Trump administration ties rural health grant scores to states' certificate of need reforms

In an effort to modernize care in remote areas, the Trump administration linked the Rural Health Transformation Program's grant scoring to states' willingness to abandon or ease certificate of need (CON) statutes that require approval for new hospitals and certain equipment. The Centers for Medicare & Medicaid Services indicated that states with fewer CON constraints would receive higher scores, effectively using federal dollars as a policy carrot.

Six states—Tennessee, Alaska, Connecticut, Delaware, Iowa and Mississippi—have indicated they will address CON laws in their applications. While opponents claim CON rules keep prices high and limit rural patients' access to new technology, experts caution that removing them could erase vital ownership reporting and lead to market consolidation that threatens smaller facilities. Tennessee has already enacted a bipartisan plan to dismantle most of its CON requirements over four years, and other states are debating similar reforms. The move reflects a broader trend of federal administrations leveraging funding to shape state health policy.