Rural Health Leaders Warn of Growing Gaps as Medicaid Cuts and Federal Shifts Loom

With potential Medicaid cuts on the horizon and the federal Department of Government Efficiency (DOGE) undergoing leadership changes, rural healthcare leaders are raising concerns about deepening access issues across underserved communities.

Beth Kluding, president of the Ohio Rural Health Association (ORHA) Board of Directors, expressed that reductions in Medicaid don’t just impact hospitals—they affect the entire rural safety net.

Mental health services, housing support and crisis response are all expected to suffer.

“It just goes so much deeper than saying you can't re-enroll for Medicaid,” Kluding said, adding the domino effect that occurs when patients lose coverage and access to medication.

DOGE, originally launched to modernize federal systems and cut spending, is now entering a new phase.

With Elon Musk stepping away from its leadership, the initiative is becoming more embedded within federal agencies.

Officials in reports have said DOGE will continue through decentralized, agency-level efforts, with many of its staff now serving as in-house consultants.

The Trump administration still considers DOGE’s goals central to reshaping federal agencies.

However, critics argue the program’s cost-cutting focus has done little to address rural infrastructure needs.

Marcel Botha, CEO and founder of healthcare tech organization 10XBeta, said its efforts have been “impactful yet superficial,” targeting short-term savings while leaving major issues like broadband access and telehealth support unaddressed.

“It will be devastating for Medicaid to just be reduced or cut to the point where it's no longer effective in supporting 66 million people in the U.S. population,” Botha said.

At the local level, Kluding noted that hospitals relying on Medicaid and Medicare reimbursements—some up to 78% of their patient base—may have to cut services if funding is reduced.

That would mean longer wait times and patients traveling further for care.

Despite the challenges, ORHA Executive Director Rosanna Scott remains committed to their mission: “Rural had a need before—rural is still going to have a need.”

As federal programs shift and Medicaid’s future remains unclear, rural leaders stressed the need for solutions that don’t leave their communities behind.