What Is the Rural Health Transformation Program (RHTP)? A Clear Explainer for States and Stakeholders

 

The Rural Health Transformation Program (RHTP) is a major federal initiative designed to strengthen healthcare systems across rural America. The RHT program seeks to improve access to care, enhance health outcomes, and ensure the sustainability of rural health and human services infrastructure. With $50 billion in funding available through 2031, the program gives states a historic opportunity to redesign how rural healthcare is delivered, financed, and sustained. The program is authorized and supported by the Centers for Medicare and Medicaid Services (CMS), which is part of the U.S. Department of Health and Human Services, ensuring federal oversight and alignment with national health priorities.

At its core, RHTP is about long-term system transformation. It is not a short-term grant or pilot project. The program offers a significant funding opportunity for states and organizations to access resources through open letters of interest and official funding application notices. It is a strategic investment in improving rural health access, stabilizing providers, strengthening the workforce, advancing health equity, and reducing preventable health crises, with support extending to both health and human services.

For states, this means moving beyond incremental improvements and toward structural change designed to benefit rural populations specifically.

 

Why RHTP Was Created

Rural healthcare systems face persistent challenges:

• Hospital closures and financial instability
• Workforce shortages across clinical and support roles, including the need to support rural providers’ practices and expanded provider types
• Limited access to specialty care
• Higher rates of chronic disease
• Fragmented care coordination
• Geographic barriers to preventive services
• Addressing the rural community’s needs through tailored workforce development and service expansion

The Rural Health Transformation Program was created to address these structural weaknesses. Rather than focusing on isolated fixes, RHTP encourages states to rethink how rural healthcare ecosystems function within the broader healthcare system.

The goal is sustainable, measurable improvement in rural health outcomes. Strengthening recruitment of high-skilled healthcare providers is a key workforce development strategy to improve access and service quality in rural areas.

 

How Much Funding Is Available?

 

The Rural Health Transformation Program is one of the largest rural health investments in recent history.

RHT Program funding is $50 billion, allocated to approved States over five fiscal years, with $10 billion available each fiscal year, beginning in fiscal year 2026 and ending in fiscal year 2030.

• 50% to be distributed equally amongst all approved States
• 50% will be allocated by CMS based on a variety of factors, including rural population, the proportion of rural health facilities in the State, the situation of certain hospitals in the State, and other factors to be specified by CMS in the Notice of Funding Opportunity (NOFO).

Half of the funding is distributed to states that submit approved transformation plans outlining how they will strengthen rural healthcare systems. The emphasis is on long-term impact, measurable results, and system-wide redesign.

This is not simply operational funding. It is transformation funding.

 

Rural Health Transformation Program Structure and Governance

 

The Rural Health Transformation Program (RHTP) operates through a cooperative agreement between the Centers for Medicare and Medicaid Services (CMS) and each participating state. This structure ensures that states have both the resources and flexibility needed to support rural health innovations and drive meaningful improvements in health outcomes for rural communities. CMS administers the program, providing not only funding but also technical assistance to help states promote efficient care delivery and achieve rural health transformation.

States are required to develop and submit a comprehensive rural health transformation plan that details their strategies to improve health care in rural areas. These plans must demonstrate how states will implement flexible care arrangements, improve patient health outcomes, and reduce long-term health care costs. The governance model is designed to foster collaboration, accountability, and innovation, ensuring that the health transformation program delivers sustainable benefits to rural populations. By focusing on system-wide change, the RHTP empowers states to lead the way in rural health innovations and create resilient, high-performing rural health systems.

 

What States Are Being Asked to Do

 

States participating in the Rural Health Transformation Program are expected to develop comprehensive strategies that improve rural healthcare access, sustainability, and quality. These projects support access to remote care, digital health tools, and emerging technologies, particularly benefiting rural providers, facilities, and patients. RHT Program support helps states achieve their goals by enabling collaboration, resource sharing, and coordination of care services.

While each state’s approach may vary, CMS outlines several core focus areas:

1. Improve Access to Care in Rural Communities

States are encouraged to ensure rural residents have reliable access to primary care, specialty care, preventive services, and behavioral health services. This may include innovative delivery models, expanded service sites, telehealth integration, new care partnerships, and the establishment of new access points to promote preventative health and expand healthcare services in rural areas. Emergency services also play a crucial role in ensuring comprehensive access and improving efficiency for rural providers.

The objective is to prevent rural communities from losing critical access points for care by establishing long-term access points and ensuring sustainable access through regional collaboration and strategic investments.

