Over the last month, Gov. Patrick Morrisey announced the first recipients of West Virginia’s Rural Health Transformation Program funding. The money, the result of a 2025 federal law, totals almost $200 million this year for new projects to improve the state’s rural healthcare system.
But West Virginia’s already-stretched hospitals, which serve more Medicaid patients than most, stand to lose $1 billion per year due to the same law, according to Jim Kaufman, a former president of the West Virginia Hospital Association.
In Morgan County, a free clinic is opening in anticipation of serving people who’ve lost Medicaid, a low-income government health insurance program. And the eight existing free clinics throughout West Virginia are fundraising, as they also expect an influx of new patients.
The law cuts nearly $1 trillion from Medicaid and the Children’s Health Insurance Program over ten years.
So far, the governor has announced millions in awards for things like healthcare worker recruitment, worksite-based health screenings and AI for documenting patient treatment notes, scheduling appointments and prescription refills.
But the Urban Institute and the Robert Wood Johnson Foundation estimate that between 40,000 and 75,000 Medicaid-covered West Virginians will lose insurance by 2028.
State health officials did not respond to a question about how many people are expected to lose health insurance. But they’ve sent thousands of notices to current recipients about new work requirements, which will result in the largest losses in coverage.
New Medicaid applicants must be working a minimum number of hours or volunteering for at least a month before they apply for Medicaid in January. Current recipients must meet the requirements when they reenroll, starting in March, unless they meet certain exceptions.
Michele Goldman, executive director of the nonprofit West Virginia Association of Free Clinics, said clinic workers are trying to educate Medicaid patients about the requirements.
A former clinic director, Goldman said while it may be easy to say people should go find work, it isn’t that simple.
“I think people sometimes don’t really understand all the difficulties that impoverished people face, because they look at them through middle-class eyes,” she said.
There aren’t enough jobs, or even volunteer options. And it isn’t as easy as walking into a grocery store and filling out an application when the closest store is an hour away. Even volunteering can be a challenge when the one local charity accepts only volunteers with certain skills.
She noted people often can’t pay for vehicles, let alone gasoline, to get them to work. And problems like finding a meal can be more urgent.
And while one goal of the Rural Health Transformation Program is to train new providers, current providers are overworked and retiring now.
“Long-term policies needed”
During the late stages of negotiations on the spending law, also known as the “Big Beautiful Bill,” rural hospitals that rely on Medicaid payments lobbied against it. So Congress tacked on the Rural Health Transformation Program fund. That fund gave $50 billion to states to be distributed over five years. But states have to demonstrate progress to continue receiving funding.
After the final federal instructions came out for using the fund, rural health advocates and the West Virginia Hospital Association praised the wider purposes, including disease prevention, training and hiring healthcare workers and pursuing technological innovation.
Hospitals have shared input for fund uses with the governor.
While hospitals have been among those who’ll be helped with workforce recruitment, the more rural ones are among the most at risk because of Medicaid cuts.
“I think we have an opportunity to make investments today that can strengthen healthcare in West Virginia for years to come,” said Tony Gregory, interim president and CEO of the West Virginia Hospital Association. “There are changes ahead, but there are also significant opportunities.”
The national Rural Health Association’s support comes with a caveat.
“While this one-time funding grant is significant, NRHA reiterates that long-term policies guaranteeing sustainable funding for rural healthcare are needed to support providers and maintain access to care,” the organization wrote.
In an email, Department of Health spokesperson Gailyn Markham noted that the rural fund is not intended to replace Medicaid, and she stated that it will address longstanding health issues as well as immediate problems.
During a meeting before West Virginia lawmakers in the joint finance committee earlier this month, Department of Health Secretary Arvin Singh, who is leading the program team, said year one was largely about the application process.
“Year two will be about implementation,” he said.
States are set to begin worthwhile projects — but at the same time, many people are set to lose the coverage they’d need to participate, said Adam Searing, research professor at the Georgetown Center for Children and Families.
“This money’s coming in, but it’s not going to make up for the loss of coverage,” he said. “Medicaid cuts are going to mean ultimately there are going to be fewer people who can pay their bills.”
