Mississippi’s rural health care system is preparing for a mix of new funding and new challenges as the federal “Big Beautiful Bill” — officially the One Big Beautiful Bill Act (OBBBA) — begins reshaping how small-town hospitals and clinics survive.
The OBBBA seeks to reduce federal health spending through deep cuts and stricter Medicaid rules. The law adds new work requirements, tightens eligibility and raises copays, while letting enhanced Affordable Care Act (ACA) subsidies expire — changes that could raise costs for many Mississippians.
At the same time, the bill introduces tax relief and new support for rural hospitals. Supporters say it will control spending and improve efficiency, while critics warn it will make coverage unaffordable for millions.
In Grenada County — where the University of Mississippi Medical Center-Grenada anchors the local system — physicians and administrators are watching closely.
“I’m glad they’re trying to make changes,” Dr. Joseph Messina Jr., a Grenada internist, said. “Coverage has been inadequate for many people for years. I hope we see a more reasonable, affordable solution.”
Dr. Messina said he has seen “lots of positives” in the current federal administration’s health agenda, particularly concerning nutrition and prevention. He said he is encouraged by Health and Human Services Secretary Robert F. Kennedy Jr.’s efforts to promote healthier food choices, including emphasizing healthy fats and “turning the food pyramid upside down” to move away from processed sweets and empty calories on children’s menus.
Signed by President Donald J. Trump on July 4, 2025, the measure is a sweeping tax and spending package affecting safety-net programs and health financing. The law also intersects with “Make America Healthy Again,” or MAHA, a broader health push spearheaded by Kennedy that focuses on reducing toxic exposures, improving nutrition and reforming health systems, efforts that are gaining momentum in state legislatures even as they face industry opposition. MAHA-inspired policies include state-level moves to ban or restrict certain synthetic food dyes in schools, tighten rules on ultra-processed foods through nutrition programs and push for stricter pesticide regulations, all framed as efforts to reduce chronic disease and improve children’s health.
Mississippi Participates
Included in the bill is the new Rural Health Transformation (RHT) Program, a multi-billion-dollar grant fund for states between 2026 and 2030. For Mississippi, that means new federal dollars to stabilize rural hospitals, strengthen clinics and expand telehealth services — even as tighter Medicaid rules and reduced incentives make it harder to expand coverage.
Mississippi’s application to the program was approved in late 2025, earning the state more than $205 million in federal funds from the Centers for Medicare and Medicaid Services (CMS). The national program provides $50 billion over five years, divided among participating states based on rural population and facility needs. Funds can be used for payments to providers, health technology upgrades, workforce training, mental health and substance abuse services, cybersecurity and new models of rural care.
“This is another big win for Mississippi,” Gov. Tate Reeves said in a Dec. 29, 2025, press conference. “When we developed our plan, we worked with experts from across Mississippi. Together, we came up with a strategy that best serves Mississippians and makes the biggest impact on healthcare in rural communities throughout the state. I’d like to thank President Trump, Secretary Kennedy and (CMS) Administrator (Mehmet) Oz for this once-in-a-generation opportunity. My administration is ready to get to work with our partners to deploy this funding on behalf of the over three million people who live in our great state.”
Mississippi’s application focused on six key initiatives:
• A statewide health assessment conducted by a third party
• A coordinated regional integrated systems initiative to transform healthcare in rural areas of the state
• Workforce expansion initiative to strengthen the number of healthcare workers
• Health technology advancement and modernization initiative to modernize health systems in rural areas
• A telehealth initiative to increase and support providers in increasing access to virtual care
• An initiative that will focus on the healthcare infrastructure in the state to increase access to specialized care and improve health outcomes
In Grenada County, where the Mississippi Division of Medicaid maintains a regional office serving Grenada, Calhoun, Montgomery and Yalobusha counties, state officials will play a key role in determining how those dollars reach local providers. Mississippi policymakers now must design a plan that meets federal priorities, a process that will determine whether the new dollars shore up existing hospitals or accelerate a shift toward outpatient and virtual care.
Changes Begin
One immediate change under the law is a federal work requirement for many Medicaid adults under 65 — excluding parents, students and people with disabilities. In places like Grenada County — where many jobs are seasonal or part-time — many critics believe that could mean more residents lose coverage, leaving hospitals to absorb higher uncompensated care costs.
