$50 Billion Health Fund to Benefit Older Adults In Rural America

AARP put the spotlight on health care, caregiving and telehealth as states sought funding

Miriam Cross,

AARP

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Published February 02, 2026

a figure in front of a blank map of the united states, on a background of farmland

AARP (Getty Images,2 ; Stocksy,1)

Older residents of rural America face a distinct set of health care challenges that those in more urban areas may not.

They often lack access to doctors and mental health services, face long drives to hospitals and scramble to find a new health clinic when rural facilities shutter. Home health care aides who can help older adults age in place are in short supply, as are navigators who guide people toward services and telehealth options.

These problems are about to get worse, as changes to Medicaid included in the One Big Beautiful Bill Act are expected to place a greater financial strain on rural hospitals. Changes to Medicaid, like new work requirements rolling out in 2027 or sooner, will likely mean that some people will lose coverage and that hospitals and health facilities won’t be reimbursed for their care. Medicaid covers a larger share of people in rural areas than in urban areas, according to health policy research nonprofit KFF, and many rural hospitals are already on shaky financial ground. If they close or cut services, patients will have few other options.

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To offset the impact, the Trump administration included a $50 billion Rural Health Transformation Program in the One Big Beautiful Bill Act to support rural health care and provide grants for initiatives in these areas.

Many AARP state offices worked closely with lawmakers as they applied for these funds through the Centers for Medicare & Medicaid Services to make sure the needs of older adults were met. All states have now received grant funding to address those health challenges. “It still won’t make up for the loss of funding rural hospitals and communities will see [from the One Big Beautiful Bill Act] but it’s important that those dollars will be there in some way to fill the void,” says Jordan Endicott, a government affairs director at AARP.

Influencing state priorities, boosting access for older adults

The Rural Health Transformation Program sets aside $50 billion to be distributed to states over five fiscal years starting in 2026, with $10 billion available per year. Half of the entire pot will be split equally between all 50 states. States applied to receive a slice of the remaining $25 billion by pointing to specific needs. All 50 states will receive an award in 2026 from that discretionary $25 billion pot, with amounts averaging $200 million per state this year.

“It’s an opportunity for states to focus on areas that may not have been a priority in the past,” says Brian Posey, a government affairs director at AARP.

AARP offices in states such as Alabama, New Jersey, North Carolina, North Dakota, West Virginia and Wisconsin all urged their state governors to apply for funding before the Nov. 5 deadline. Some AARP state offices proposed programs they hoped to maintain or expand with grant funding. In other cases, the governor’s office reached out directly to AARP state offices for input.

In these three states, AARP influenced what the state prioritized in its application when it requested and received funding to improve rural health care:

Alabama: AARP Alabama highlighted the outsize financial strain on family caregivers of rural residents compared to those in urban or suburban areas. AARP Alabama also recommended programs to strengthen the nursing workforce, attract direct care workers, invest in oral health care and improve telehealth access while ensuring data is secure.

Alabama received $203 million in funds.

The state’s grant application cited AARP as a stakeholder and emphasized the need for increased access to safe and secure telehealth services and solving workforce shortages.

North Dakota: AARP North Dakota highlighted the importance of supporting family caregivers financially, through respite care and more, in a letter to the state’s Rural Health Transformation Committee. AARP also suggested investing in direct care workers because family caregivers are not always available and boosting funding to telehealth services. The state was awarded $199 million and plans to direct some of the funds toward training and retaining a rural health workforce as well as establishing “clinics without walls” in schools, libraries, tribal centers and other locations where local residents can access telehealth services. The state will focus on telehealth adoption, especially by older adults who may be less familiar with the technology.

West Virginia: AARP West Virginia teamed up with West Virginia University’s Health Affairs Institute in 2022 to examine the lack of direct care workers serving rural areas and pilot a project to recruit, train and retain these home care aides. The state had a deficit of nearly 4,000 such workers in 2020. Although the pilot was winding down in 2025, the results were promising: The state recruited 2,100 individuals and put more than 700 of those through training. AARP West Virginia suggested that the governor’s office make direct care workforce recruitment, retention and training top priorities in its grant application and had follow-up conversations to stress their importance.

The governor’s office submitted a grant proposal for a “Mountain State care force” to expand training opportunities and incentivize clinicians and care workers to serve rural areas. At a press conference announcing the proposal submission, the governor thanked AARP for its support during the process. Ultimately, the state was awarded $199 million in funding that it plans to put toward several initiatives, including the recruitment and retention of health care workers.

“Home and community services advocacy work is always on our agenda,” says Gaylene Miller, state director of AARP West Virginia. “Not only is it less expensive to keep people in their homes, it’s where people want to be.”