White House Details $50 Billion Rural Health Transformation Program Under Trump Administration

Congress set up the $50 billion Rural Health Transformation Program as a five‑year stream of state grants, not direct payments to individual hospitals. CMS will distribute $10 billion per year from FY2026–2030, with 50% divided equally among all approved states and 50% awarded by formula based on factors like rural population, the share and condition of rural facilities, and the strength/impact of each state’s plan. In FY2026, awards range from about $147 million to $281 million per state. Within each state, funds flow to rural providers only through state‑run initiatives (sub‑grants and contracts) that can support many provider types—e.g., critical access and other rural hospitals, rural health clinics, FQHCs, EMS, behavioral health providers, and community organizations—for approved uses such as infrastructure, technology, workforce, and new care/payment models; there is no single national formula that earmarks fixed percentages to specific provider categories.

Individual rural hospitals and clinics do not apply to CMS; only the 50 states are eligible grantees. To receive money, a provider must be included in its state’s CMS‑approved Rural Health Transformation plan and generally must (1) serve rural communities as defined in that plan, and (2) participate in projects that use funds for at least three of CMS’s approved purposes—such as prevention and chronic‑disease management, sustaining local access points, workforce recruitment and retention, innovative care/payment models, and technology/telehealth upgrades. States can then impose additional eligibility rules (for example, data‑sharing, reporting, quality targets, service‑area definitions, or match requirements) when they pass funds through to rural hospitals, clinics, FQHCs, behavioral health providers, and other local partners.

The Rural Health Transformation Program is structured as a separate grant‑style funding stream on top of existing Medicare and Medicaid payments and other rural support programs. It does not change how Medicare or Medicaid currently pay rural providers (e.g., critical access hospital cost‑based reimbursement, Rural Health Clinic payments) but gives states extra money to invest in things those systems often underfund—like capital upgrades, telehealth, workforce, and new value‑based models. CMS and the White House explicitly describe the $10 billion per year as additional to prior Medicaid spending on rural hospitals. At the same time, analysts note that the same 2025 law that created RHTP also enacted significant federal Medicaid spending cuts over the next decade, so in many states this new rural money partly offsets, rather than fully replaces, pressure from lower baseline Medicaid funding.

According to the White House, The Great Healthcare Plan would:

• Cut prescription drug prices by “codifying” Trump Administration Most‑Favored‑Nation deals so Americans pay prices comparable to peer countries, and by allowing more safe drugs to be sold over the counter to increase competition and reduce doctor‑visit costs.
• Lower insurance premiums and redirect subsidies by stopping extra subsidy payments to insurers and instead sending that money as direct payments to eligible people so they can buy the coverage they want; it also funds a cost‑sharing reduction program that CBO estimates would save taxpayers at least $36 billion and cut premiums for common Obamacare plans by over 10%.
• Crack down on middlemen and insurer practices by ending certain pharmacy benefit manager (PBM) kickback arrangements, creating a “Plain English Insurance” standard (simple online comparisons of rates and coverage), and forcing insurers to publish what share of premium revenue goes to claims vs. overhead/profit, their claim‑denial rates, and average wait times for routine care.
• Maximize price transparency by requiring any provider or insurer that takes Medicare or Medicaid to prominently display their prices and fees in their offices and comply with strengthened federal price‑transparency rules.

In the Trump Administration’s 2020 Most Favored Nation (MFN) Model for Medicare Part B (the main detailed blueprint for this policy), CMS proposed to:

• Identify the 50 highest‑spend Part B drugs and biologics (about 73% of Part B drug spending) and calculate an MFN price for each as the lowest GDP‑adjusted price paid in comparable OECD countries.
• Gradually replace the current payment (ASP+6%) with the MFN price over four years (starting with a 75% ASP / 25% MFN blend and phasing to 100% MFN), while paying providers a flat per‑dose add‑on instead of a percentage add‑on; patient coinsurance would drop because it’s based on the lower MFN price, and coinsurance on the add‑on would be waived.
• Make participation mandatory nationwide for almost all providers that bill separately for those drugs (physicians, hospital outpatient departments, ASCs, etc.), with some facility types (e.g., critical access hospitals, rural health clinics, FQHCs, Indian Health Service facilities) excluded.

