Edward Shanshala, CEO of Ammonoosuc Community Health Services, a nonprofit Federally Qualified Community Health Center operating four clinics in New Hampshire’s rural North Country, said new federal rural health funding will not fully offset the pressures created by Congress’s recent tax and spending legislation. The organization closed its Franconia clinic in anticipation of the law’s impacts and now serves close to 10,000 patients across locations providing primary care, addiction treatment, nutrition, mental health, and vision care.
The Law and Its Rural Impact
When the One Big Beautiful Bill Act—President Donald Trump’s key legislative priority during the first half of 2025—was debated, critics highlighted its cuts to Medicaid, which rural areas rely on more heavily than urban centers. According to KFF, the law will cut federal spending on Medicaid by about $991 billion over the next decade. As a compromise, lawmakers created the $50 billion Rural Health Transformation Program to counteract anticipated negative effects. New Hampshire expects to receive roughly $200 million annually through the end of the decade.
Limited Resources for Growing Challenges
Shanshala acknowledged the Rural Health Transformation Program represents “a significant investment” but stressed that “the de-investment in Medicaid and the ACA (Affordable Care Act) as being larger than that and will last longer.” He emphasized the bill arrives during a precarious time for rural health services, pointing to labor and delivery as an example. Androscoggin Valley Hospital “is the only critical access hospital in Coös County that has the capacity to deliver babies,” according to Shanshala. He warned that losing obstetric care would devastate communities and hinder recruitment efforts.
Tom Mee, CEO of Androscoggin Valley Hospital’s parent organization North Country Healthcare, stated that more than half of the health system’s patients pay with Medicare or Medicaid. When the bill was being debated, he warned that OB-GYNs and baby deliveries would be among the first services considered for elimination in response to Medicaid cuts.
Gov. Kelly Ayotte established the GO-NORTH office in late 2025 to manage the funds, designating five community organizations as distribution hubs. The Trump administration has argued the law does not actually cut Medicaid for eligible recipients but rather eliminates waste, fraud, and abuse, though health care experts say several provisions will likely result in eligible recipients losing coverage. When ACHS closed its Franconia branch, it transferred staff to other locations and employed patient navigators to help residents find transportation to clinics in Littleton or Whitefield.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.laconiadailysun.com/news/state/co-s-county-health-center-ceo-says-new-rural-health-funds-not-enough-to-counteract/article_3516fd96-9776-53dd-b286-b3acedcdbe05.html