Blog Post | 115 KY. L. J. ONLINE | November 5, 2026
The Ripple Effects of Medicaid Cuts: Kentucky’s Rural Healthcare Access After OBBBA
By: Brianna Blake, Staff Editor, Vol. 115
Medicaid changes threaten healthcare access throughout the Commonwealth.[1] On July 4, 2025, the One Big Beautiful Bill Act (“OBBBA”) was signed, becoming the catalyst for one of the “largest funding cut[s] in [Medicaid’s] history.”[2] Congress also severely limited the Affordable Care Act (“ACA”), which allowed states to use their own funds to expand their own healthcare plans.[3] If states do not comply with the new Medicaid requirements, they run the risk of losing federal funding.[4] Another OBBBA requirement places even further burdens with respect to Medicaid recipients.[5] To remain eligible, Medicaid expansion members must document over eighty hours of work, community service, or other community engagement for one month to a maximum of three months before applying and must be reverified every six months.[6] Not only are Medicaid members at risk, but the general population is at risk for cuts to “public health departments and community outreach efforts.”[7]
Kentucky would be one of the states most affected by OBBBA’s budget cuts.[8] For Kentuckians, these changes will result in fewer Medicaid recipients and fewer covered services.[9] The counties most vulnerable to Medicaid cuts are the rural southern and eastern counties, such as Clay, Knox, and Wolfe.[10] Medicaid recipients rely heavily on Medicaid providers located throughout these rural communities.[11] Kentucky leaders have begun meeting to discuss Medicaid concerns, with projections that approximately 35 rural hospitals are at risk of closure, more than any other state.[12] Rural hospitals and clinics are the only medical resources for many in rural Kentucky.[13]
Even before OBBBA passed, many rural Kentuckians faced great barriers to accessing medical care.[14] Only 25% of Kentucky doctors practice in these rural areas, despite approximately 41% of Kentucky’s population living there.[15] The lack of providers forces many rural Kentuckians to travel longer distances for care.[16] If already depleted rural hospitals reduce services or shut down, rural Kentuckians will have to travel even farther to get the care they previously received in their community.[17]
These cuts will not only affect rural hospitals, but also create extra barriers to managing chronic diseases prevalent in Kentucky.[18] In rural Kentucky, diabetes affects approximately 16% of the adult population, yet diabetes self-management education and training (“DSME/T”), while shown to have a positive impact, remains severely underused.[19] DSME/T is an essential, cost-effective diabetes management program that is “associated with glycemic control, reduced mortality, [and] better quality of life.”[20] However, patients need a written referral or prescription from their diabetes-treating medical provider to access DSME/T.[21] Because approximately 90% of patients receive diabetes care from a primary-care provider,[22] rural Kentuckians losing access to medical providers may have fewer opportunities to receive the referral required for DSME/T.[23]
As Medicaid cuts put financial pressure on rural hospitals, many rural Kentuckians will face an extra barrier to accessing medical care.[24] Rural Kentuckians will not be able to access primary care providers and chronic care, such as DSME/T, at rural hospitals that are currently at risk of shutting down.[25] If many Kentuckians have major difficulties getting transportation to nearby rural hospitals, how can Medicaid recipients who need a referral access DSME/T? The reduced access to medical care providers creates not only a barrier to receiving medical care, but also to obtaining the referral needed for DSME/T. The concern grows because, although approximately 90% of patients receive diabetes care from their primary care physician, only 12% nationwide are referred to DSME/T.[26] OBBBA not only affects Medicaid coverage and services but also creates a ripple effect that harms rural hospitals and the chronic care services they could provide.[27]
There are a few possible routes to help address this crisis. First, Kentucky could prioritize available state resources for Medicaid recipients toward medical services most vulnerable to provider losses. Second, while it could only “partially offset cuts,”[28] Kentucky could strategically use funds from the Rural Health Transformation Program to mitigate the damage and effects of the Medicaid funding cuts on rural medicine and hospital services.[29] Finally, as access to medical providers declines, Kentucky should explore alternatives to connect rural patients with DSME/T medical care providers and strengthen referral pathways.
[1] See D’Quan Lee, Louisville Roundtable Highlights Medicaid Concerns in Kentucky, Spectrum News 1 (last updated Aug. 21, 2026 at 5:00 EST), https://spectrumnews1.com/ky/louisville/news/2026/08/20/louisville-roundtable-medicaid-cuts.
[2] States Are Planning Their Responses to H.R. 1 Cuts in Medicaid Funding — Will Enrollees Lose Benefits?, The Commonwealth Fund (Oct. 14, 2025), https://www.commonwealthfund.org/blog/2025/states-responses-hr-1-cuts-medicaid-funding; see also Nicole Huberfeld, The Anti-Federalism of HR1, 106 B.U. L. Rev. (forthcoming 2026) (manuscript at 3) (available at https://dx.doi.org/10.2139/ssrn.7075558).
[3] Miranda Yaver, From Flexibility to Forced Alignment: The One Big Beautiful Bill Act’s Reshaping of Medicaid Federalism, 56 Publius 711, 712 (2026).
[4] Huberfield, supra note 2.
[5] Id. at 4.
[6] Id. at 3.
[7] Id. at 8–9.
[8] See Aaron Mudd, Facing Trump’s Medicaid Cuts, KY Hospitals to Scale Back Services, Lexington Herald-Leader (November 11, 2025 at 11:04 ET), https://www.kentucky.com/news/state/kentucky/article312860840.html.
[9] See Jason Bailey, Medicaid Cut Vulnerability Index Shows Which Kentucky Counties Are Most at Risk, KY. Ctr. Econ. Pol’y (July 15, 2026), https://kypolicy.org/kentucky-medicaid-cut-vulnerability-index.
[10] Id.
[11] Id.
[12] Mudd, supra note 8.
[13] See Kendall Staton, Kentucky Has a Dire Health Care Worker Shortage. Burnout Is Making It Worse, Lexington Herald-Leader (September 30, 2025 at 14:03 ET), https://www.kentucky.com/news/state/kentucky/article312305313.html.
[14] Id.
[15] Id.
[16] Id.
[17] Mudd, supra note 8.
[18] Lee, supra note 1.
[19] Aaron J. Kruse-Diehr, Borsika A. Rabin, Jessica Elliott, Vance Drakeford, Laura Wright, Brent McKune, Russell E. Glasgow, Key C. Douthitt, James W. Keck & Mary E. Lacy, Clinic Practitioner and Support Staff Perspectives on Implementation Strategies to Increase Patient Referrals to Diabetes Self-Management Education and Support Services, 7 Implementation Sci. Commc’ns 1, 2 (2026).
[20] Id.
[21] Id.
[22] Kruse-Diehr et al., supra note 19.
[23] See Staton, supra note 13.
[24] See Mudd, supra note 8.
[25] Id.
[26] See Kruse-Diehr et al., supra note 19.
[27] See Mudd, supra note 8.
[28] Adrianna McIntyre, Michael Kyle & Rachel Sachs, The Rural Health Transformation Program: Trends in Projected Scores and Actual Awards, 4 Health Affs. Scholar 1, 2 (2026).
[29] Id.