Kaine meets with Rural Health leaders over changes to Medicaid funding

Tim Kaine visited Eastern Shore Rural Health System on Tuesday to hear concerns about federal health care policy, including Medicaid changes, 340B prescription drug reforms, rural health funding, and workforce shortages.

Kaine, who serves on the Senate Health, Education, Labor and Pensions Committee, said he is gathering input from Virginia health care providers as Congress addresses the effects of the 2025 federal budget reconciliation law. That law includes new Medicaid eligibility and work-verification requirements scheduled to begin January 1, 2027, and rolled back increases to Medicaid funding enacted during the COVID-19 pandemic.

“I’m trying to convince my colleagues that some of the Medicaid cuts that were put into the budget reconciliation bill last summer went too fair,” Kaine said. “The question it, does this truly validate qualification for Medicaid, or are we just putting hurdles in people’s way to reduce spending?”

Eastern Shore Rural Health CEO Jeanette Edwards said uncertainty over the new Medicaid rules is already making it difficult to plan budgets, staffing, and compliance. She said concerns include patients potentially losing coverage due to lack of reliable mail service, phone access, transportation, literacy, or the ability to navigate repeated paperwork requirements.

“We don’t know what the administrative burden is going to be,” she said. “Are we going to have to hire more employees to take care of this? We’re trying to plan for the next year and run an organization, but we still don’t know what exactly the rules are going to be.”

Kaine said he is concerned the new requirements may function less as a true eligibility check and more as a barrier that causes qualified individuals to lose coverage.

Rural Health staff also pointed to the pending expiration of enhanced Affordable Care Act premium tax credits, warning that more people could become uninsured.

The 340B prescription drug program was another major focus. Rural Health’s Kimberly Savage said the program helps patients afford medications and supports services that are not fully reimbursed, including outreach, health education, referrals, care management, and pharmacy assistance. Kaine is part of a bipartisan Senate working group examining potential 340B reforms aimed at preserving the program while addressing concerns about misuse.

“We want to prevent abuse of this program, but we do not want to gut its effectiveness for organizations that are serving low-income patients,” said Kaine.

Rural Health leaders asked that any reforms protect Federally Qualified Health Centers, which they described as central to the program’s original mission of serving low-income and underserved patients.

The discussion also touched on rural health transformation funding. Virginia was awarded nearly $190 million through the federal Rural Health Transformation Program, part of a $50 billion national initiative. Edwards said that funding may help address infrastructure and technology needs but should not be viewed as a replacement for Medicaid reimbursement or base funding.

Other issues raised included Medicare Advantage reimbursement challenges, immigration-related concerns affecting whether farmworker visits are reimbursed by the federal government, dental and behavioral health needs, telehealth in schools, pharmacy expansion, cybersecurity, interoperability, and shortages of nurses, dental hygienists, and primary care providers.

“We will provide care for everybody on this Eastern Shore regardless,” Edwards added at the end. “No services have been cut, and we are going to continue taking care of our patients.”