New Hampshire will receive $500 million in federal healthcare grants over the next five years from the Rural Health Transformation Program, a federal initiative created by the One Big Beautiful Bill Act after it was signed into law by President Donald Trump in July 2025. Some healthcare providers and state politicians told The Dartmouth they worry that the funding will not compensate for the One Big Beautiful Bill Act’s simultaneous cuts to Medicaid and the Supplemental Nutrition Assistance Program.
The program will “strengthen rural healthcare access, quality and long-term sustainability” across the county, according to the U.S. Department of Health and Human Services website. All 50 states will receive funding. Of the six states in New England, New Hampshire will receive the highest amount over the five-year period.
Dartmouth Health senior director of government relations Courtney Tanner said the program “will not offset” federal cuts to Medicaid and SNAP benefits. The One Big Beautiful Bill Act will create a reduction in Medicaid resources over the next decade of $1 trillion nationwide and $2 to $3 billion in New Hampshire, according to Tanner. Approximately 14,000 to 29,000 New Hampshire residents are expected to lose healthcare in 2028 due to the more stringent Medicaid eligibility requirements passed in the One Big Beautiful Bill Act.
Tanner said that while the state will see “significant reductions” to Medicaid in the future, the “implementation [of cuts] is forthcoming.” She added that New Hampshire has not released any ways to request funding yet and that Dartmouth Health is “actively reviewing opportunities as they roll out.”
“The high level point is that there will be significant reductions to states in our Medicaid resources, and that’s going to impact patients and the health care delivery in every state,” Tanner said.
Tanner said Dartmouth Health “worked with” the New Hampshire Department of Health and Human Services “to inform the state’s application” for Rural Health Transformation funding before it was submitted last November.
“We would like to do some innovative work with those funds and support the state, but it’s also really important to think about our health care ecosystem,” she explained. “We champion resources also going to support some of the additional healthcare, some of our healthcare providers and social store service organizations, so that we can best serve our patients.”
The funding will be administered by the New Hampshire centers for Medicare and Medicaid services through five “hubs” assigned by the Governor’s Office of New Opportunities and Rural Transformational Health, according to the Office of the Governor’s website. The hubs are the Foundation for Healthy Communities, the Community College System of New Hampshire, the University of New Hampshire, the Community Development Finance Authority and the New Hampshire Community Behavioral Health Association, which was approved in late March, according to a press release from the Office of the Governor.
New Hampshire Executive Council member Dave Wheeler, R-5, said one of the most “important” uses of the rural healthcare funding will be “training” young people at community college and UNH to work in healthcare. The NHEC oversees the funding’s distribution.
Some grants to universities will be contingent on young people working in New Hampshire for a certain number of years after graduation, according to Wheeler.
“With our population aging and the older citizens needing more healthcare, the workforce is going to be critical,” Wheeler said.
New Hampshire executive councilor John Stephen, R-4, said he is concerned about the “challenge” of “meeting those goal lines” and “outcomes” that are intended for the funding.
“I do not want this program … to be more top-heavy administrative and cost that will not show immediate impact to the communities to our rural communities,” he said. “That’s the bottom line — that’s the biggest challenge right there.”
Because the funding is limited to a span of five years, the federal government imposed a “requirement” that its use by states must be “sustainable,” Wheeler said. He added that some sides of the funding, such as training health workers, can more easily “claim sustainability.”
“Once you get the workforce up to capacity, then hopefully maintaining that capacity becomes easier,” he said. “And by targeting young people, hopefully they stay in the profession for more years than if you’re targeting an older person, so that sustainability is relatively easy.”
New Hampshire State Senator Dan Innis, R-7, said the rural healthcare funding will “help address” the lack of access.
“It can be really hard to find a physician or even a hospital” in rural areas of the state, he said.
Innis added that the “idea” is for the government to “get the care established” so that it will be “self-sustaining going forward.”
“I’m hoping that our universities and community colleges will partner with the state to make sure we’re training and preparing the right people to go staff these new facilities, and hopefully we’ll be able to get better care to more people, so they don’t have to travel as much,” Innis said.
Geisel School of Medicine health policy professor and health economist Carrie Colla told The Dartmouth that the funding includes “meaningful amounts of money” for the “small states” of New England and that the plans for use are “well informed,” but added that it comes with cuts to the “rural safety net,” including Medicaid and SNAP benefits, which may lead to people losing healthcare coverage or food safety.
“According to the [Congressional Budget Office], the effects of this law are not evenly distributed,” she explained. “Households at the bottom of the income distribution will see their resources fall, about four percent of their income reduced, driven by reductions in Medicaid and SNAP, while households at the top will see their resources increase.”
Geisel professor Matthew Mackwood said he has “optimism” that the funding would allow New Hampshire health centers to continue “provid[ing] primary care to vulnerable communities” and that Dartmouth Health may “find meaningful opportunities” in the funding, but added that the impact is “nowhere near equivalent” to “cuts to Medicaid.”
“A lot of people are going to be losing access,” he said. “I think there’s still quite a lot of existential angst about how many of our patients are going to go from insured on Medicaid to needing to be on a sliding scale, cash-pay basis.”
Eliza Dorton '29 is a reporter from Washington, D.C. and is studying English and public policy. Outside the classroom, she enjoys reading and going on walks.