That 2020 MFN rule was later blocked and then proposed for rescission, but President Trump’s current Great Healthcare Plan says Congress should codify MFN-style deals the Administration has since negotiated with major drug makers, again tying U.S. prices—especially for high‑cost Part B drugs and insulin—to the lowest prices in similar countries. The full list of drugs covered by the new voluntary MFN‑style contracts has not been published, but they are described as high‑cost products used by large numbers of Medicare beneficiaries.

Through CMS, the Trump Administration made two major sets of transparency changes:

Hospital price transparency (finalized 2019, effective 2021)

• Requires virtually all U.S. hospitals to post a machine‑readable file online with their "standard charges" for every item and service: gross charges, payer‑specific negotiated rates, discounted cash prices, and de‑identified minimum and maximum negotiated rates, with billing codes and descriptions.
• Requires a consumer‑friendly display or online estimator for at least 300 “shoppable” services (70 CMS‑specified plus 230 hospital‑chosen), showing payer‑specific negotiated prices, cash prices, and min/max negotiated rates in plain language.
• Creates enforcement tools: CMS monitoring, warning letters, corrective action plans, and civil monetary penalties (initially up to $300 per day per hospital) for noncompliance.

Insurer / health plan transparency (“Transparency in Coverage” final rule, 2020)

• Requires most non‑grandfathered group health plans and insurers to give members a self‑service online tool (and paper on request) showing personalized, real‑time estimates of their out‑of‑pocket costs and underlying negotiated rates for all covered items and services.
• Requires public posting of three machine‑readable files: in‑network negotiated rates for all covered items/services; historical out‑of‑network allowed amounts and billed charges; and in‑network negotiated rates and historical net prices for prescription drugs, updated at least monthly.
• Allows plans that share savings when members choose lower‑cost providers to count those payments positively in their medical loss ratio calculations, encouraging benefit designs that reward price‑shopping.

In his second term, Trump’s White House says CMS has also intensified enforcement of these rules and proposed technical updates to make the data clearer and easier to use.

The Working Families Tax Cuts Act (also called the One Big Beautiful Bill Act) broadens who can use Health Savings Accounts (HSAs) among people on Obamacare plans by reclassifying many ACA marketplace plans as HSA‑eligible high‑deductible health plans (HDHPs). Republican lawmakers describe it as:

• Treating Bronze and Catastrophic marketplace plans as qualifying HDHPs, which lets enrollees open and contribute pre‑tax dollars to HSAs for premiums and out‑of‑pocket costs, where they often could not before.
• Expanding HSA eligibility nationally by millions of people on exchange plans; one senator estimates over 157,000 additional Wisconsinites can now use HSAs because of this reclassification, and the White House fact sheet says the law "expanded access to health savings accounts for up to ten million people on Obamacare." Later GOP proposals build on this by directing more federal support into individuals’ HSAs instead of enhanced ACA premium tax credits, but the core WFTC change is making more marketplace coverage HSA‑compatible.

CMS has not published a single national scorecard yet, but program documents and analyses show that states must set measurable goals and report regularly on whether Rural Health Transformation funding is improving access and sustainability. Required or expected metric areas include:

• Access to care: number and location of new or sustained access points (e.g., rural primary care, maternal and behavioral health services, EMS capacity), use of telehealth/remote monitoring, and changes in travel time or wait times for rural residents.
• Workforce sustainability: recruitment and retention of rural clinicians and staff (including residency slots, pipeline programs, and community health workers), turnover rates, and training completion.
• Infrastructure and technology: modernization of facilities, cybersecurity and interoperability improvements, and adoption of digital tools that support coordinated, data‑driven care.
• Care models and financial viability: uptake of new value‑based or alternative payment models, participation in rural ACOs or regional networks, and indicators of provider financial stability (e.g., reduced risk of closures, improved margins for rural facilities).

CMS’s Office of Rural Health Transformation will monitor these state‑reported metrics, provide technical assistance, and use yearly reporting and an annual Rural Health Summit to decide whether states are making enough progress to keep receiving funds through 2030.