West Virginia can’t invest its way out of losing coverage

West Virginia has been given an extraordinary opportunity to invest in the future of rural health care.

The Rural Health Transformation Program is providing our state nearly $200 million in federal funding for 2026, with additional funding available through 2030. The program promises to expand access, strengthen the healthcare workforce, improve technology and modernize how rural health care is delivered.

Those are worthwhile goals. We should put these dollars to work. We should use them wisely. And we should hold ourselves accountable for making sure they improve the lives of people in every corner of our state.

But there is a fundamental problem with presenting this investment as though it answers West Virginia’s rural health crisis. It doesn’t. West Virginia cannot invest its way out of losing health coverage. The distinction matters.

The Rural Health Transformation Program is a five-year investment designed to change how healthcare is delivered. Medicaid is an ongoing source of health coverage and healthcare financing for hundreds of thousands of West Virginians.

One cannot simply replace the other. The numbers tell the story.

West Virginia received nearly $200 million for the first year of the Rural Health Transformation Program. Over the full five-year program, the federal government will distribute $50 billion nationally.

At the same time, analyses of the federal law’s Medicaid cuts estimate that West Virginia stands to lose more than $5.3 billion in Medicaid funding over the coming decade.

That is not a solution to a funding crisis. It is a fraction of what is being taken away. And we need to be honest about what these new dollars can — and cannot — do.

The Rural Health Transformation Program can support telehealth. It can support remote monitoring, artificial intelligence and other technology-enabled care. It can help recruit and retain healthcare workers and develop new models of delivering care.

All those things have a place in the future of rural healthcare. But AI cannot replace a doctor, telehealth cannot replace a hospital and technology cannot replace health insurance.

A person does not become insured because a new digital platform connects them to a provider. A rural hospital does not become financially stable simply because it has new technology. A community does not maintain access to healthcare when the people who live there can no longer afford to use it.

This is particularly troubling because West Virginia’s rural hospitals were already vulnerable before these Medicaid cuts.

There are hospitals in our state operating on razor-thin margins, some with negative revenue. We have declining patient volumes and persistent workforce shortages. Our hospitals serve an older, sicker and poorer population, and many rely heavily on Medicaid and Medicare, which reimburse providers at rates that can fall below the cost of providing care.

A national analysis published last year identified eight West Virginia hospitals at heightened risk of closure.  The analysis does not predict that these hospitals will close. It demonstrates where the financial pressure could be greatest. West Virginians  deserve to understand the vulnerabilities within their own communities and how policy decisions directly affect them. 

That is the part of this conversation that cannot be solved with a ribbon cutting for a new program.

When a hospital loses Medicaid revenue, it does not simply lose money for innovation. It often means fewer services, fewer providers, more uncompensated care, longer travel distances and, ultimately, the possibility that a hospital that has served a community for generations may no longer be able to keep its doors open.

And not only will there be a massive spike in uncompensated care, but we will see aggressive patient collection efforts that will increase West Virginians’ medical debt and undoubtedly more personal bankruptcies.    

Moreover, beginning Jan. 1, 2027, certain adults ages 19 through 64 enrolled in Medicaid expansion will generally have to complete 80 hours each month of qualifying work, education, training or community service — or meet another exemption — to maintain coverage.

For the people affected, this is not an abstract policy debate. It is another requirement they will have to understand, document and navigate to remain connected to healthcare.

West Virginia has already experienced what happens when administrative requirements become barriers to coverage. During the Medicaid unwinding, people lost coverage because they missed notices, did not understand what information was being requested or could not complete the renewal process on time.

Now we are asking many of the same people to navigate another set of requirements. And when people lose Medicaid, the consequences do not stop with them. They show up in doctors’ offices. They show up in hospitals’ uncompensated-care costs. They show up in pharmacies. They show up when someone delays treatment until a health problem becomes an emergency. And they show up in the financial stability of the very rural health care system we are now being told this new funding will transform.

That is the contradiction we need to confront. You cannot make a healthcare system more sustainable by simultaneously making it harder for people to pay for the care they need.

If we want people to work, they need to be healthy enough to work. If we want people to manage chronic conditions, they need access to a doctor and the medications they need. If we want rural hospitals to remain open, they need patients who have coverage and can pay for the care they receive. If we want mothers and babies to have healthy outcomes, women need access to prenatal and maternity care before a crisis occurs. And if we want West Virginians to live healthier lives, they need health coverage they can count on.

This is not an argument against the Rural Health Transformation Program. It is an argument against pretending that it solves a problem it was never large enough to solve.

West Virginia should take advantage of every dollar available to strengthen rural healthcare. We should invest in our workforce. We should improve transportation. We should use technology where it genuinely improves care. We should expand access to specialists. We should find new ways to bring care closer to people’s homes.

But we also must protect the foundation underneath all those efforts. People need coverage. Providers need patients who can pay. Hospitals need predictable revenue. Those things are connected.

We cannot celebrate an investment in rural health care while ignoring the much larger loss of Medicaid dollars that threatens the stability of that same system.

West Virginia has spent years bringing down our uninsured rate. The Affordable Care Act and Medicaid expansion changed what healthcare access looks like for hundreds of thousands of West Virginians.

That progress matters. And it can disappear much faster than we built it.

So, as we move forward with rural health transformation, let’s measure success by more than dollars awarded, programs launched or technology deployed.

Let’s ask the questions that matter to the people we are trying to serve.

Can they get an appointment? Can they afford to go? Can they get there? Is there a provider close to home? Will their local hospital still be open? Can they afford their prescriptions? And when they need care, will they still have health insurance?

West Virginia has an opportunity to build a stronger rural healthcare system. Let’s seize it. But let’s not confuse an investment with a replacement.

We cannot build a stronger healthcare system by making it harder for West Virginians to remain insured. We need to invest in our hospitals, our providers and our communities. And we need to protect the coverage that allows West Virginians to use them.

We need both.