Leveraging the Rural Health Transformation Fund to Improve Access to Care

May 14, 2026

Rural communities have been navigating serious health challenges for a long time—hospital closures, workforce shortages, long drives to see a specialist, and higher rates of chronic disease, to name just a few. These issues are deeply connected, and for many communities, they’ve reached a breaking point.

Congress aimed to address these challenges by creating the Rural Health Transformation (RHT) Fund, part of the One Big Beautiful Bill Act (HR1) passed last July. The RHT Fund represents an important federal investment—designed not just to keep rural health systems afloat, but to help them evolve into models that are more stable, preventive, and community‑centered over the long term.  And at the same time, while the RHT Fund is key in strengthening rural health access, with the level of Medicaid funding cuts overall including in HR1, resources will continue to be a challenge more broadly. And because the funding for the RHT Fund is for five years, sustainability also needs to be further considered as this work moves forward.

Now that states are moving from planning into implementation, the RHT Fund is starting to shape how rural health care is financed, organized, and delivered. While states receive the funding directly, nonprofits and community‑based organizations are essential partners in turning system‑level investments into real improvements in people’s lives.

If your organization works in or alongside rural communities, understanding how the RHT Fund works—and how your state is approaching it—is becoming increasingly important. To further inform how the Lutheran Services in America network can leverage the RHT Fund, read: The Rural Health Transformation Fund: What It Is, How States are Using It, and Where Nonprofits Fit In.

Shao-Chee Sim is Executive Vice President for Health Policy, Research, and Strategic Partnerships at Episcopal Health Foundation and Sue Polis is Vice President of Public Relations and Government Affairs at Lutheran Services in America.

Here We Stand: Coming Together with New Resources

May 14, 2026

On April 23, Lutheran Services in America network members from our Policy and Advocacy Committee, the Disability Network, and the board of directors convened in Washington, D.C., for a day of meetings with Congressional offices. Nineteen member organizations were represented, and over 40 meetings were conducted in total.

Our Asks? No more cuts to Medicaid. Support for Workforce and Housing.

As part of our recent re-launch of our Here We Stand campaign to protect Medicaid, network members went to the Hill with three primary asks:

What can you do?

This is a pivotal moment as we work on two fronts:

  • Federal: Congress is considering a third budget reconciliation bill that may mean even deeper cuts to Medicaid. Learn more and take action.
  • State-level efforts: Whether your state is already working on implementation of H.R. 1 provisions including work reporting requirements and limitations from provider tax constraints, state budgets are tightening and most will be trying to do more with less.

Also consider the following:

  • 5/21: Join our May Capitol Conversations webinar to learn more about future budget reconciliation efforts.
  • Sign-up for one-on-one consultation to review updated Here We Stand. Resources and options for action. to review updated Here We Stand. Resources and options for action.
  • Use our new Here We Stand resources to engage with lawmakers and the media. Materials include:
    • Medicaid Brief: Backgrounder on state fiscal challenges, Medicaid program integrity and waste, fraud and abuse.
    • Action Guide: Suggested ways you can engage policymakers at the state or federal levels.
    • Medicaid FAQs: Frequently asked questions and answers about the importance of Medicaid, policy impacts, and the Here We Stand campaign.
    • Messaging for Federal Lawmakers: Suggested messaging for meetings with members of Congress (House and Senate).
    • Messaging for State Lawmakers: Suggested talking points for your meetings/engagements with state lawmakers and officials.

Please contact the Lutheran Services in America government relations and public policy team:

Sue Polis
Sarah Dobson
Bill Kallestad
Kylie Bowlds

Support with communications efforts:

Christopher Findlay

 

Sarah Dobson is Senior Director of Advocacy and Public Policy at Lutheran Services in America.

Transforming Together Cohort Starts with Lived Experience

May 13, 2026

The people most affected by a system usually know the most about how to fix it. At Lutheran Services in America, we are building the capacity to act on that. 

We work with more than 300 organizations serving 1 in 50 people. And one of the most consistent things we hear from leaders across that network is this: we need to listen better to the families we serve and to the communities we’re part of.

Knowing it and building the capacity to actually do it are two different things. And that is what Transforming Together is about.

This week, 14 organizations from across the Lutheran Services in America network launched a nine-month action cohort — one of the first initiatives of its kind in our network — designed to embed lived experience at the center of how organizations work and how they influence the systems around them. Not as a checkbox or consultation, but as a genuine driver of strategy, evaluation, and practice.

