States are racing to win their slice of a new $50 billion rural health fund amid worries the program's lack of guardrails and rushed timeline could mean the providers who need the most help will get squeezed out by larger, politically connected health systems.

The One Big Beautiful Bill Act created the fund as a backstop for states that are set to lose nearly $1 trillion in Medicaid funding over the next decade.

“I think everyone would agree that the money is not nearly enough to fill the hole caused by the cuts in H.R. 1. But of course, states are still excited to apply for federal funding when there's any available, at the time when resources are constrained,” said Heather Howard, a Princeton University professor and a former New Jersey health official who has been tracking state applications.

The money could be a significant help to keep some rural hospitals and health clinics afloat, but those providers are skeptical about whether their needs will be drowned out.

“There's just some concern that, in the end, when you have these sort of insider systems, that the people who need it the most aren't going to get it, and there's going to be, either intentionally or unintentionally, some missed opportunities to really deliver health care,” said Michael Chameides, a county supervisor in Columbia County, N.Y., and communications director at the Rural Democracy Initiative.

Congressional Republicans included the five-year, $50 billion Rural Health Transformation........

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