Texas passes major rural health bill

Texas lawmakers passed House Bill 18 in June 2025, a sweeping rural health law designed to keep small hospitals open and expand access to care in underserved parts of the state. The bill, effective immediately, creates a new State Office of Rural Hospital Finance to help struggling hospitals stay solvent, establishes several new grant programs to stabilize or modernize rural facilities, and directs the state to expand tele-health and mental health services in those areas.

A key provision requires Texas to build a perinatal mental-health network by September 2026, giving hospitals and clinics in rural counties access to mental-health specialists for children and new mothers. The law also adjusts Medicaid reimbursement rates for rural hospitals and requires the state to track which hospitals are most at risk of closing.

Note: While the bill is primarily about rural health infrastructure, it does include a clause that restricts gender-affirming mental-health services for minors.

Why it Matters

By shoring up rural hospitals and expanding tele-health, HB 18 helps preserve access to primary care, maternity support, and mental health services — all areas where women are most affected by local closures. But the law’s total impact will depend on funding: many of its programs take effect only if future legislatures approve the money. Texas has also chosen not to expand Medicaid, leaving hundreds of thousands of women uninsured. That coverage gap remains the biggest barrier to care.

Background

Texas has lost 26 rural hospitals since 2010 — more than any other state — and many more operate on thin margins. Women, who make up a large share of healthcare workers and patients in these communities, are disproportionately affected when hospitals close or reduce services.

HB 18 creates new funding streams and tools to address that trend. Supporters see it as a turning point for rural access. But without Medicaid expansion or guaranteed funding for the tele-health rollout, it’s more of a foundation than a full fix. HB 18's success will depend on whether Texas continues to invest in the programs it just created.