2. Strengthen and Stabilize the Rural Healthcare Workforce

Workforce shortages are among the most pressing rural health challenges. States are asked to implement strategies that:

• Recruit and retain healthcare professionals in rural areas
• Expand training pathways
• Support cross-disciplinary roles
• Improve workforce sustainability
• Expand the role of community health workers in rural areas to help patients navigate the healthcare system and support a broader range of providers

This includes not only physicians and nurses, but also allied health professionals, care coordinators, community-based providers, and community health workers who play essential roles in rural systems. Collaboration with accountable care organizations is also encouraged to enhance workforce sustainability and care delivery through innovative care models.

A stable workforce is foundational to long-term transformation.

3. Promote Preventive Health and Address Root Causes

RHTP emphasizes shifting from reactive, crisis-driven care to preventive and proactive models.

States are encouraged to:

• Strengthen early detection efforts
• Address chronic disease management
• Improve care coordination
• Coordinate care across providers and settings to enhance prevention
• Focus on upstream drivers of health
• Promote flexible care arrangements that support innovative, patient-centered preventive health approaches

Reducing avoidable hospitalizations and emergency department visits is a key outcome target. Prevention improves health outcomes while also lowering avoidable costs. These strategies are designed to improve health outcomes for rural populations by fostering more efficient, coordinated, and adaptable healthcare delivery.

4. Support Innovative Care Delivery and System Redesign

States are given flexibility to test new care models that improve rural healthcare sustainability. This could include:

• Integrated care networks
• Value-based payment models
• Data-driven quality improvement systems
• Community-based partnerships
• Building high-quality regional systems to support rural providers through shared resources and coordinated care across facilities

Rural facilities are key participants in system redesign, adopting digital health tools and fostering technology adoption to enhance efficiency, sustainability, and care coordination. Improving efficiency is a central goal, enabling rural healthcare providers to become long-term access points for care through better coordination and resource sharing. The program also emphasizes the importance of data security in digital health innovations, ensuring the protection of sensitive health information and safe data sharing within these initiatives.

The program encourages innovation that leads to measurable improvements in access, quality, and cost efficiency.

5. Ensure Long-Term Sustainability

A major component of RHTP is building systems that last beyond the funding window.

States must demonstrate how their transformation strategies will create durable infrastructure, improved care coordination, stable workforce models, and measurable outcomes that continue well into the future.

The goal is not temporary stabilization — it is structural resilience.

 

Statewide Initiatives and Partnerships

 

The RHTP encourages states to launch ambitious statewide initiatives and build strong partnerships to improve health outcomes in rural communities. These initiatives are designed to promote preventative health, enhance chronic disease management, and strengthen cybersecurity capability development across rural health facilities. States are incentivized to develop projects that support access to care, improve disease prevention, and address the root causes of health disparities in rural areas.

Collaboration is at the heart of these efforts. The program fosters partnerships between healthcare providers, community partners, and rural health facilities to create more effective healthcare delivery systems. Technical assistance is provided to rural providers to help them adopt innovative care models, such as value-based care arrangements and alternative payment models, which are proven to reduce health care costs and improve patient health outcomes. By supporting these statewide initiatives and partnerships, the RHTP helps rural communities benefit from cutting-edge care approaches, ensuring that rural health systems are equipped to meet current and future challenges.

 

Advisory Councils and Stakeholder Engagement

 

To ensure that the Rural Health Transformation Program reflects the needs and priorities of rural communities, RHTP establishes advisory councils composed of diverse stakeholders in each state. These councils include healthcare providers, community partners, and rural health experts who offer guidance on program implementation and funding priorities. Their insights are crucial for identifying needed preventative measures, promoting evidence-based practices, and supporting the adoption of innovative models of care.

Stakeholder engagement goes beyond advisory councils. The program actively involves rural communities and healthcare providers through webinars, meetings, and collaborative forums, ensuring that a wide range of voices are heard throughout the transformation process. Additionally, RHTP invests in workforce development initiatives, such as community health worker programs, to build local capacity and strengthen the rural health workforce. This inclusive approach helps ensure the health transformation program is responsive, effective, and tailored to each rural community’s unique needs.

 

What Makes RHTP Different from Previous Rural Health Initiatives?

 

Many past rural health efforts have focused on individual grants, pilot programs, or isolated service expansions.

RHTP is different because it:

• Operates at the state systems level
• Encourages broad redesign rather than incremental change
• Emphasizes prevention and sustainability
• Ties funding to measurable transformation goals
• Provides a multi-year financial runway

This scale enables states to align rural hospitals, clinics, workforce development programs, public health systems, and health care providers—including those collaborating with Tribal health programs, community organizations, and local governments—under a unified transformation strategy.

 

Evaluation and Monitoring

 

A robust evaluation and monitoring framework is central to the RHTP’s commitment to improving health outcomes in rural communities. The program tracks key metrics on patient health outcomes, healthcare costs, and access to care, providing a clear picture of its impact. Evaluation efforts also focus on promoting efficient care delivery, retaining clinical workforce talent, and advancing cybersecurity capability development within rural health systems.