With expert facilitation from Greater Good Studio, these 14 organizations are building real skills: 

  • how to gather and use community feedback in ways that actually change decisions 
  • how to tell stories rooted in lived experience 
  • how to design evaluation that captures what matters to the people served  

We have long recognized that the people closest to the problem are closest to the solution. Transforming Together puts capacity behind that belief with a cohort of leaders focused on building the infrastructure to truly listen and make change.

We’re excited to share what this cohort discovers and the changes we make alongside people and families.

Participating organizations include: 

This work is made possible, in part, through the generous support of the Evangelical Lutheran Church in America (ELCA) and other national partners. We are deeply grateful for their partnership and commitment to strengthening communities and advancing opportunities for those we serve. 

Lutheran Services in America Adds Four Members to its Board of Directors

May 4, 2026

Rekindling Connection and Joy: How Technology is Transforming Memory Care in Rural Nebraska

April 28, 2026

In a memory care community in rural Nebraska, a simple yet powerful idea is reshaping how older adults living with dementia connect with the world around them: meeting people where they are—with tools designed to spark recognition, joy, and human connection.

Building on its longstanding partnership with the Consumer Technology Association Foundation, Lutheran Services in America has secured funding for member organization Eventide, formerly Tabitha. Eventide at Prairie Commons in Grand Island, Nebraska, a pilot program supported by grant funding in partnership with Lutheran Services in America and the Consumer Technology Association Foundation, is using interactive digital technology to enhance connection and quality of life for older adults living with dementia. Through Lifeloop’s iN2L (“It’s Never Too Late”) system, approximately 75 residents, staff, volunteers, and family members are engaging with personalized content—music, videos, and games—designed to spark recall of pastime memories and foster meaningful interaction of older adults and visiting family members. By meeting individuals where they are cognitively through this innovative tool, the program addresses a critical need in memory care: reducing isolation, anxiety, and communication barriers. 

Since implementation in early 2026, about 75% of residents are using the system regularly, with staff reporting improved moods and reduced agitation—especially during challenging periods like sundowning. The mobile touchscreen allows staff to bring activities directly to residents, increasing accessibility and participation. Families are also benefiting, using the platform to connect with their loved ones in new and engaging ways, helping to ease visits that can otherwise feel difficult or uncertain. 

The impact is best seen in the moments it creates: a resident recalling the names of her horses after watching a video, another rediscovering joy through virtual casino games, or individuals finding calm in simple interactive activities. These experiences show how personalized, accessible technology can restore connection, dignity, and joy—even in the face of cognitive decline. 

“Even in its early stages, the program makes one thing clear: when thoughtfully applied, technology can humanize care, bridging communication gaps, easing emotional distress, and creating meaningful moments between residents and those who care for them,” said Jon Riewer, CEO of Eventide.

As rural communities navigate workforce shortages and limited access to specialized services, innovations like this offer a promising path forward—blending compassion, creativity, and technology to support aging with dignity.

“Sometimes, all it takes is a familiar song, a shared laugh, or the memory of a beloved horse to remind someone—and everyone around them—of who they are,” said Alesia Frerichs, president & CEO of Lutheran Services in America.

Rural Voices Shaping Transformation (and Better Policy) for Older Adults

April 16, 2026

Rural older adults navigating both Medicare and Medicaid face some of the most complex challenges in our healthcare system, and Lutheran Services in America went directly to the source to understand why.

In July 2025, Lutheran Services in America launched Rural Voices 2025: Elevating the Resilience of Rural Older Adults Navigating Medicare-Medicaid, in partnership with The SCAN Foundation. This human-centered initiative reflects Lutheran Services in America’s longstanding leadership in rural aging, and its belief that the people closest to a problem hold the most important insights for solving it. Drawing on our network’s Rural Aging Action Network and in partnership with Lutheran Social Service of Minnesota and Lutheran Social Services of South Dakota, Lutheran Services in America engaged dual-eligible older adults across rural Minnesota, North Dakota, and South Dakota — communities that are too often invisible in national policy conversations yet disproportionately burdened by access barriers and system complexity.

Working with Public Policy Lab and The People Say, Lutheran Services in America conducted in-depth, human-centered interviews with 16 rural older adults whose stories now contribute to a growing national archive of firsthand insights. These are not data points. They are detailed, lived accounts of what it actually takes to age in place in rural America: navigating fragmented care, confusing benefits, workforce shortages, and policies that weren’t designed with them in mind.

