Data shows federal health cuts will harm rural communities nationwide.
Three smokestacks towering over the recently-opened Caesars Virginia Casino in Danville serve as a reminder of the city’s industrial roots.
Danville’s economy was built on the textile and tobacco industries until many of its manufacturing plants closed during the 2000s, leaving behind thousands of struggling residents.
The casino’s grand opening last December was a major step in city leaders’ multi-decade revitalization plan. But despite the new growth, many residents are still living on the edge — one medical emergency away from homelessness. And discussions about federal Medicaid cuts are causing concerns for patients and care providers alike.
About 30% of Danville’s roughly 42,000 residents relied on federal low-income health coverage through Medicaid or the Children’s Health Insurance Program in 2023, according to U.S. Census Bureau data analyzed by Georgetown University’s Center for Children and Families.
In its report, Georgetown found that people in rural parts of the country use those federal programs more often than their counterparts in larger metropolitan areas. Virginia follows the same trend; seven of the 10 localities with the highest rates of Medicaid coverage — including Danville — are classified as small towns or rural areas in the Georgetown study.
About 1.9 million Virginians rely on Medicaid, according to the state’s Department of Medical Assistance Services. Roughly 630,000 of them qualify through a 2018 expansion in which the state extended coverage to adults under the age of 65 making less than $21,600 a year.
The federal government pays 90% of the cost of coverage for Virginians insured under the expansion, with Virginia’s private hospitals covering the remainder. But earlier this year, the General Assembly did not do away with a trigger law that would terminate the expansion if Washington dropped its share below 90%, which advocates said would be a devastating outcome for rural communities.
A budget framework passed by the Republican-controlled Congress earlier this month calls for $880 billion in spending cuts from the House Energy and Commerce Committee. A report from the nonpartisan Congressional Budget Office said it’s not possible to make those cuts without removing funding from Medicaid.
”You want to feel like a human being”
Brenda Moore, 52, first moved to Danville with her family when she was 8 years old. Her stepfather worked at Dan River Mills, which made textiles for clothing and home decor, before it closed in 2006.
As an adult, Moore worked as a daycare provider, and at one point juggled three different jobs. But she developed rheumatoid arthritis, which she said made it difficult for her to work. Now, she relies on a walker to move around her home.
“I can’t bend my knees, and when I walk, I walk like a tin man,” Moore said. “Some people might say, ‘Well, you can sit down and work, but you need your hands.’ I wake up with swollen hands every day. So for me, it’s not a reality.”
Moore was living in Atlanta at the time and struggling with bipolar disorder in addition to her physical disability. Her caseworker suggested she move back to Danville, where she would have family support — but when Moore returned to Virginia, she was unable to find an affordable place to live.
She spent two months living in a homeless shelter in Danville before getting on Medicaid.
She said the combination of Social Security Disability Insurance and Medicaid helps her afford housing — which she shares with two other women — and a personal care assistant who helps her clean, cook and take care of herself.
“I felt like God had come through for me and sent a caring hand to my rescue,” Moore said. “You actually feel inhuman when you’re homeless, you feel like nobody cares. You’re just a fixture in society. Who wants to feel like a fixture? You want to feel like a human being.”
Kathy Gibbs, 64, shares her home near Danville’s train tracks with her adult brother and daughter, both of whom have disabilities. All three are on Medicaid.
Gibbs worked as an in-home care provider for adults with developmental disabilities. She got into the work after years of supporting her brother’s needs. She was employed by a local agency for nearly a decade before a sudden onset of crippling pain forced her to stop working in 2019.
“I just kept on getting weaker and weaker, and I couldn’t hold myself up,” Gibbs said. “Then it got to a point where I couldn’t even get up.”
Doctors at the University of Virginia Medical Center eventually diagnosed Gibbs with POEMS syndrome, a rare blood disorder that damages the nerves across a person’s body, making movement difficult.
