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Unpacking the Rural Health Transformation Fund Created by Congress to Soften Impact of Medicaid Cuts on Rural Hospitals

Reposted by Joan Alker

Edwin Park @edwincpark.bsky.social · 23d

From @adamsearing.bsky.social the latest on the budget reconciliation law rural health fund. Trump Admin is telling states they can’t use more than 15% of $ for provider payments including to rural hospitals & wants states to expand enrollment in short term plans. ccf.georgetown.edu/2025/09/19/u...

I grew up in North Carolina and often split my time between the urban center of the state and some of its most beautiful and rural areas on the back sounds “Down East.” This part of NC is so rural …

Federal watchdog report on Georgia's Medicaid program raises concerns about administrative costs

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Joan Alker @joanalker1.bsky.social · 24d

As states around the country are mandated by HR1 to rush to implement Medicaid work requirements by HR 1 the risk for waste of taxpayer $$ to corporate vendors is huge.

Federal watchdog report on Georgia's Medicaid program raises concerns about administrative costs apnews.com/article/geor...

A government watchdog has raised concerns about high administrative costs in Georgia's Medicaid program. The U.S.

apnews.com

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Reposted by Joan Alker

Katiesaurus @katiesaurusseven.bsky.social · 24d

"Idaho, along with just about every other state, has seen increased spending for its Medicaid program. But 97% of this growth is from the 'traditional' Medicaid population, not the expansion group that continues to face attacks from the state legislature and was heavily targeted in H.R. 1."

Joan Alker @joanalker1.bsky.social · 24d

Even before huge Medicaid cuts from HR 1 kick in, the state of Idaho is moving quickly to make Medicaid cuts.

Our blog, written with our colleagues in Idaho, explains:

ccf.georgetown.edu/2025/09/17/m...

Medicaid Cuts Kick in Quickly and Quietly in Idaho

Amber and Darrell Daniels with three of their four children. They live in Caldwell, Idaho. Darrell works for a pest control company while Amber enjoys being a stay-at-home mom to care for their chi…

Medicaid Cuts Kick in Quickly and Quietly in Idaho

Joan Alker @joanalker1.bsky.social · 24d

Even before huge Medicaid cuts from HR 1 kick in, the state of Idaho is moving quickly to make Medicaid cuts.

Our blog, written with our colleagues in Idaho, explains:

ccf.georgetown.edu/2025/09/17/m...

Amber and Darrell Daniels with three of their four children. They live in Caldwell, Idaho. Darrell works for a pest control company while Amber enjoys being a stay-at-home mom to care for their chi…

Joan Alker @joanalker1.bsky.social · 25d

Remember that last week we shared new analysis of the child uninsured rate going up by 18% from 2022 to 2024 due to some states doing a poor job with Medicaid unwinding.

ccf.georgetown.edu/2025/09/12/p...

Another 450,000 kids could soon lose coverage if enhanced tax credits expire in 2025.😢

Edwin Park @edwincpark.bsky.social · 25d

According to the @urbaninstitute.bsky.social estimates, the number of uninsured children would increase by about 450,000 (a 14% increase: some because of loss of Marketplace coverage but also as parents lose Marketplace coverage fewer of their eligible children will enroll in #Medicaid & CHIP.

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Reposted by Joan Alker

Edwin Park @edwincpark.bsky.social · 25d

New @urbaninstitute.bsky.social analysis finding 4.8M more uninsured in 2026 if the enhanced ACA premium tax credits are allowed to expire at the end of this year, with the coverage losses concentrated among those with low and moderate incomes: www.urban.org/research/pub...

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Joan Alker @joanalker1.bsky.social · 26d

⬇️As we wait for the ACIP meeting later this week not enough attention has been paid to the enormous consequences for 1/2 of the children in the US for whom access to free vaccines is at stake.

Our @georgetownccf.bsky.social blog explains
ccf.georgetown.edu/2025/09/10/w...

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Joan Alker @joanalker1.bsky.social · 27d

The NOFO is out for the Rural Health Transformation Fund - very fast timeline. App deadline for states is 11/5 and Grants will be awarded 12/31.

Sounds like a fun holiday season for CMS employees!

grants.gov/search-resul...

Lock

grants.gov

Joan Alker @joanalker1.bsky.social · 28d

The answer for those of you who missed the webinar is Texas....

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Joan Alker @joanalker1.bsky.social · 28d

I will be joining @floridapolicy.bsky.social for a press conference Monday 1130am ET to dive into the new data on Florida's child uninsured rate which went up in 2024.

Also Florida leg passed unanimously a CHIP expansion in 2023 but the Governor has not implemented it yet. We will discuss.

Joan Alker @joanalker1.bsky.social · 29d

This increase in the child uninsured rate affected kids of all races/ethnicities except Asian kids who held steady.

Joan Alker @joanalker1.bsky.social · 29d

Other states that saw an increase in their child uninsured rate include: Alabama, Colorado, Oklahoma, South Carolina, Tennessee, Florida, Ohio, Washington, Michigan, Missouri, New Jersey, Virginia, North Carolina and Massachusetts.

One state saw its rate improve - New Hampshire!

