Proposed Medicaid Cuts Threaten Rural Healthcare

By Amy Blouin, President & CEO, Missouri Budget Project

June 13, 2025 — Medicaid means health insurance for rural Missourians. Rural hospitals and health clinics rely on Medicaid payments to keep their doors open.
But Congress is now rushing through a tax package that would eliminate Medicaid coverage for tens of thousands of rural Missourians and hurt their communities. Our U.S. senators need to stop this rush to avoid doing a lot of harm in rural areas.
Across Missouri, the consequences of Medicaid cuts go beyond individuals’ access to health care, and the harm to rural residents is multiplied.
When communities lose hospitals and health clinics, it means the loss of good-paying health care jobs. That hurts the local economy at a time when rural communities are already struggling.
This ripples into waves of poor community health, unemployment, population loss and a bleak future. It winds up driving people away from places they call home.
House-approved legislation in Washington, which awaits Senate consideration later this month, cuts Medicaid by $800 billion nationally. The proposal creates new mountains of red tape and harsh work requirements. It imposes obstacles so steep that eligible people, including working families, will lose coverage.
Here in Missouri, those cuts would take health care away from 170,000 Missourians, including children, older adults, patients with serious health conditions and disabilities, veterans, and low-paid workers. 
Missourians already struggle to get and keep Medicaid because our state enrollment and eligibility systems can’t keep up and are already very restrictive on participation. It takes much longer for our state to process applications, and Missourians routinely lose coverage for so-called “procedural reasons,” like accidentally leaving a space blank on a form, or a typo.
Folks trying to reach someone at the state’s call centers frequently face wait times of almost an hour - that is, if they don’t have to hang up the phone to go back to work, care for kids and seniors, or cook a meal.
New red tape would multiply these challenges, with Missourians having to file piles of paperwork every month to prove their activities or demonstrate why they are exempt. Rural Missourians would face even bigger obstacles to complying because of things like slow internet speeds, demanding work schedules, and having farther to travel.
For financially struggling rural hospitals, health clinics and nursing homes, cuts to Medicaid could force shutdowns, leaving everyone in those communities without access to senior or prenatal care, even basic care or emergency rooms. Already, rural Missourians are forced to travel long distances just to get the care they need. In a crisis, that delay can be deadly.
Even if Missourians can make it through Medicaid’s bureaucratic maze, their coverage would still be at risk when they most need it. For example, a cashier doesn’t get enough hours one pay period because business is slow. With the bill’s new work requirements, slow weeks would cost her health care coverage.
Or imagine a 56-year-old widow who stayed home with her children and helped watch her grandkids until they started kindergarten – she was able to get health coverage after Missouri approved Medicaid expansion. She looks for a job, but struggles to find work because of age discrimination. She would lose her health care under the legislation’s tough work requirements.
When Missourians like these can’t get health care, they and their families struggle. But we all pay the price.
When that cashier can’t pay for the medicine to control her high blood pressure and has a heart attack, or the grandmother doesn’t get an annual check-up that would have detected a cancer early, what would have been lower-priced prevention or treatment became an expensive health crisis. And when hospitals and clinics have to absorb more uncompensated care, those costs are passed on to us all through higher health care costs and insurance premiums.
Extra bureaucratic requirements don’t increase employment and don’t help struggling Missourians make ends meet. But they do eliminate health coverage and increase costs, make life harder for working families, and hurt rural communities.
Missouri’s U.S. senators will hopefully join a majority of their colleagues in stopping this impending train wreck of Medicaid slashing. Rural Missourians’ lives and indeed the survival of rural communities hang in the balance.

The Missouri Budget Project is a nonprofit public policy analysis organization that analyzes state budget, tax, and economic issues.