Hana Elizabeth Hinkle, PhD, MPH, is the Assistant Dean for Rural Health Professions and Director of the National Center for Rural Health Professions at the University of Illinois College of Medicine Rockford. She also serves as Director of the Illinois Area Health Education Center Network Program and Research Assistant Professor in the Department of Family and Community Medicine. Her work centers on rural health disparities, healthcare workforce development, culturally appropriate healthcare delivery, and community-based public health interventions.
She spoke with IGPA about how the proposed Medicaid cuts may impact rural Illinois residents.
In this fiscal year, Medicaid accounts for about 27.9% of the state’s total spending, covering 3.4 million Illinois residents. The proposed Medicaid cuts could put nearly 1 million Illinois residents at risk of losing coverage. How do Medicaid cuts, particularly in rural areas, impact the access to care for marginalized populations that you work with, such as rural and racial minorities?
Hinkle: Medicaid cuts would have significant and far-reaching impacts in rural communities, where the healthcare system is already under strain. Roughly 20% of rural residents and 40% of rural children rely on Medicaid or CHIP for healthcare. When you factor in racial and ethnic minorities living in rural areas, the potential consequences are even more severe.
Medicaid makes up a much higher portion of the payer mix for rural hospitals, which already operate on thin margins—about half of them run in the negative. Any reduction in Medicaid funding could jeopardize these hospitals’ ability to provide essential services, retain staff, and remain open. For individuals, this could lead to impossible decisions between paying for healthcare or basic needs like food and housing. Overall, these cuts could create a “perfect storm” for already vulnerable rural health systems.
How can community-based interventions mitigate these effects? What other strategies could be implemented?
Hinkle: Community-based interventions are a critical part of the safety net, but they’re also facing challenges. Local health departments and agencies often rely on federal funding streams like HHS and NIH grants, many of which are also at risk. Preventive health initiatives and programs like Women, Infants, and Children (WIC) have historically filled gaps in rural care access, but if those resources are also threatened, there are few alternatives left.
It’s essential to recognize that the traditional public health infrastructure is already fragile. If both Medicaid and these other funding sources are diminished, there isn’t a backup system to step in. Some opportunities do exist, like workforce development programs or community-driven partnerships, but these are long-term solutions. Right now, the immediate concern is that without proper funding, rural communities may lose access to basic healthcare entirely.
In your experience with health workforce development, how do funding cuts to Medicaid affect the availability and retention of healthcare professionals in rural regions of Illinois, and what strategies could help maintain a strong workforce in these underserved areas?
Hinkle: Medicaid is fundamental to keeping rural hospitals open, and when those institutions struggle financially, it becomes increasingly difficult to recruit and retain healthcare professionals. Providers are unlikely to work in areas where they can’t be reimbursed for their services. Without Medicaid, hospitals face closures, and with them goes the community’s access to care and job opportunities.
To help address this, our Rural Medical Education (RMED) program at the University of Illinois is focused on long-term workforce development. We partner with rural hospitals and schools to identify students—often first-generation or from underserved backgrounds—who are passionate about returning to serve their communities. This mission-driven approach has made our program the top in the country for placing graduates in rural healthcare settings. However, even with a strong pipeline, we still need stable institutions for these professionals to join. Workforce development and policy reform must go hand-in-hand.
Given your research on culturally appropriate healthcare delivery, how might Medicaid cuts affect the ability of health systems to provide equitable care to diverse populations?
Hinkle: Culturally appropriate care is vital in both rural and urban areas. It is important to stay focused on the mission of providing quality care to all populations. In the work we do, we stay focused on the policy rather than the politics of issues.
Many rural communities are more diverse than people realize, and Medicaid serves a portion of this population. When policies like work requirements are added—even though most adult Medicaid recipients are already working—it creates additional barriers for these groups to access care.
Hinkle is open to further requests for comment on this topic and can be reached at hhinkle1@uic.edu.