To support these efforts, RHTP offers technical assistance to states, helping them develop effective data systems and performance metrics. The program also encourages the adoption of innovative technologies, including digital health tools, to enhance healthcare delivery and patient engagement. By continuously monitoring progress and leveraging data-driven insights, the RHTP ensures that its strategies remain effective and that rural communities experience real, measurable improvements in health and wellness.

 

Why RHTP Matters for Rural Communities

 

Rural residents experience higher rates of chronic disease, greater transportation barriers, and more limited provider access than urban populations. Without intervention, these disparities widen over time.

RHTP represents a significant opportunity to:

• Preserve rural hospitals and clinics
• Expand care access
• Reduce preventable health crises
• Strengthen local economies through workforce investment
• Improve long-term health outcomes

By focusing on health innovations, preventive care, and the root causes of health issues specific to rural communities, the program aims to make rural America healthier and revitalize rural populations.

The program signals a federal recognition that rural healthcare requires structural solutions, not temporary fixes.

 

Looking Ahead

As states develop and submit their Rural Health Transformation plans, stakeholders across healthcare, public health, workforce development, and community services will play important roles in shaping implementation.

The success of RHTP will depend on thoughtful design, data-driven strategies, and inclusive planning processes that account for the needs of diverse rural populations.

Because true transformation only happens when systems are built to work for everyone who depends on them.

Why #IDDinRHTP Matters: Ensuring People with IDD Are Part of the Rural Health Transformation Program

 

The Rural Health Transformation Program (RHTP) is historic. Authorized by the One Big Beautiful Bill Act under specific sections of public law, and administered by the Centers for Medicare & Medicaid Services (CMS) through a federal cooperative agreement, this $50 billion federal investment is designed to transform rural healthcare delivery across America by improving access, quality, sustainability, and outcomes for rural communities. The funds are distributed annually over each federal fiscal year from 2026 to 2030. It gives states a once-in-a-generation opportunity to rethink how healthcare is delivered, how health systems operate, and how prevention becomes a core part of rural health strategy.

Yet unless people with intellectual and developmental disabilities (IDD) are intentionally included in that transformation, rural systems will fall short of their own goals — and rural residents with IDD will continue suffering disparate, preventable outcomes.

That’s why the movement #IDDinRHTP goes beyond hashtag advocacy, serving as a community strategy for health equity, workforce stability, and measurable impact in rural communities.

What CMS’s Rural Health Transformation Program Is — and Why It Matters

 

CMS’s official RHTP overview describes a bold framework for change: states will strengthen rural healthcare ecosystems by transforming how care is delivered so that preventive health, access, workforce development, and sustainability are central drivers of improvements. This large-scale, systematic healthcare improvement initiative aims to enhance access, quality, workforce, and infrastructure for better health outcomes across rural communities.

The RHTP is built around strategic goals that are familiar to anyone who has worked on rural health issues — goals that also align closely with long-standing gaps in IDD support:

• Make rural America healthy again, by promoting prevention and explicitly working to address root causes of disease through evidence-based interventions.
• Ensure sustainable access, so rural providers remain long-term access points for support.
• Build and retain a strong rural workforce, with recruitment, retention, and expanded roles.
• Support innovative care delivery and systems redesign, including the transformation of health care delivery systems to improve access, strengthen the workforce, and organize services more effectively across rural regions.

These goals reflect not just CMS priorities, but the future of rural health in the United States.

Yet a program this ambitious — and this flexible — depends on how states design and implement their transformation plans. And that design must include the realities of people with IDD.

 

Program Structure and Funding Opportunity

 

The Rural Health Transformation Program (RHTP) represents a landmark $50 billion federal funding opportunity dedicated to advancing rural health transformation across the United States. Administered by the Centers for Medicare & Medicaid Services (CMS), the program is structured to deliver $10 billion annually to states over five fiscal years, beginning in 2026. This substantial investment is designed to support rural communities by improving health outcomes, strengthening health and human services, and expanding Medicaid services in rural areas.

The RHTP’s program structure is intentionally flexible, allowing states to tailor their approaches to the unique needs of their rural populations. Funding is directed toward supporting rural health innovations, promoting efficient healthcare delivery, and ensuring sustainable access to care and support. States are encouraged to use these resources to retain and develop the clinical workforce, enhance cybersecurity capability development, and build resilient rural health systems. By focusing on these strategic priorities, the RHTP aims to drive meaningful health transformation and create lasting improvements in rural health outcomes.

 

The Rural IDD Reality: Why Inclusion Is Non-Negotiable

 

People with IDD experience significantly higher rates of preventable health complications, unmet healthcare needs, and premature mortality compared to the general population. In rural areas — where health systems are already strained, and where workforce shortages and structural barriers are more acute — these disparities are amplified. The rural population, with its unique geographic, demographic, and resource challenges, faces additional barriers to accessing appropriate healthcare and support, especially for people with IDD.

