Rural Health News is a weekly segment of Rural Health Today, a podcast by Hillsdale Hospital.
Most Urgent
The Centers for Medicaid and Medicare released their plan for the Rural Health Transformation Fund, which has gained popular attention despite most rural hospitals’ opinions that the fund will be minimally helpful in the face of deep Medicaid cuts. After a two-tier review process, CMS announced that all 50 states have received funding in response to their individual applications submitted by their respective Department of Health and Human Services. The primary concern of rural healthcare providers is that the state offices will have control over the funding, especially since many states (including Michigan) did not use hospital recommendations in their project applications. Contributing further to the administrative burden around these funds, CMS established the Office of Rural Health Transformation to oversee the plan. As the state containing the most rural hospitals, Texas was awarded the most funding while Michigan came in at 43rd on the recipient list.
Damage Report
In 2025, ED (emergency department) boarding times went downhill. ED boarding occurs when patients need to be admitted to the hospital after being seen in the ED, but no inpatient beds are currently available. This usually means the patients remain in the ED until a bed opens up, putting their care at risk and overcrowding departments where new emergencies are constantly coming in. It also means patients in the waiting room without immediately life-threatening conditions have to wait longer to get care. This is a challenge for many hospitals because of staffing challenges, ED volumes and the pressure it places on inpatient capacity.
This past year, the duration of time patients spent boarding in EDs followed previous years’ patterns by climbing once again. According to a recent analysis, 25% of patients waited four hours or more for a bed in the last three years. Some hospitals saw ED boarding times of 24 hours. In the winter, this number is usually worse as accidents peak and sickness spreads. This is important because rural communities across the nation need urgent and emergent care more than ever, and the challenges that result in longer ED boarding times are not easily solved. As the care demand grows and patients become more vulnerable, boarding is expected to increase further, putting hospital staff and those they serve at risk. Solving this would take an industry overhaul, from proper staffing to improved reimbursement to process change.
Success Story
The 340B Drug Pricing program provides affordable pharmaceuticals to rural hospitals across the country, but the recently proposed shift from this model to a rebate pilot program would severely limit access to affordable drugs for healthcare providers. Last week, U.S. District Judge Lance Walker of the District of Maine placed a temporary restraining order to prevent the new rebate model from going into place at the start of 2026, arguing the rebate model would put detrimental costs on hospitals and cause a permanent disruption to services. The order came at the prompting of the American Hospital Association, the Maine Hospital Association and four safety-net hospitals that understood the value of the current 340B model. This isn’t the end of the fight to sustain this valuable program, but it’s certainly a win along the way.
News sources for this episode:
Ella Jeffries, “CMS approves rural health awards for all 50 states,” December 29, 2025, https://www.beckershospitalreview.com/financial/cms-awards-50b-to-states-for-rural-health-transformation/, Becker’s Hospital Review.
CMS.gov, “CMS Announces Establishment of the Office of Rural Health Transformation,” December 29, 2025, https://www.cms.gov/newsroom/press-releases/cms-announces-establishment-office-rural-health-transformation/
Erica Cerutti, “ED boarding in 2025: 4 notes,” December 29, 2025, https://www.beckershospitalreview.com/care-coordination/ed-boarding-in-2025-4-notes/, Becker’s Hospital Review.
Kara Gavin, “Wait times for emergency hospitalization keep getting higher,” August 4, 2025, https://www.michiganmedicine.org/health-lab/wait-times-emergency-hospitalization-keep-getting-higher, Michigan Medicine.
Ella Jeffries, “Judge blocks 340B rebate pilot program,” December 29, 2025, https://www.beckershospitalreview.com/pharmacy/judge-blocks-340b-rebate-pilot-program/, Becker’s Hospital Review.
Elizabeth S. Eaton, “’Threadbare administrative record’: Federal judge stops 340B rebate pilot,” December 30, 2025, https://firstwordpharma.com/story/7022857, FirstWord Pharma.
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.