Gibbs’ medical bills piled up as she sought answers and treatment for her condition. She wasn’t able to work during that time — and said if she hadn’t been approved for disability coverage through Medicaid, she would have lost her home.
“I didn’t have no means of paying my bills,” Gibbs said. “I had to really give them all of my money to get caught up on my mortgage.”
She says since her diagnosis, her body has been riddled with cancer — in both breasts, her lungs, blood and bones. Gibbs takes a medicine that doctors believe could keep her alive for ten years.
She now qualifies for Medicaid and Medicare, which help her cover the cost of her prescriptions and the five-hour round trip to and from her doctor’s visits at UVA Health in Charlottesville.
“Without that medicine, I can’t survive,” Gibbs said. “Without Medicaid, I wouldn’t be able to afford it.”
Gibbs worries about what will happen to her brother and daughter after she dies, and hopes she can leave them a place to live once she’s gone.
“You’ve worked for it all your life, and you want to have something to pass down to your child,” Gibbs said. “I just want to make sure she had a place in case anything happened to me.”
A complex system of care
In addition to in-home caregivers, both Moore and Gibbs rely on help from Martina Tatum, a community health worker who has assisted them in navigating the Medicaid system and accessing resources.
Tatum, who was born in Germany, has been providing care to people in Danville since 2016. Currently, she handles the cases of about 20 people who depend on a variety of government-sponsored programs including Medicaid, Medicare and Social Security for their care.
Her job is funded by the Danville Regional Foundation through a $6.3 million REACH partnership grant, a collaborative effort to address health disparities for poor and underserved communities. The program’s goal is to provide clients support while cutting down on emergency room visits, which can be costly for hospitals and patients.
“A lot of people did not have health insurance,” Tatum said about her clients prior to Virginia expanding its Medicaid coverage in 2018. “They were relying on the emergency room, because that’s the only place that really had to see them.”
Tatum said she noticed a “huge difference” in people being able to access care after the expansion: “The majority of my clients make between $900 [and] $1,200 a month, and you have to pay rent, you have to pay your utilities, you have to eat. So, there is really no money left — not only to go to the doctor, but also to get the prescription filled that the doctor might give you.”
Her clients would often skip regular preventive care services like mammograms or colonoscopies because of the cost associated with the visits. But she says that could leave them in crisis situations, with late diagnoses and fewer options for treatment.
Tatum said she worries what could happen to her patients if Congress cuts funding for Medicaid: “This hits the people that are struggling anyway.”
Congress considers Medicaid cuts
It’s still unclear at this point what, if any, cuts Congress may make to Medicaid funding.
On April 14, a dozen Republican members of Congress sent a letter to the leadership in the U.S. House of Representatives, reiterating their support for Medicaid. The letter said, “Balancing the federal budget must not come at the expense of those who depend on these benefits for their health and economic safety.”
The group, which includes Virginia GOP Reps. Rob Wittman (1st District) and Jen Kiggans (2nd District) — two members that Democrats are reportedly targeting for 2026’s Congressional elections — said they “will not support a final reconciliation bill that includes any reduction in Medicaid coverage for vulnerable populations.”
The Republicans said they’re committed to identifying responsible savings through deregulation, streamlining federal programs and cutting administrative red tape.
VPM News reached out to Rep. John McGuire (R–5th), who represents Danville, for comment, but his office did not respond prior to publication.
Both Brenda Moore and Kathy Gibbs are waiting to see what decisions Congress makes.
“If [they] cut Medicaid services today, I would be homeless.” Moore said. “I just don’t understand why they want to see such a lapse like that.”
Congress returns from recess this week and is expected to make decisions on funding cuts over the next several weeks. Republican lawmakers have until May 9 to outline budget resolution tax cuts, according to reporting by PBS.
Gibbs said Congress should consider cuts elsewhere: “When you worked all of your life, and you paid in and then they’re gonna take your money away from you, it’s just not right.”