The findings are now available, and urgently relevant. Lutheran Services in America’s newly released e-report, “Rural Voices Shaping Transformation,” translates these experiences into a clear roadmap for change: simplifying eligibility and enrollment, reducing administrative burden, improving benefit communication, and modernizing policies that inadvertently penalize rural older adults with farm-based assets. At a moment when federal policy affecting older adults is shifting rapidly, this report offers policymakers, providers, and advocates concrete, community-grounded direction.

To extend the reach of these findings, Lutheran Services in America hosted the webinar “From the Ground Up: Using Rural Voices to Build Better Policy for Aging Americans,” the recording of which is available. Together, the report and webinar equip anyone working in aging, rural health, or policy with the evidence and tools to act.

Lutheran Services in America is actively sharing these findings with policymakers, faith and aging partners, and advocates nationwide. The goal is clear: systems that honor the dignity and complexity of aging in place, wherever someone calls home.

Read the report. Watch the webinar. Join the effort. To learn more or explore partnership opportunities, contact Regan McManus.

Regan McManus, Director of Aging Initiatives at Lutheran Services in America.

GOP Push for Second Budget Reconciliation Accelerates Amid DHS Shutdown

April 16, 2026

Republicans are moving quickly toward a second budget reconciliation package as they seek to break the ongoing Department of Homeland Security (DHS) funding stalemate and advance the President’s priorities following release of his Fiscal Year 2027 budget request. Recent White House meetings with GOP leaders signal growing alignment around using reconciliation to fund immigration enforcement, with additional defense and security priorities potentially addressed in subsequent packages.

Senate Majority Leader John Thune (R‑SD), Senate Budget Chair Lindsey Graham (R‑SC), and House Budget Chair Jodey Arrington (R‑TX) are working to advance a budget resolution later this month—the procedural step required to unlock reconciliation. GOP leaders are aiming to pass an initial, narrowly scoped reconciliation bill by late May, potentially before Memorial Day recess.

The immediate focus is funding for Immigration and Customs Enforcement (ICE) and Customs and Border Protection (CBP), as the DHS shutdown stretches beyond 60 days and continues to strain agency operations, including disaster response. Senate leaders have emphasized keeping the bill tightly focused to avoid procedural complications and limit intraparty conflict. However, pressure remains—particularly from House conservatives—to expand reconciliation to fund all of DHS rather than relying on bipartisan appropriations.

Offsets, “Waste and Fraud,” and Medicaid in the Crosshairs

As in prior reconciliation debates, disputes over offsets are re‑emerging. Fiscal conservatives are pressing for spending reductions to pay for new enforcement and defense funding, while Republican leaders increasingly point to “waste, fraud, and abuse” as a source of potential savings. Medicaid has again become central to those discussions.

Although the President’s FY 2027 budget does not explicitly propose Medicaid cuts, it calls for steep reductions in nondefense spending and shifts greater responsibility to states, raising concern among advocates. Arrington and other conservatives have publicly suggested revisiting Medicaid policies that failed Senate reconciliation rules last year, framing potential changes as antifraud or program‑integrity measures rather than benefit reductions.

Advocacy organizations warn that this framing obscures real risks to coverage and services—particularly home‑ and community‑based services—and note that recent polling shows voters prioritize protecting access to basic needs over preventing fraud. They argue that the resurgence of antifraud rhetoric is less about program integrity and more about creating political cover for cuts that would otherwise be difficult to advance.

Divisions Within the GOP Complicate the Path Forward

Despite White House pressure to move quickly, internal GOP divisions continue to complicate the path forward. Senate appropriators are uneasy about sidestepping the traditional funding process, while politically vulnerable Republicans remain wary of being forced into tough votes during reconciliation “vote‑a‑rama” sessions. In the House, razor‑thin margins amplify tension between leadership and hard‑line conservatives pushing for broader scope and deeper offsets.

Why it matters for Medicaid: By relying on reconciliation to fund homeland security and defense priorities, the administration has intensified pressure on Republicans to identify large offsets. Medicaid remains one of the few programs sizable enough to generate those savings, making it likely to stay in the crosshairs—particularly under the banner of antifraud reforms—even as leaders insist benefits will be protected.

Sarah Dobson is Senior Director of Advocacy and Public Policy at Lutheran Services in America.

The Dragonfly’s Journey: Reflections from the 2026 Disability Network Winter Meeting

March 12, 2026

Leaders from across the Lutheran Services in America Disability Network (LSA-DN) gathered for the 2026 Winter Meeting for two days of connection, reflection, and forward-looking conversation about the future of services for people with disabilities. The gathering opened with a reminder that our work is ultimately about people, dignity, and family. Participants reflected on the importance of sustaining themselves and one another in this work while continuing to pursue the shared mission of strengthening communities and expanding opportunity for those we serve.

