States Prepare Applications for Rural Health Transformation Program

In late September, the Centers for Medicare & Medicaid Services (CMS) released guidance and additional information for how states can apply for the appropriated $50 billion in grant funds from the Rural Health Transformation (RHT) Program authorized under the One Big Beautiful Bill Act. The RHT program was designed to help states strengthen rural health care delivery by providing funding and technical assistance to expand access, modernize infrastructure, and support sustainable, community-driven health system transformation. Between FY2026 and FY2030, CMS will distribute the $50 billion across states, with half of each year’s allocation split equally among all approved states and the other half allocated based on state-specific rural health metrics and proposed programming as outlined within applications that will be submitted in response to the RHT Program NOFO. 

State Application Requirements and Program Goals

In preparing their applications, states will need to describe how they will meet the goals of the RHT Program—such as improving rural access, developing workforce strategies, or integrating technology—and outline measurable interventions, sustainability plans, reporting metrics, and coordination with existing rural health systems. Once approved, funding is awarded through a cooperative agreement, meaning states will work collaboratively with CMS during implementation. The program also allows funds for alternative payment model development, mental health and substance use treatment expansion, and strengthening cybersecurity and data systems in rural facilities.

State Preparation Strategies and Early Implementation Approaches

To date, some states have already iterated how they either intend to propose to utilize any awarded funds or how they plan to gather the requisite information to inform their application. While most state processes are relatively consistent, this set of examples illustrates the unique approaches and, in some cases, how far along some states are already in the information collection process.

Mississippi's Consultant-Assisted Application Process

The Governor of Mississippi and state agencies have opened a public survey and are convening a stakeholder forum to collect input on the state’s RHTP plan. Uniquely, the state is requesting quotes from consultants to help draft the state’s application.

Oklahoma's Thematic Focus Areas and Stakeholder Engagement

The Oklahoma State Department of Health issued a Request for Information to collect ideas and feedback from rural residents, providers, and stakeholders as part of drafting its state transformation plan. Notably, the state has identified thematic areas of workforce development, technological innovation, regional partnerships, and healthcare access, among others, as their focus. 

North Dakota's Legislative Committee Approach

The North Dakota Legislature formed an interim committee tasked with forming recommendations and assisting the Department of Health and Human Services with submitting the state’s application for the Rural Health Transformation Program. Notably, legislative leaders said it’s likely a special session will be called in 2026 to accommodate the newly acquired funds, given the Legislature doesn’t reconvene until 2027.

Washington's Comprehensive Public Input Process

The Washington Governor’s office and state agencies are collaborating to prepare the state’s application. They have already collected 285 written responses in its public input process, which helped the state agencies identify priorities that include workforce, supporting essential hospital services, technology infrastructure and building maintenance, and payment reform, among others. 

Application Timeline and CMS Review Process

The application deadline for states to submit their proposals under the Rural Health Transformation (RHT) Program is November 5, 2025. CMS will review, approve, and notify selected state applications by December 31, 2025.

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