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Leveraging the Rural Health Transformation Fund to Improve Access to Care

May 14, 2026

BY: Shao-Chee Sim and Sue Polis

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

BY: Sarah Dobson

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.

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

BY: Eventide

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.

GOP Push for Second Budget Reconciliation Accelerates Amid DHS Shutdown

April 16, 2026

BY: Sarah Dobson

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

BY: Bill Kallestad

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

BY: Alesia Frerichs

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

BY: Susan Newton

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.

What We’re Expecting in 2026: Takeaways from our Capitol Conversations

January 29, 2026

BY: Kylie Bowlds

As 2026 begins, many forces, especially in changes to federal policy, are further shaping an already challenging landscape. With a one-seat Republican majority in the House, will compromise be the order of the day? That question looms, along with a key government funding deadline, and rising concerns about further impacts in access to care with the ACA tax credits expired. In our January Capitol Conversations webinar, we examined federal policy developments across our three priority areas — Medicaid, workforce, and health and housing — with a clear takeaway: decisions in Washington will have immediate, real-world impacts on providers and the communities they serve. Here are three key takeaways:

Medicaid and Behavioral Health: Medicaid remains a key focus, particularly as states move forward with implementing new work requirements and managing constraints on provider taxes, which in many states take effect later this year. Speakers also highlighted the recent reversal of SAMHSA grant cancellations that would have affected mental health and addiction treatment providers – and concern that we may see more sudden funding shifts ahead. Moreover, with Congress expected to finalize government funding by January 30 even with strong Democratic opposition to further funding for Immigration and Customs Enforcement (ICE), speakers emphasized close monitoring of funding decisions and the critical role of provider advocacy in shaping outcomes.

Workforce: Workforce shortages across health care and long-term services and supports continue to draw attention. Several immigration-related bills — including the Healthcare Workforce Resilience Act, Strengthening Our Workforce Act, Dream Act of 2025, and Dignity Act — aim to bolster the workforce while maintaining system integrity. While bipartisan interest remains, momentum may slow as midterm elections approach, making provider engagement especially important.

Health and Housing: Speakers discussed recent Department of Housing and Urban Development (HUD) disruptions related to Continuum of Care funding – although 12-months of continued funding is part of the Transportation and Housing funding bill, which is expected to pass.  At the same time, speakers noted cautious optimism around the bipartisan Road to Housing Act, which could advance later this year and would strengthen coordinated, evidence-based responses to homelessness.

Across all issues, speakers stressed the importance of grounding advocacy in lived experience and maintaining strong relationships with policymakers. Now more than ever: stay engaged, stay informed, and stay grounded in your communities.

 

Kylie Bowlds is an Issue Education & External Relations Associate at Lutheran Services in America. 

Midterm Elections: Redistricting and Competitive House Races

March 3, 2026

BY: Kylie Bowlds

Ahead of November’s midterm elections where the balance of power in the House of Representatives is currently down to a one-seat margin, there are several factors coming into play. From efforts across the country to redraw congressional maps (also known as ‘redistricting’) continue to take shape to several states entangled in legal battles and pending judicial decisions, while other states are considering last-minute changes that could materially alter the electoral map ahead of this year’s midterm elections.

Redistricting & Legal Challenges in States: Recent reporting shows that states including Texas, California, Ohio, Florida, Maryland, Illinois, New York, Utah, Missouri, and North Carolina are either facing active lawsuits, implementing new maps, or considering further redistricting measures.

Federal Law: Two major pieces of federal law — the Safeguard American Voter Eligibility (SAVE) Act and the Voting Rights Act — also have the potential to significantly influence the conditions under which the midterms unfold.

The SAVE Act, which passed the House in 2025, would require documentary proof of U.S. citizenship for voter registration in federal elections. This requirement would effectively make online and mail–in registration inaccessible, since applicants must present original documents in person. Analyses indicate that access to qualifying documents varies widely across demographic groups, with low–income voters, urban residents, and others facing potential barriers due to difficulties obtaining or updating documents such as birth certificates or passports.

Under the Voting Rights Act, the Supreme Court’s upcoming decision in Louisiana v. Callais could significantly weaken or even effectively eliminate Section 2 of the Voting Rights Act –a provision that has long prevented states from dismantling minority opportunity districts. If the Court guts Section 2, Republicans could gain numerous House seats across the South, though tight election timelines may limit states’ ability to redraw maps before the midterms elections later this year.

Taken together, these legal and legislative developments introduce substantial uncertainty into the 2026 landscape, with both voter access and the shape of key congressional districts hanging in the balance. And with so much still unsettled, the stakes become even clearer when looking at the individual House and Senate races that will ultimately decide control of Congress.

In the House, Democratic Toss Ups include:

  • OH-01 Landsman
  • OH-09 Kaptur
  • TX-34 Gonzalez
  • WZ-03 Perez

Republican Toss Ups:

  • AZ-01 Open (Schweikert)
  • AZ-06 Ciscomani
  • CA-22 Valadao
  • CA-48 Issa
  • CO-08 Evans
  • IA-01 Miller-Meeks
  • IA-03 Nunn
  • MI-07 Barrett
  • NJ-07 Kean Jr.
  • NY-17 Lawler
  • PA-07 Mackenzie
  • PA-10 Perry
  • VA-02 Kiggans
  • WI-03 Van Orden

Senate races that are expected to be competitive include:

  • Sen. Susan Collins (R-ME)
  • Sen. Jon Ossoff (D-GA)
  • Open seats in Michigan and North Carolina

What you can do now? 

With the midterms approaching and many competitive toss ups, we encourage our members to take the following steps to stay engaged and prepared:

  • Stay connected and monitor emerging candidates in toss-up states and districts — including congressional and gubernatorial races.
  • Monitor State Level Redistricting in your State to stay aware of any newly competitive seats that emerge as maps evolve.
  • Utilize the Congressional calendar to check as to when your elected officials are on recess and available for meetings and site visits.
  • Strengthen Voter Outreach by ensuring your communities understand potential documentation requirements and any changes to voter registration processes.

Kylie Bowlds is an Issue Education & External Relations Associate at Lutheran Services in America.

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