Rural Voices Advocate for Rural Health Funding

By Sabrina Ho, Government Affairs and Policy Coordinator at the National Rural Health Association

Despite well-documented challenges to access to care in rural communities, the FY 2026 President’s Budget request eliminates bipartisan, longstanding, core rural health programs located at HHS’ Federal Office of Rural Health Policy (FORHP).

NRHA used its “Rural Stories” advocacy tool to show the impact of the potential cuts on rural residents across the country. Many of our members’ messages to Congress focused on the FY 2026 President’s Budget proposed elimination of the State Offices of Rural Health and Medicare Rural Hospital Flexibility (Flex) Grant programs. Below, NRHA shares impact stories from our members on how important both these programs are to rural communities across the country.

Rural Infrastructure: State Offices of Rural Health (SORH)

SORHs across the country serve as the backbone of rural health coordination within their respective states, strengthening rural health care delivery systems by maintaining a focal point for rural health. SORHs work with rural health care providers and small rural communities to leverage state and federal resources to develop long-term solutions to rural health challenges. Eliminating SORH programs would remove core staffing and operations that enable states to expand rural workforce development and primary care access.

NRHA members have commented on how cutting SORH programs would impact their rural community:

“In Kansas, our state office of rural health, in conjunction with our state hospital association's foundation, use Flex funding to deploy many valuable education/training programs, quality and performance improvement projects, infection prevention initiatives, mock surveys and other programs that enhance and improve the quality and access to care in our rural communities. I believe the state of Kansas is incredibly responsible, efficient and accountable with these funds. Without them, all those support efforts will go away, thus, jeopardizing rural health care as well as the viability of the hospitals in those communities.” - KS-01

“As the Executive Director of a rural health clinic organization in Oregon supporting six rural communities, over 10,000 patients, with comprehensive primary and preventative care, I can speak from direct experience in sharing that our partnership with our State Office of Rural Health has been the single most important factor in our organization’s success bringing care to communities” - OR-03

“As someone who has dedicated my career to serving rural communities, I can tell you firsthand just how vital [the SORH] support is. These aren’t just patients—we’re caring for our neighbors, our friends, and our own family members. When access is limited or resources are strained, it isn’t an abstract problem—it’s something we see and feel every single day. Thanks to our partnership with the State Office of Rural Health and the funding we've received, we've been able to make meaningful improvements to the quality of care we provide. From implementing better care coordination practices to training staff in evidence-based protocols, we've seen real change—not just in data, but in the lives of the people we serve.”- NE-03

Supporting Small Rural Hospitals

The Flex program helps Critical Access Hospitals (CAHs) and rural communities deliver quality, sustainable health care. The Flex program also offers education and training and provides infrastructure support that allows small rural hospitals to strengthen financial and operational performance and invest in activities that improve access to high quality care in rural areas. Flex funding is a lifeline that keeps Critical Access Hospitals (CAHs) and small rural hospitals open and improves quality of care.

Our members spotlight the impact cutting the Flex program would have on their rural community:

“Rural [hospitals] in Montana are the leading healthcare delivery system. Counties are large and underserved. Sanders County, MT, is larger than the state of Delaware and has one critical access hospital which is supported through rural funding programs including the Flex program and SHIP grants to name a few. We serve a large population of uninsured and underinsured community members. Many lives will be impacted by the loss of funding proposed in the upcoming cuts.” - MT- 01

“Rural Coloradoans are already underserved and among the most vulnerable of people in the state because rural tends to be the older, sicker and poorer populations. They cannot absorb complete or even deep cuts in their healthcare availability, quality, service, and support. The programs that are being considered [for elimination] (Flex, SORH, SHIP) are fundamental and foundational for healthcare clinics and hospitals to continue operating on their near zero or negative profit margins. There is no room to cut. When healthcare fails to thrive in a community, within just a few years, the community itself has lost its economic base, people have fled to other areas for work, school and life. Quality and timely healthcare is a fundamental human right. These will not, and cannot continue, without the Federal Grant support from FLEX, SORH and SHIP [programs].” - CO-06

Cuts to core rural health programs in HHS would lead to a critical underfunding of rural health care and ultimately threaten rural provider stability and patient access. Programs managed by FORHP deliver outsized value in terms of access to care, workforce support, and chronic disease management.

Since 2010, rural America has seen over 190 hospitals close or cease to provide inpatient care (i). Unfortunately, the President’s proposal comes at a time when almost half of rural hospitals are operating with negative margins (ii) and facing further losses due to the One Big Beautiful Bill Act (P.L. 199-21) (iii). The rural health care system cannot sustain cuts to federal programming.

To view NRHA’s full list of FY26 rural health priorities, please reference our FY26 Appropriations Requests. To lend your voice and story to the rural health movement, please utilize our advocacy campaigns here. For more information, please contact NRHA’s Government Affairs and Policy Director, Alexa McKinley Abel (amckinley@ruralhealth.us).

The National Rural Health Association (NRHA) is a non-profit membership organization with more than 21,000 members nationwide that provides leadership on rural health issues. Our membership includes nearly every component of rural America’s health care, including rural community hospitals, critical access hospitals, doctors, nurses, and patients. We work to improve rural America’s health needs through government advocacy, communications, education, and research. For more information see https://www.ruralhealth.us/advocacy.

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i https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/

ii  https://www.chartis.com/insights/2025-rural-health-state-state

iii https://www.ruralhealth.us/blogs/2025/06/federal-medicaid-cuts-imperil-rural-%E2%80%93-impacts-of- the-rural-transformation-fund