Throughout the meeting, members engaged with national leaders, policy experts, and one another to explore the evolving landscape related to Medicaid, including long-term services and supports (LTSS) and home- and community-based services (HCBS). Conversations highlighted both the challenges and opportunities ahead, from workforce shortages and budget pressures to innovation in care models, technology, and value-based approaches that prioritize quality of life and independence. Members also celebrated the growing impact of Lutheran Services in America initiatives that are driving system changes across the country, reaching tens of thousands of children, youth, and families while elevating community voice and equity in policy and practice.

Above all, the meeting reaffirmed the strength of the Lutheran Services in America network. By sharing insights across states, learning from emerging models, and advocating together for strong community-based services, members continue to demonstrate the power of collaboration in advancing dignity, independence, and belonging for people with disabilities and their families.

We closed our time together with a devotion reflecting on the dragonfly’s journey from dark waters to flight, a reminder that even in uncertain times, leadership grounded in courage, faith, and care can help our communities rise toward light.

Bill Kallestad is Senior Director of Public Policy and Advocacy for the Lutheran Services in America Disability Network.

2026: Catalyzing Innovation and Collaboration, and Driving Impact

March 11, 2026

We are in a time when change, challenge, and opportunity are all converging across our network. The unique strength of Lutheran Services in America comes from aligning around purpose, partnership, and shared action. As we look ahead, we are putting this mission into action by growing leadership, catalyzing collaboration and innovation, and amplifying a united faith-based voice that shares solutions.

Catalyzing Collaboration and Innovation
Together, we are responding to this moment in meaningful ways. As we celebrate ten years of the Results Innovation Lab, we’re leaning into innovation, partnership, and new ways of working to meet today’s challenges and tomorrow’s needs.

Our Health Through Housing work continues to help members grow their mission by accessing capital, building partnerships, and expanding housing with services at a time when too many people still don’t have a place to call home. In February, we announced an innovative partnership with California Lutheran Homes to provide flexible funding for early-stage development projects. At the same time, new collaborations with SCAN, the RRF Foundation for Aging, and others are helping elevate and deepen our rural aging work.

Growing Leadership Across the Network
We recently hosted our first Leadership and Growth Forum, bringing members together to explore the role of private equity in social service organizations. Peer networks like the Lutheran Information Technology Network (LITN), Lutheran Financial Managers Association (LFMA), and the Mission Leaders community amplify this work, offering trusted spaces for learning, collaboration, and innovation throughout the year. Our monthly “Capitol Conversations” also provide timely insights on federal and state policy.

Amplifying Our Voice, Sharing Solutions
Together, we are advancing practice-informed policy through our ongoing Here We Stand campaign and our broader policy priorities.

Partnering for Impact in a Shifting Medicaid Landscape
Through a two-year partnership with The George Washington University and Health Management Associates, we have surfaced innovations from across our network and translated those insights into a practical guide to help strengthen partnerships and navigate a rapidly changing Medicaid landscape. We will share the guide and key insights from this work during a webinar on March 26.

This network exists for moments like this, to align our leadership, strengthen how we act together, and help shape what comes next.

Alesia Frerichs is the President & CEO of Lutheran Services in America.

Health & Housing Strategy Update

January 30, 2026

Lutheran Services in America’s health and housing strategy continues to gain momentum through the insights and input of our member-driven Housing Solutions Collaborative. After 18 months of shared learning, partnership, and design, we are nearing fruition on a key initiative: the launch of the LSA Flexible Loan Fund. The Fund provides Lutheran Services in America members multiple opportunities to participate, whether as Program Related Investment (PRI) investors, or joining a new, targeted cohort focused on helping members become “loan ready” with projects poised to move from concept to “shovel ready.”

Additional elements of our strategy include working more closely with churches in local communities as trusted partners as they consider new uses for underutilized property to expand affordable housing.

The bi-monthly Housing Solutions Collaborative is an open and energizing space to engage in innovation across the network, advancing solutions that ensure people in our communities have access to safe, stable housing with the services and supports they need to thrive.

To join the Collaborative or learn more about our health and housing strategy, contact Susan Newton at snewton@lutheranservices.org.

Susan Newton is Senior Director of Strategic Initiatives at Lutheran Services in America.

Supporting
Our Neighbors,

TOGETHER.

Our shared Lutheran tradition of service to our neighbor is more vital than ever.

Join us as we work to ensure our network continues delivering essential services to all in need.