Eastern Shore Rural Health System CEO Responds to State and Federal Medicaid Policy Changes

Following Governor Youngkin’s release of Executive Directive Twelve last week and this week’s announcement by the Centers for Medicare & Medicaid Services (CMS) regarding a nationwide initiative to remove ineligible Medicaid enrollees, Eastern Shore Rural Health System, Inc. CEO Jeannette Edwards has issued a statement addressing the potential impact of these policy developments on rural healthcare access and vulnerable populations served by the health system.

Eastern Shore Rural Health has been and will continue to monitor developments out of both Washington D.C. and Richmond with regard to the federal law H.R. 1., also known as “the big beautiful bill” to include the actions set forth by Governor Youngkin in his Executive Directive Twelve signed Aug. 13, 2025.

As has been reported, H.R. 1, or the “big beautiful bill,” created a Rural Health Transformation Program that will provide $50 billion to support health care in rural America. While half of the money will be divided among the 50 states, $25 billion is available to states competing for additional funding. Governor Youngkin’s Executive Directive Twelve states that representatives from Federally Qualified Health Centers will participate in the development of the Rural Health Transformation Plan required to be considered for additional funding. Eastern Shore Rural Health is a Federally Qualified Health Center – which are also known as Community Health Centers. We are proactively engaging with the appropriate people and organizations to provide input for this plan.

Executive Directive Twelve also references other changes brought about by H.R. 1. with regard to Medicaid. As of today the federal government has not provided direction to the states on how work and community engagement requirements for Medicaid recipients will work. The deadline to provide direction to the states is Dec. 31, 2025. Therefore the state has not provided this information to Community Health Centers like Eastern Shore Rural Health. Until we know more, Eastern Shore Rural Health can’t fully ascertain how Medicaid work and community service requirements may affect our operations.

The same can be said for how recent reinterpretation of the Personal Responsibility and Work Opportunity Reconciliation Act, or PRWORA, will affect Community Health Centers. This is not addressed in the Governor’s Executive Directive, but also relates to Medicaid coverage. PRWORA defines who is eligible for Medicaid, particularly regarding non-U.S. citizens. The Trump administration has a broader definition of what a federal public benefit is and who is considered a “qualified immigrant or alien” eligible to receive a federal public benefit. This reinterpretation will affect lawfully present immigrants holding various visas who were previously eligible for these benefits. But, until direction from the federal government is available, we can’t fully understand the implications of this change.

We will continue to care for all members of our community. As more information becomes available, we will be able to better understand how the changes affect Eastern Shore Rural Health and how we will respond to these changes. We will update the community and communicate any changes when we know more.

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Wayne Creed

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