the Health Podcast Network. Our host is JJ Hodshire, our producer is Kyrsten Newlon, and our audio engineer is Kenji Ulmer. Special thanks to our special guests for sharing their expertise on the show, and also to the Hillsdale Hospital marketing team. If you want to submit a question for us to answer on the podcast or learn more about Rural Health Today, visit ruralhealthtoday.com.