The Big Beautiful Bill also effectively ends a lucrative window that had encouraged holdout states to expand Medicaid under the ACA. A temporary incentive would have provided a large bump in federal funding for states like Mississippi if expansion had been approved before the new law took effect.
That bonus is now off the table, leaving Mississippi with the option to expand Medicaid, but without the additional sweetener that once made the budget math more appealing. Health advocates argue that decision has real consequences for rural hospitals, which continue to treat large numbers of uninsured adults and depend heavily on Medicaid and emergency-room write-offs to survive. Local providers, including Grenada-area clinics that accept Medicaid and Medicare patients, could see a growing share of uncompensated care if coverage rolls shrink.
The Big Beautiful Bill will also reshape federal nutrition programs in ways critics warn could undermine healthier eating rather than improve it. The law makes major changes to the Supplemental Nutrition Assistance Program (SNAP), including new eligibility restrictions, additional work rules and limits on the U.S. Department of Agriculture’s ability to update benefit levels. Future updates to the Thrifty Food Plan — the market basket used to set SNAP benefit amounts — must now be cost neutral, which analysts and anti-hunger groups say will make it harder to reflect real food prices and current dietary guidance, potentially reducing access to healthier foods and widening gaps in diet quality.
Dr. Messina added that those efforts to cut processed sugars, empty calories and artificial colors could help reduce childhood obesity and lower the risk of a “whole generation” developing chronic disease later in life.
“I am encouraged with the changes that Robert F. Kennedy Jr., has made to promote healthier food choices such as healthy fats and turning the food pyramid upside down,” he said. “They’re getting a lot of the processed sweets and empty calories out of children’s menus and raising healthier children as a result of getting rid of those processed sugars, empty calories and artificial colors. Many of our children are overweight and that is providing a whole generation of children who are going to be at risk for chronic disease.”
Mississippi has taken steps to adopt policies that receive higher scores, including reestablishing the Presidential Fitness Test in schools and seeking a waiver to restrict purchases of sugary foods and drinks through the SNAP in October 2025.
Anti-hunger advocates also believe that deep SNAP cuts, added work requirements and the elimination of SNAP-Ed nutrition education will worsen food insecurity, even as the law’s supporters argue that tighter rules and cost controls will make programs more efficient and better targeted. Alongside those cuts, the bill controversially brings back whole milk in school lunches and shifts more costs to states, moves critics say run against MAHA’s stated goals of steering families toward less-processed, more nutritious options.
State Statistics
Many of Mississippi’s rural hospitals entered 2026 in fragile financial shape after years of low margins, workforce shortages and shifting patient volumes. Statewide, Mississippi has 29 critical access hospitals, six rural emergency hospitals and 245 rural health clinics, all of which face an uncertain future as federal policy shifts. Hospital leaders worry that the law’s Medicaid cuts and work requirements could deepen their uncompensated care burden at the very moment when they are being asked to transform how they operate.
At the same time, the new Rural Health Transformation funding offers a rare chance to invest in long-delayed upgrades, from electronic health records to telehealth and community paramedicine programs.
But it’s not all about spending a lot of federal dollars, State Health Officer Daniel Edney, MD, FACP, FASAM told the media in late 2025.
“As the outcomes in our rural counties begin to improve, the outcomes for the state will continue to improve,” he said. “And as we improve rural health care, we improve all health care in the state.”
UMMC-Grenada, which offers more than 20 types of specialized care and is backed by the state’s only academic medical center, could be positioned to benefit from investments in telehealth and coordinated care. Some facilities across the state are weighing whether to convert to freestanding emergency departments or hybrid clinic–hospital models, trading inpatient beds for more outpatient and primary care services to better match local needs.
Health policy experts describe the Big Beautiful Bill as both a lifeline and a test for Mississippi’s rural health system. If state leaders move quickly to craft a strong plan, they can steer federal dollars toward keeping critical-access hospitals open, building out telehealth networks and improving coordination among small-town providers.
But without careful planning — and without broader coverage strategies such as Medicaid expansion — the new money could prove temporary, while long-term cuts to Medicaid leave more rural residents uninsured and more hospitals on the brink.
For Grenada County and communities across Mississippi, the coming months will determine whether the Big Beautiful Bill becomes a turning point for rural health care, or just another chapter in a long-running struggle to keep the doors open.
This coverage is supported by a grant from Press Forward Mississippi, part of a nationwide philanthropic effort to strengthen local news so communities stay informed, connected and engaged.
