Federal cuts to Medicaid could hurt a health care lifeline in Eastern Kentucky | Opinion

After Valentine’s Day, record flooding left Eastern Kentucky reeling when six inches of snow arrived, further isolating already devastated communities. Local organizations and my classmates at the University of Pikeville Kentucky College of Osteopathic Medicine continued volunteering long hours — whether in hospital wards or local food pantries — highlighting how quickly crisis can overwhelm a community.

Eastern Kentucky is no stranger to hardship. Poverty, chronic disease, and a fragile healthcare infrastructure have been compounded by recent natural disasters, uprooting residents and shuttering businesses. Now, just when rural clinics need the strongest support, the Department of Oversight and Government Efficiency (DOGE) is proposing federal cost-cutting measures that could have dire consequences for Medicaid reimbursement rates. If these proposals move forward, they risk fracturing a healthcare system already under enormous strain.

Medicaid is vital for low-income families, seniors, and disabled individuals. According to the Appalachian Regional Commission, the 2024 median household income in Eastern Kentucky is $33,878 — significantly below both the state and national medians. Estimates suggest more than 40% of Eastern Kentucky relies on Medicaid, a critical buffer for rural hospitals operating on razor-thin margins. Even a small drop in reimbursement can force service closures or outright hospital shutdowns.

DOGE insists these cost caps will reduce fraud and manage escalating expenses. Yet applying uniform constraints to struggling rural providers, who already face thin margins and less diverse payer mixes, can devastate entire communities.

Existing Medicaid rate increases were meant to address chronic disease burdens, but severe flooding and economic struggles have only increased financial pressures. Neighboring Tennessee, which declined Medicaid expansion, has lost over a dozen rural hospitals in the last decade. Recruiting physicians is already difficult in Eastern Kentucky due to lower compensation and limited amenities. Should Medicaid rates fall further, private practices and hospital-owned clinics may consolidate or close. Essential departments — obstetrics, oncology, mental health — are often the first to go.

Proposals like block grants or per-capita caps would limit federal funding, forcing states to either make up the difference or slash services. Complications of pregnancy are more likely seen in communities with higher existing burden of disease — patients with diabetes, chronic hypertension, morbid obesity are more likely to need specialty OB care because of increased risk of preeclampsia, maternal diabetes, etc. According to the American Hospital Association, at least 89 rural OB units shut down nationwide between 2015 and 2019. Known as “maternity deserts,” these closures push expectant mothers to travel 30–70 minutes for prenatal care. Women who live far away often delay visits, risking complications. With 41% of U.S. deliveries paid by Medicaid (often more in rural areas), cuts risk a domino effect: more closures and poorer maternal-infant outcomes.

While DOGE’s Elon Musk insists, “The waste and fraud in entitlement spending …is the big one to eliminate”, broad-stroke crackdowns translate into heavier paperwork and stricter eligibility checks that could disqualify truly needy patients over small errors. For rural clinics with limited staff, this could escalate minor issues into chronic conditions and ultimately increase costs for those Medicaid was designed to protect

Critics acknowledge the need for balanced budgets and accountability but warn that deep Medicaid cuts harm the most vulnerable and can drive long-term costs higher. While industry leaders emphasize efficiency, scaling back Medicaid jeopardizes current progress against chronic disease in fragile communities. Instead of broad cuts, solutions like telehealth expansion, rural physician training, and refined fraud oversight can address inefficiencies without dismantling a precarious healthcare network.

For Eastern Kentucky, Medicaid isn’t just a program—it’s a lifeboat. Slashing it in the name of cost-savings might yield short-term wins but unravels the well-being of some of America’s most vulnerable communities. If DOGE genuinely seeks governmental efficiency, it must work with local stakeholders to strengthen, not gut, the infrastructure that keeps Eastern Kentucky afloat.

Soham Apte is a student at the University of Pikeville’s Kentucky College of Osteopathic Medicine. James Vithoulkas is a medical student at the University of Virginia.