Others no change

Joan Alker @joanalker1.bsky.social · 29d

Texas dropped 1.3 million kids from Medicaid during the unwinding and their child uninsured rate jumped up from 10.9% to 13.6% -- a 29% increase in the number of uninsured children in Texas.

Next up for large jumps: Delaware, Idaho, New Mexico, Arkansas, Kansas, South Dakota, Georgia.

Progress for Children is Eroding as Child Uninsured Rate Spikes to Highest Level since 2014

Joan Alker @joanalker1.bsky.social · 29d

The number of uninsured children rose 18% in the US from 2022 to 2024. Adult uninsured rate stayed the same.

This is very likely due to states that did a poor job during Medicaid unwinding.

🧵

My blog explains:
ccf.georgetown.edu/2025/09/12/p...

State-By-State Data Every year we examine data provided by the U.S. Census Bureau’s American Community Survey (ACS) which provides the most comprehensive look nationally and by state at important t…

Welcome! You are invited to join a webinar: State-by-State Child Health Coverage Trends. After registering, you will receive a confirmation email about joining the webinar.

Joan Alker @joanalker1.bsky.social · Sep 12

Pop quiz: Which state saw the biggest increase in its child uninsured rate during Medicaid unwinding.

The answer will be revealed on our webinar today at 1p ET - sign up below.

Joan Alker @joanalker1.bsky.social · Sep 11

NEW: Census ACS data shows child uninsured rate went up to 6% in 2024 - the highest it has been since 2014

1. Medicaid unwinding likely cause

2. Lots of state variability

3. Negative trend is likely to continue

To learn more join our webinar at 1p ET Friday

georgetown.zoom.us/webinar/regi...

Join the Georgetown University Center for Children and Families for a rapid analysis of newly released U.S. Census American Community Survey (ACS) data. The webinar will take place on Friday, Septembe...

Welcome! You are invited to join a webinar: State-by-State Child Health Coverage Trends. After registering, you will receive a confirmation email about joining the webinar.

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Reposted by Joan Alker

Joan Alker @joanalker1.bsky.social · Sep 11

NEW: Census ACS data shows child uninsured rate went up to 6% in 2024 - the highest it has been since 2014

1. Medicaid unwinding likely cause

2. Lots of state variability

3. Negative trend is likely to continue

To learn more join our webinar at 1p ET Friday

georgetown.zoom.us/webinar/regi...

Join the Georgetown University Center for Children and Families for a rapid analysis of newly released U.S. Census American Community Survey (ACS) data. The webinar will take place on Friday, Septembe...

Augusta Health closes three clinics, citing One Big Beautiful Bill Act • Virginia Mercury

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Joan Alker @joanalker1.bsky.social · Sep 12

Pop quiz:
Which state saw the largest increase in its child uninsured rate during the Medicaid unwinding?

The answer will be revealed on our webinar at 1ET today.

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Joan Alker @joanalker1.bsky.social · Sep 12

Augusta Health closes three clinics, citing One Big Beautiful Bill Act virginiamercury.com/2025/09/08/a...

The move will force Shenandoah Valley residents to travel further for their primary and emergency health care needs.

virginiamercury.com

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Joan Alker @joanalker1.bsky.social · Sep 11

BTW the child uninsured rate went up more than adults likely due to eligible children losing Medicaid when they should not have during the unwinding especially in those states that did a poor job.

We will name names on that score tomorrow on our webinar.

Joan Alker @joanalker1.bsky.social · Sep 11

NEW: Census ACS data shows child uninsured rate went up to 6% in 2024 - the highest it has been since 2014

1. Medicaid unwinding likely cause

2. Lots of state variability

3. Negative trend is likely to continue

To learn more join our webinar at 1p ET Friday

georgetown.zoom.us/webinar/regi...

Welcome! You are invited to join a webinar: State-by-State Child Health Coverage Trends. After registering, you will receive a confirmation email about joining the webinar.

Join the Georgetown University Center for Children and Families for a rapid analysis of newly released U.S. Census American Community Survey (ACS) data. The webinar will take place on Friday, Septembe...

Welcome! You are invited to join a webinar: State-by-State Child Health Coverage Trends. After registering, you will receive a confirmation email about joining the webinar.

3 6

Joan Alker @joanalker1.bsky.social · Sep 11

NEW: Census ACS data shows child uninsured rate went up to 6% in 2024 - the highest it has been since 2014

1. Medicaid unwinding likely cause

2. Lots of state variability

3. Negative trend is likely to continue

To learn more join our webinar at 1p ET Friday

georgetown.zoom.us/webinar/regi...

Join the Georgetown University Center for Children and Families for a rapid analysis of newly released U.S. Census American Community Survey (ACS) data. The webinar will take place on Friday, Septembe...

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Joan Alker @joanalker1.bsky.social · Sep 10

Thanks for a moment of levity today that even a non lawyer got.

Is West Virginia ready for Capito Care? • West Virginia Watch

Joan Alker @joanalker1.bsky.social · Sep 10

Ten rural hospitals and 3 nursing homes could close in W Virginia as a result of the Trump budget bill. They won’t have many left nor much OB/GYN capacity in rural areas when cuts are fully implemented.

westvirginiawatch.com/2025/07/31/i...

By 2027, the largest cuts to Medicaid in history will have been ushered in by HB 1 hurting a broad swath of West Virginia families.

westvirginiawatch.com