top of page
Modern Architecture
Search

Pulling the Plug: The True Cost of Rural Health Care Cuts


What would you do if a decade-long contract you'd built your business plan around disappeared in a single email?


Key Takeaways


  • CMS shut down Making Care Primary (MCP) in 2025, just one year into a planned 10-year program, leaving nearly 700 practices across eight states scrambling for alternatives.

  • Its replacement routes funding through health care organizations and companies instead of directly to frontline clinicians.

  • CMS projected $750 million in taxpayer savings from ending MCP and three other programs, but former program leaders argue the data needed to justify that conclusion was never collected.

  • Rural primary care is in a full-blown crisis. More than 90% of rural U.S. counties face a primary care physician shortage, compared to 74% of nonrural communities.

  • For big carriers, agents, and marketers, abrupt federal policy shifts like this one create downstream disruption in member access, network adequacy, and product positioning.

  • Trust erosion among rural providers is a real and measurable risk that can affect insurer relationships, Medicare Advantage enrollment, and value-based care contracting.


$10 Million Promise Disappears Overnight

A decade-long commitment vanished in a single email. In March 2025, as the Department of Government Efficiency moved to slash federal spending, the U.S. Centers for Medicare & Medicaid Services (CMS) officially ended Making Care Primary (MCP).


For the 700 practices across eight states that had built their long-term strategies around this 10-year program, the news was a localized earthquake.


For insurance professionals and health care marketers, this is a case study in how abrupt federal decisions ripple outward, affecting provider networks, member access, and long-term market strategy.


What Making Care Primary Was Built to Do

Think of Making Care Primary as a bridge program, one designed to meet smaller, less experienced primary care practices where they were and help them gradually move toward value-based care models.


The program offered a multilayered support structure: prospective payments for primary care services to reduce reliance on traditional fee-for-service billing, bonuses tied to keeping patients healthy, and flexible funding that could be used for nonclinical needs like patient transportation, food vouchers, moving expenses, and utility assistance. It also represented the first time Federally Qualified Health Centers (FQHCs), community health centers serving low-income populations, were included in a multistate advanced primary care payment model.


Clinics enrolled with specific plans in mind. One network of seven clinics in the mountains of western North Carolina was positioned to receive up to $10 million over 10 years. That money was earmarked to hire more staff, improve communication with local specialists, and expand patient transportation services. All of that planning stopped when the cancellation email arrived.


CMS's Rationale: Why Providers Aren't Buying It

CMS didn't cancel Making Care Primary in a vacuum. The agency framed it as a fiscal decision, projecting roughly $750 million in savings by ending MCP and three other programs. The official agency position: Making Care Primary "was not on track to meet its intended savings goal."


That reasoning hasn't gone unchallenged. Elizabeth Fowler directed the CMS Innovation Center (the division that created Making Care Primary) under President Biden. She said the program ended too early to produce any meaningful outcome data. "It's not enough time," she noted, pointing out that enrollment had lagged and that a year simply isn't sufficient to measure health transformation at scale.


A 2023 Congressional Budget Office (CBO) report added further context, criticizing the CMS Innovation Center for increasing spending at nearly double the rate the CBO had projected the center would save. But critics note that canceling programs before they generate evidence doesn't prove they failed. It just guarantees they can't succeed.


For insurers and agents operating in value-based care arrangements, this raises an uncomfortable question: if CMS can walk away from a 10-year commitment in under 12 months, what does that mean for your long-term contracting strategies and provider relationships?


Rural Health Was Already in Crisis; This Made It Worse

To understand why this cancellation stings so deeply, you need to understand the landscape it left behind.


The rural primary care crisis in the United States isn't a talking point. It's a documented emergency. More than 90% of rural U.S. counties face a shortage of primary care physicians, compared to 74% of nonrural communities. As of 2025, 63.1% of all primary care Health Professional Shortage Areas (HPSAs, federally designated zones with inadequate primary care supply) are located in rural areas. In 2023, more than 100 million Americans had no access to a primary care doctor in their immediate area.


The workforce numbers are getting worse. Between 2017 and 2023, the number of rural family physicians dropped by 11% nationally. Rural areas in the Northeast saw the steepest losses, over 15% in just six years. And this is happening at the same time young adults are migrating to rural communities in numbers not seen in nearly a century.


Making Care Primary wasn't going to solve all of that. But it was a structured, federally funded attempt to keep rural providers financially stable enough to stay open.


