New Rural Health Funding of $50 Billion

Swift Action to Leverage B2H Benefits will Protect Community Wellbeing 

New Authority and Funding for Rural Health: Impactful new funding ($50 Billion) for rural health is authorized through amendments to the Social Security Act (42 U.S.C.1397ee).[i]  The $50 billion will be allocated to the 50 states through the Administrator of Centers for Medicare and Medicaid Services (CMS) over a five-year period for fiscal years 2026-2030. Twenty-five billion dollars will be distributed equally among all states with approved applications and the remaining $25 billion will be distributed based on an approach determined by CMS within broad requirements. This funding will be implemented through CMS’s new Rural Health Transformation Program. 

Ultimately, the purpose of the new authority and funding is to enhance healthcare access and sustainability in rural areas by addressing systemic challenges faced by rural healthcare providers. Overall, it seeks to improve health outcomes and ensure long-term viability of rural healthcare facilities.  

Access: For health care, access is a multidimensional concept that has been defined as “those dimensions which describe the potential and actual entry of a given population group into the health care delivery system.” The five key elements are availability, accessibility, accommodation, affordability, and acceptability. [ii]

Brownfields to Healthfields (B2H): B2H is an established, collaborative and balanced approach that fosters healthy, resilient, sustainable, and equitable communities, including under-sourced and overburdened populations.  Inspired by community champions and supported by government, nonprofit organizations, academic institutions and brownfields consultants, B2H transforms contaminated properties into reuses that strengthen children, family and community wellbeing. Essential components are remediation of contamination, meaningful engagement of people living near brownfields, and redevelopment that fosters health. B2H addresses all five elements of access to health care.  B2H provides an innovative opportunity to leverage resources and strengthen policy and practice for rural health, environment and economic well-being.  

State Roles: To improve health care outcomes of rural residents, States may use the new rural health funds to improve access to hospitals, other health care providers, health care items and services for rural residents.States should prioritize the use of new and emerging technologies, emphasizing the prevention and management of chronic disease. These actions should enhance economic opportunity and supply and the recruitment of health care providers. Program activities are also meant to strengthen local and regional strategic partnerships between rural hospitals and other health care providers and increase the long-term solvency of rural hospitals, through a problem identification and solution driven approach.

A state must use Program funds for three or more of the use-of-funds categories as detailed in Table 1. Importantly, each pillar has a potential overlap to B2H. 

Timeline: A proposed Rural Health Transformation Program must be submitted by a State to the CMS Administrator no later than December 31, 2025. States will therefore require an even shorter deadline, and these dates should be posted soon, along with an application template.  

Action: Now is the time to leverage B2H with rural health funding to increase access to health care in rural areas and improve health, environmental and economic vitality. The full range of B2H stakeholders can participate in policy and practice opportunities at the federal and state levels of government. They can help develop programs, plans and projects to access this funding and to help ensure positive community health outcomes urgently needed. Examples of policy and practice actions are provided below. 

POLICY

•  Contact your government officials at the Federal and State department levels (e.g. Centers for Medicare and Medicaid (CMS) regional office (of which there are 10 based on your state) and let them know that your organization or entity would like to assist with the development of programming related to the detailed rural health transformation plan that will be submitted to the Administrator. https://share.google/qUyzIkRcHc2bd6W7r

•  Leverage your understanding of B2H to multiply the effectiveness of potential CMS programs and to integrate improved clinical outcomes to environmental stewardship and improved community health.

•  Example of Policy Opportunity: Provide comments on the coordinated effort across Federal agencies to establish a foundation for development and expansion of emergency preparedness systems. This reinstatement includes a new facility type, Rural Emergency Hospitals (REHs), which was created in 2021. https://www.federalregister.gov/documents/2025/06/20/2025-11324/agency-information-collection-activities-proposed-collection-comment-request

PRACTICE

•  Develop a B2H project in a rural area leveraging brownfields funding and rural health funding. For example, the LEAF PPOD+A Rural Health Model for diabetes delivered on former Brownfields LUST sites as an innovative and integrative care opportunity.

•  Conduct a landscape analysis using an inventory of Petroleum Brownfields that can be redeveloped to bridge early prevention and disease detection through a comprehensive health program. 

•  Propose a five-year program that applies B2H to meet at least three of the Rural Health Transformation Program goals

LEAF’s Chief Public Health Officer- Dr. Michael Duenas  

As a clinician and Fellow, National Academies of Practice (Optometrist/ Physician) in a rural community for over 20 years Dr. Duenas provided both private and hospital based primary care. He also served as Chair of the State of Florida Diabetic Retinopathy Task Force and as a member of his Local Emergency Planning Commission. His focus on chronic disease led to Federal appointments to the U.S. Centers for Disease Control and Prevention (CDC) where he ultimately served as a CDC Division (Diabetes Translation) project officer and codeveloped the PPOD model for diabetes care. Dr. Duenas served as a Chief Public Health Officer for a national healthcare organization and served as Chair of Improving Healthcare Systems Panel of the Patient Centered Outcomes Research Institute. Dr. Duenas has additionally served on committees of the National Institutes of Health, testified before the U.S. Congress and has published dozens of peer reviewed publications enjoying hundreds of citations.

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[1] The One Big Beautiful Bill Act (OBBBA) that the President signed on July 4, 2025. https://www.congress.gov/119/bills/hr1/BILLS-119hr1eas.pd

[1] X.Zhang, R.Andersen, J. Saddine, G. Beckles, M. Duenas, P. Lee (2008) Measuring Access to Eye Care: A Public Health Perspective, Ophthalmic Epidemiology, 15:6, 418-425