REGIONAL — The 25th annual Minnesota Rural Health Conference opened in Duluth on June 9-10 with an unmistakable sense of uncertainty hanging over the roughly 450 attendees from Minnesota and neighboring states.
Sweeping federal policy proposals from the Trump administration targeting Medicaid, food assistance, and rural health funding dominated conversations throughout the two-day event.
Collaboration amid uncertainty
Mark Jones, executive director of the Minnesota Rural Health Association, said the conference struck the right tone by emphasizing model programs and innovative collaborations.
“Rural health has always had challenges,” he said. “But rural communities figure things out. We lean on each other.”
Jones said collaboration was a dominant theme, with sessions highlighting success stories from across the state. The goal was to share what’s working so other communities can adapt it.
“There’s no way to do this work alone,” he said. “That’s why we keep coming back together.”
Policy concerns take center stage
While only one session was specifically dedicated to federal policy changes, the stakes were already clear to attendees.
“There’s real concern and a lot of questions,” Jones said.
He pointed to potential Medicaid cuts and new eligibility restrictions in the U.S. House-passed reconciliation bill.
“Nobody wants to see less insurance coverage,” he said. “All that does is shift more cost back onto the providers, and Medicaid already doesn’t cover the full cost of care.”
Programs like Critical Access Hospitals and Federally Qualified Health Centers aren’t directly targeted, but Jones warned they will still be affected by fallout from broader policy shifts.
“You never know what might get pulled in,” he said.
Jones emphasized the need for rural stakeholders to stay engaged in the national conversation, calling on them to reach out to members of Congress and make rural needs visible.
Signs of progress in Minnesota
Jones sees signs of progress in Minnesota, especially in workforce development. He praised the University of Minnesota’s expansion of its Duluth medical school to a full four-year program, and the addition of a new campus in St. Cloud. He also pointed to growing support for health care students at all levels, including loan forgiveness, scholarship programs, and efforts to create stable health care jobs in rural communities.
“It’s an explosion of commitment to rural medicine,” he said.
Federal policy forum details changes
The conference’s public policy forum, led by Alexa McKinley Abel, government affairs and policy director for the National Rural Health Association, provided a detailed examination of the Trump administration’s health care and public assistance proposals. Much of the forum centered on the reconciliation bill moving through Congress, known as the “One Big Beautiful Bill Act,” which passed the House by a narrow 215–214 vote on May 22. The Congressional Budget Office projects that the bill, if enacted, would result in 7.7 million more people becoming uninsured and more than $700 billion in Medicaid cuts over 10 years.
Among the proposed changes to Medicaid, states that newly expand Medicaid would lose eligibility for a temporary 5 percent enhanced match rate, and those already expanded could face a 10 percent match rate penalty if they offer coverage to undocumented immigrants.
Work requirements for Medicaid eligibility, set at 80 hours of employment per month, would be required nationwide by 2027, with some exceptions.
Changes to the Affordable Care Act’s insurance marketplaces are also significant. The legislation would end auto-renewals and reduce the open enrollment window by a month. It would eliminate special enrollment periods based on income, bar eligibility for tax credits under those circumstances and restrict the definition of “lawfully present” to legal permanent residents.
The bill also targets the Supplemental Nutrition Assistance Program, proposing an estimated 30 percent reduction in funding. It would shift a significant portion of the cost of food benefits to states, eliminate the SNAP-Ed education program, and impose expanded work requirements and citizenship restrictions.
Looking ahead to fiscal year 2026, the president’s proposed budget would cut funding to the U.S. Department of Health and Human Services by $31.3 billion from the previous year. It eliminates three major rural programs: the Medicare Rural Hospital Flexibility Program, state Offices of Rural Health, and the Rural Hospital Stabilization Pilot Program.
With both the reconciliation bill and appropriations process still active in Congress, the presentation served as an alert to rural stakeholders that foundational health programs are seriously at risk.