The AMA is highlighting one element of Public Law 119-21—the massive budget reconciliation package known as the One Big Beautiful Bill Act of 2025. The provision aims to boost access, innovation, and recruitment of physicians and other health professionals in rural communities.
The Rural Health Transformation Program (PDF) is one of six issue briefs featured on a new AMA webpage designed to keep physicians up to date on implementation of the One Big Beautiful Bill Act and related federal rulemaking.
Under the Rural Health Transformation Program, the Centers for Medicare & Medicaid Services (CMS) will distribute $50 billion to states over five years—$10 billion annually through fiscal year 2030—to support the delivery of health care in rural areas.
CMS opened the application period in September. States must submit a one-time application and rural health transformation plan by Nov. 5.
The funds aim to improve the health of rural America by fostering rural health innovations and creating new access points to promote preventative health and address root causes of diseases.
CMS identified five priorities for Rural Health Transformation Program funding:
- Make rural America healthy again: Support rural health innovations and new access points to promote preventative health and address root causes of diseases. Projects will use evidence-based, outcomes-driven interventions to improve disease prevention, chronic disease management, behavioral health and prenatal care
- Sustainable access: Rural facilities will work together or collaborate with high-quality regional systems to share or coordinate operations, technology, primary and specialty care, and emergency services.
- Workforce development: The goal is to strengthen recruitment and retention in rural communities by helping providers practice at the top of their license and expand the workforce to include community health workers, pharmacists, and other individuals trained to help patients navigate the healthcare system.
- Innovative care: Introduce payment mechanisms incentivizing providers or Accountable Care Organizations to improve quality of care, and shift care to lower cost settings.
- Foster innovative technologies: Projects will support and invest in emerging technologies to promote efficient care delivery, data security and access to digital health tools by rural facilities, providers, and patients.
The Rural Health Transformation Program is intended to address severe health gaps and resource shortfalls in rural communities, which are often designated as health-professional shortage areas. People who live in rural areas of the U.S. are at higher risk of dying from a multitude of diseases such as cancer, heart disease and stroke than those who live in urban and suburban areas. The AMA has a long-standing commitment to bolstering rural health care.
Some of the factors that will go into determining grant eligibility are in line with AMA policy. These include promoting coverage for remote care and repealing certificate-of-need laws. But, as noted in the issue brief, the AMA “has significant concerns about some of the state policy-based factors, including the ‘scope of practice’ factor that promotes expanded scope of practice laws for physician assistants, nurse practitioners, pharmacists and dental hygienists.”
The AMA also is “concerned about state policy factors that support mandatory continuing education for physicians on nutrition and short-term, limited-duration insurance plans.”
The AMA’s new webpage summarizes select provisions of the One Big Beautiful Bill Act and an implementation timeline for changes to the Affordable Care Act (ACA), Medicaid, the Supplemental Nutritional Assistance Program and medical student loans. These resources highlight the impact that forthcoming funding cuts and policy changes to Medicaid and the ACA marketplaces will have on patients, physicians, hospitals and health care coverage. While the Rural Health Transformation Program funding is welcome, it will not come close to making up for the estimated $1 trillion in Medicaid cuts that were part of the One Big Beautiful Bill Act and that are expected to exacerbate problems in rural health care access.
In addition to the Rural Health Transformation Program, the AMA has created issue briefs covering a variety of topics:
- Medicaid community engagement requirements (PDF).
- Changes to Medicaid financing (PDF).
- Changes to Medicaid and CHIP enrollment, eligibility and cost-sharing (PDF).
- Changes to ACA marketplace eligibility, enrollment and affordability (PDF).
- Changes to ACA marketplace eligibility and access for immigrants (PDF).