LEAD and Why It Matters to Carriers

CMS didn't leave a vacuum. The agency announced it would replace Making Care Primary with a new 10-year initiative called the Long-term Enhanced ACO Design (LEAD). On paper, LEAD continues the push toward primary care value-based care.


In practice, the structure is meaningfully different, and that difference matters to anyone doing business in this space.


Under Making Care Primary, funding flowed directly to primary care practices and clinics. Under LEAD, money is routed through health care organizations, which often means managed care companies and larger health systems. For small, independent rural clinics, that's an extra layer of administration and negotiation standing between them and the dollars they need to operate.


A physician and executive in western North Carolina who has direct experience with LEAD-style models put it plainly: "Anytime you put multiple layers of bureaucracy between us and the patients and the dollars, it just costs more."


Practices that want to participate in LEAD must formally apply. That's not a trivial barrier for under-resourced rural clinics already stretched thin.


Signals to Watch

Here's what the end of Making Care Primary is really telling the insurance and health care marketing industries:


  • Federal funding volatility is now a product risk—If you're building Medicare Advantage or Medicaid managed care strategies around federal value-based care program participation, you need contingency planning baked in. Programs that were supposed to run for 10 years can end in 12 months. Network adequacy commitments made with the assumption of certain provider revenue streams may not hold.

  • Provider trust is fragile and it affects your network—State health department spokespeople from multiple states enrolled in Making Care Primary reported that physicians have lost confidence in federal program sustainability. When doctors are skeptical of federal programs, they're also more cautious about insurer partnerships that depend on those programs. Rebuilding that trust takes time you may not have.

  • Rural members are increasingly at risk of being unserved—For carriers administering Medicare Advantage plans in rural markets, network adequacy requirements become harder to meet when rural clinics are financially destabilized. The loss of federal supplemental funding to rural practices is a direct upstream cause of downstream member access problems.


What Agents and Marketers Can Do Right Now

The market disruption created by policy shifts like this one doesn't have to be a liability. Here's how professionals in insurance and health care marketing can turn the situation into strategic clarity:


  • Audit your rural provider network health—Identify which practices in your network were enrolled in Making Care Primary or similar federal programs. Understanding their financial exposure helps you anticipate churn risk before it becomes a claims or access problem.

  • Educate enrollees proactively—Rural members who relied on clinics supported by Making Care Primary may face appointment delays or referral gaps. Getting ahead of those communications protects your member satisfaction scores and reduces avoidable emergency department utilization.

  • Reframe the LEAD opportunity—For agents working with provider groups that qualify for LEAD, the transition period is an opening. Help them understand application timelines, eligibility criteria, and how participation could intersect with your existing value-based care arrangements.

  • Differentiate on stability—In a policy environment this volatile, carriers and agents who communicate long-term partnership commitments and actually honor them will stand out. Rural providers are actively looking for partners they can trust not to disappear.

  • Track state-level responses—Some states, including Colorado, have passed legislation to increase primary care funding outside of federal channels. State-level programs may create opportunities for localized product development or provider contracting that doesn't carry federal program risk.


Lessons for Health Care Strategy

The Making Care Primary story isn't about one canceled program. It's about the systemic fragility of a primary care infrastructure that runs on a patchwork of grants, pilot programs, and federal experiments, none of which are guaranteed past the next administration.


For major carriers, the lesson is that rural market strategy can't be built entirely around federal program participation. For agents, it's a reminder that your rural clients' access situations are shifting in real time and that awareness of those shifts makes you more valuable. For digital marketers in health care, it's an opportunity to tell a different story, one about provider access, care continuity, and what health plans actually do when Washington changes its mind.


Primary care is the foundation of a functioning health system. When that foundation is unstable, everyone downstream feels it, including the people whose job it is to insure, market, and sell health care coverage.


Sources:



Further Thoughts

The end of Making Care Primary is a reminder that health policy moves faster than health systems can adapt. Rural clinics that spent months building staff plans and specialist referral networks around anticipated federal funding are now recalibrating. The providers who remain in these communities are doing so out of genuine commitment to their patients.


For insurers, agents, and marketers who want to build durable relationships in rural markets, that's worth remembering. The trust you earn by showing up consistently, especially when federal programs don't, compounds over time.


The patients are still there. The question is whether the partnerships and the payment structures will be, too.


Follow us on LinkedIn and join the Insurance Marketing Coalition (IMC) to connect with fellow members.



 
 
 

Recent Posts

See All

Comments

The IMC Blog

bottom of page