The One Big Beautiful Bill Act has fundamentally changed the policy landscape surrounding Oklahoma’s rural healthcare providers, and the challenges they face will persist in the foreseeable future. Despite these headwinds, opportunities may be available to rural providers who are able to leverage programs funded by the Act.
The Congressional Budget Office estimates the Act will reduce spending on Medicaid, the joint federal-state program principally associated with providing healthcare to low-income individuals and families, by close to $1 trillion dollars over the next decade. This spending reduction may disproportionately impact states, like Oklahoma, which opted into the Medicaid expansion and has a significant rural population. One estimate, from the non-partisan Kaiser Family Foundation, projects a $137 billion decrease in federal Medicaid spending in rural areas—including a $5.13 billion reduction in federal Medicaid spending in rural Oklahoma—over the next decade.
The bottom line is there are likely to be fewer federal Medicaid dollars in rural Oklahoma health systems over the next decade, creating another challenge during an already unprecedented era of rural health strain. Oklahoma currently has 22 rural hospitals at “immediate risk” of closing in the next 2-3 years, according to one analysis. In 2025 alone, two rural Oklahoma hospitals closed their doors, and some fear the trend of rural hospital closures will accelerate with cuts to Medicaid.
In the midst of these challenges, some rural healthcare providers may see opportunities. To mitigate potential negative impacts to rural health, the Act included the “Rural Health Transformation Program” (RHTP), which will provide $50 billion to states approved by federal regulators. Half will be paid in equal amounts to those approved states. The other half will be paid out to states that successfully apply for federal grants. Approved states will be responsible for distributing funds to providers, who may be able to use the funds for various rural health initiatives like creating value-based care arrangements or upgrading IT systems.
The program’s $50 billion, which will be paid over five years, may not, on a dollar-per-dollar basis, offset the projected $137 billion cut to rural Medicaid over 10 years. But it may help soften the blow, and proponents of the program, including Oklahoma Senator Markwayne Mullin, believe the program will result in a higher percentage of federal spending reaching rural hospitals.
Against this backdrop, rural healthcare providers would be wise to consider how to make up for potential lost revenue by leveraging programs like the RHTP, building strategic partnerships with urban and other rural providers, and, perhaps most importantly by communicating with regulators and elected officials to ensure rural healthcare providers have a seat at the table as the state evaluates what to do with any RHTP funds. Rural health may change considerably over the next decade—only time will tell. Until then, rural healthcare providers in Oklahoma must adapt to a shifting financial landscape while continuing to serve some of the state’s most vulnerable populations.
This article appeared in the November 6, 2025, issue of The Journal Record. It is reproduced with permission from the publisher.
