Utahns are being encouraged to celebrate a new federal investment in rural health care. And to be clear, any funding that helps strengthen access to care in rural communities is welcome. But we should not confuse a targeted grant with a solution to a much larger problem. When it comes to the health of Utah’s children, the math simply doesn’t add up.
Over the next five years, Utah is expected to receive millions through the federal Rural Health Transformation Program. That is real money, and it can help support innovation and infrastructure in rural areas. But during that same five-year period, federal proposals under HR1 are projected to reduce Medicaid funding to Utah by $2 billion to $3.5 billion.
If Utah loses $559 million a year and receive $197 million in grants, we are losing 2.8 times the funding. So, even using the most optimistic assumptions, Utah is losing $2 to $3 for every $1 gained.
That imbalance matters because Medicaid is not a niche program. It is the backbone of health care for Utah’s children. Nearly 17% of children in our state rely on Medicaid or CHIP for coverage. Medicaid helps cover prenatal care, which enables babies to arrive healthy. It covers well-child visits, immunizations, mental-health treatment and therapies for children with disabilities. It keeps clinics open and hospitals solvent — especially in rural communities where margins are thin and options are limited.
The rural health grant, by contrast, is intentionally limited. It is temporary. It is program-specific. And it cannot be used to replace lost coverage, backfill rising uncompensated care or stabilize ongoing operating costs when Medicaid dollars disappear. Grants are meant to test ideas and support short-term improvements. Medicaid sustains systems.
When Medicaid funding is cut, families feel it quickly. Providers stop accepting new patients. Waitlists for behavioral-health services grow longer. Children miss early intervention windows that can make a lifelong difference. Rural hospitals and clinics — often the only providers for miles — face deeper financial strain. These are not abstract concerns; they are predictable outcomes that Utah has worked hard to avoid.
Supporters of HR1 have pointed to the rural health grant as evidence that vulnerable communities will be protected. But protecting children and families requires more than pointing to a single funding stream while ignoring much larger losses elsewhere. A cup of water cannot fill a canyon, no matter how welcome that cup may be.
This is not a partisan issue. Utah has a long-standing tradition of valuing children, supporting families and utilizing data to inform policy decisions. We should apply that same common sense here. If the net effect of federal policy is billions of dollars less for health care, then a smaller grant — no matter how well intentioned — does not change the reality on the ground.
Utah’s leaders should be clear-eyed about what these proposals mean for children. Accepting deep Medicaid cuts while celebrating a limited rural grant sends the wrong message and puts families at risk. We can support rural innovation and protect children’s health at the same time — but only if new investments add to, rather than replace, the foundation families depend on.
Utah’s children deserve stable coverage, accessible care and a health system that works for them — not budget trade-offs that leave them worse off in the end.
(Moe Hickey) Moe Hickey is the Executive Director of Voices for Utah Children.
Moe Hickey is the Executive Director of Voices for Utah Children.
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