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WASHINGTON, D.C. — Congressman August Pfluger (TX-11) and U.S. Senator John Cornyn (R-TX) led a letter with members of the Texas congressional delegation to Administrator of the Centers for Medicare and Medicaid Services (CMS) Dr. Mehmet Oz, urging him to prioritize funding from the Working Families Tax Cuts’ $50 billion Rural Health Transformation Program for the State of Texas.

The lawmakers wrote, in part, “We are writing in strong support of Texas’s application for funding through the Rural Health Transformation Program.”

“Texas is ready and more than able to meet this critical moment for improving health care access and outcomes in our rural communities,” they continued.

The lawmakers concluded, “As you consider state applications, we ask that you ensure an appropriate balance in funding distribution and consider the increased need of a large, rural state like Texas to ensure we can make critical improvements in health care for rural Texas communities. Thank you for your careful attention to these concerns.” 

Several outside organizations applauded Rep. Pfluger and Senator Cornyn for their efforts, including the Texas Association of Community Health Centers and the Texas Hospital Association, which released the following statements:

Jana Eubank, CEO, Texas Association of Community Health Centers, said, "Community health centers have always been the primary care backbone for rural and underserved areas, and this initiative will allow us to expand that role even further. By investing in local care teams, infrastructure, and technology through the Rural Health Transformation Program, we can ensure rural Texans receive high-quality care close to home. This work is not just about improving health outcomes, it’s about sustaining the vitality of our rural communities."

John Hawkins, President/CEO, Texas Hospital Association, said, "Texas hospitals are grateful to Senator Cornyn, Congressman Pfluger, and other members of the Congressional delegation for their efforts to ensure a fair allocation of funds to Texas through the Rural Health Transformation Program. Federal investments to strengthen rural health in Texas will have an outsized impact due to our large rural population and geographic landscape. We are hopeful CMS will see this as a high-value return on public dollars." 

Text of the letter is available here and below. Additional signatories include Senator Ted Cruz (R-TX) and Representatives Pete Sessions (TX-17), John Carter (TX-31), Michael McCaul (TX-10), Randy Weber (TX-14), Roger Williams (TX-25), Brian Babin (TX-36), Jodey Arrington (TX-19), Michael Cloud (TX-27), Craig Goldman (TX-12), Dan Crenshaw (TX-02), Lance Gooden (TX-05), Pat Fallon (TX-04), Ronny Jackson (TX-13), Beth Van Duyne (TX-24), Jake Ellzey (TX-06), Monica De La Cruz (TX-15), Wesley Hunt (TX-38), Morgan Luttrell (TX-08), Nathaniel Moran (TX-01), Keith Self (TX-03), Tony Gonzales (TX-23).

December 5, 2025

The Honorable Dr. Mehmet Oz

Administrator

Centers for Medicare & Medicaid Services

200 Independence Avenue SW

Washington, DC 20201

Dear Dr. Oz:

We are writing in strong support of Texas’s application for funding through the Rural Health Transformation Program, authorized by the One Big Beautiful Bill Act. 

As you know, Congress approved a historic investment in rural health care earlier this year by creating this program and ensuring that states can work with CMS to determine how to use these funds most effectively to meet the needs of their rural communities. 

Specifically, Congress provided $50 billion for state grants, with half being distributed by CMS “equally among all states with approved application.” Under this directive, each state could receive the same amount from the pool regardless of the number of rural hospitals and providers or the size of its rural population. For example, Connecticut, which has three rural hospitals, could receive the same amount as Texas, which has 155 rural hospitals. Texas hospitals and clinics will be clearly disadvantaged under this model, while facilities in more urban states will see an unearned windfall. 

For the remaining $25 billion, CMS has broad discretion to consider a range of factors in allocating funds and is not required to distribute additional funding to all states that receive baseline awards. We respectfully ask CMS to carefully consider this dynamic and exercise this discretionary authority when determining the criteria and allocations for the second tranche so that the program’s intent is preserved. We emphasize the following points:

·     Texas has 4.3 million rural residents, more than any other state, while also being the second-largest state by geographic area. These residents are spread across 202 rural counties covering over 260,000 square miles of rural territory.

·     Texas has more rural hospitals and clinics than any other state, four times the national average.

·     Since 2005, Texas has had more rural hospital closures than any other state, ten times the national average, and continues to have more vulnerable rural hospitals than any other state. The financial crisis facing these facilities is severe with 77% of rural Texas hospitals having negative net income from patient services in 2025, while 40% are operating with negative margins and fewer than 20 days cash on hand. Additionally, 48 hospitals currently have fewer than 10 days cash on hand. In comparison, Delaware, Maryland, New Jersey, Rhode Island, and Utah have zero hospitals at risk of closure.

·     Over 500,000 Texas residents must travel an hour or more to reach urban areas for health care services, with rural residents averaging 59 miles to the nearest referral center and some West Texas patients having to travel up to 109 miles. Women may travel more than 70 miles to reach the nearest labor and delivery hospital, as 96 rural hospitals no longer provide obstetric services, creating maternal health deserts larger than the combined land mass of Connecticut, Delaware and Rhode Island.

·     Almost all rural Texas counties are designated as health provider shortage areas (HPSA) and every rural county in Texas is designated as a HPSA for mental health providers. Nearly one in five rural Texas counties lacks a licensed primary care physician, and rural areas have 60% fewer primary care physicians per capita than urban areas. The workforce crisis extends beyond physicians, as rural communities have nearly three times fewer community health workers per capita than urban areas, while one-third of the existing rural healthcare workforce is nearing retirement.

·     This rural health care crisis imposes a staggering economic burden, with excess medical spending and productivity loss due to preventable health conditions costing the Texas economy $7 billion annually, while rural Texans continue to experience higher mortality rates and increased incidence of chronic diseases.

Texas is ready and more than able to meet this critical moment for improving health care access and outcomes in our rural communities. Texas will collaborate with rural hospitals, Federally Qualified Health Centers, and other providers across the state, using the funding from this program “to reach residents in 100% of Texas’s rural counties and make rural Texans healthy again.” In its application, “Rural Texas Strong: Supporting Health and Wellness,” Texas is prioritizing the following areas:

·     Reducing chronic disease;

·     Increasing remote patient monitoring;

·     Deploying artificial intelligence and telehealth services to bridge service gaps;

·     Recruiting and retaining rural health care workers;

·     Improving cybersecurity to protect patient data; and

·     Upgrading equipment in rural hospitals and clinics.

These are worthy and significant goals that closely align with the strategic goals laid out by CMS, and they can be achieved with the necessary funding. 

As you consider state applications, we ask that you ensure an appropriate balance in funding distribution and consider the increased need of a large, rural state like Texas to ensure we can make critical improvements in health care for rural Texas communities. Thank you for your careful attention to these concerns. 

Sincerely,