Despite being one of the highest-risk populations, people with IDD are often left out of broad rural health strategies unless inclusion is intentional.

That means health risk identification systems, workforce development plans, preventive health care innovations, and access models must be designed to meet the needs of rural residents with IDD and their supporters.

CMS’s RHTP goals underscore prevention, sustainability, and workforce development — but without intentional inclusion, states may overlook people with IDD even as they pursue these very priorities.

 

Prevention Is Central — for Everyone

 

CMS’s vision for RHTP places preventive health and root cause intervention at the forefront of rural transformation. States are encouraged to support rural health innovations and new access points that promote preventative health and address underlying disease causes.

For people with IDD, preventive support is essential. Many chronic and avoidable health conditions in people with IDD result from a lack of early screening, insufficient provider training, or failure to coordinate across systems.

When rural transformation includes structured risk identification, integrated data systems, and provider education that explicitly accounts for people with IDD, prevention becomes real. It means fewer hospital visits, fewer emergencies, and improved quality of life.

Prevention is the foundation of cost-effective, sustainable rural health care. And #IDDinRHTP ensures people with IDD are part of that foundation.

Workforce Development: Solving Two Problems at Once

Workforce shortages are a critical barrier in rural health. CMS’s RHTP goals emphasize that states should focus on strengthening recruitment and retention of healthcare providers as a key workforce development strategy to expand the rural workforce.

Yet the disability services workforce — particularly direct support professionals (DSPs) — experiences some of the highest turnover in rural systems, with some estimates showing 40–50% annual turnover. This workforce gap directly affects people with IDD by limiting support continuity, undermining preventive healthcare, and increasing avoidable crises.

RHTP funding can help states invest in robust training, cross-disciplinary workforce development, and career pathways that unify healthcare and disability support roles. When workforce development includes IDD-competency training and retention incentives, rural systems benefit from:

• Improved provider confidence and skill
• Reduced turnover and higher continuity of support
• Better outcomes for rural residents with complex needs

This is exactly the kind of workforce strategy RHTP was designed to support — and #IDDinRHTP ensures that these investments reach one of the most underserved populations.

 

Tech Innovation for Sustainable Access

 

A core pillar of the Rural Health Transformation Program is its commitment to tech innovation to ensure sustainable access to support for rural communities. The program champions the adoption of innovative technologies, including digital health tools, to help rural providers and facilities deliver high-quality, efficient health care. By leveraging significant advances in information technology, the RHTP empowers rural health systems to implement evidence-based, outcomes-driven interventions that directly improve patient health.

The program also prioritizes the development of secure digital infrastructure, recognizing that data security is essential for protecting patient information and supporting the effective use of digital health tools. Through targeted investments, rural facilities gain the capacity to implement innovative technologies that streamline health care delivery, facilitate chronic disease management, and promote preventative health. These advancements not only improve health outcomes but also help reduce healthcare costs and ensure that rural communities have sustainable access to the health care they need.

 

Collaborative Approaches to Rural Healthcare

 

The Rural Health Transformation Program recognizes that collaboration is key to addressing the complex challenges faced by rural healthcare systems. By fostering partnerships among healthcare providers, rural facilities, and community partners, the program encourages the development of innovative models that are tailored to the unique needs of rural communities. These collaborative efforts are designed to promote flexible care arrangements, support value-based care arrangements, and explore alternative payment models that reward high-quality, patient-centered support.

To further support rural providers, the RHTP provides technical assistance to develop projects that improve patient health outcomes and address social determinants of health. By working together, stakeholders can create new access points, coordinate support more effectively, and implement measurable interventions that drive health transformation. This collaborative approach not only improves access to health care but also helps reduce health disparities and enhances the overall well-being of rural populations.

 

Data, Outcomes, and Accountability: The Power of Measurement

 

One of the most exciting aspects of the Rural Health Transformation Program is its emphasis on innovative healthcare models, measurement, and sustainable system redesign. CMS encourages states to think beyond short-term fixes and toward structures that will produce long-lasting impact.

But data systems that measure rural health outcomes must also capture the realities of people with IDD. Traditional healthcare metrics often miss critical aspects of disability health — such as functional status, unmet support needs, or service coordination effectiveness. Without disability-inclusive metrics, transformation outcomes will remain blind to the very populations most in need.

#IDDinRHTP advocates for data systems that:

• Track IDD-specific health outcomes
• Integrate across clinical and community services
• Enable linkage between preventive care and long-term support outcomes

When data reflect real experience, rural systems can adapt in ways that genuinely improve lives — especially for those historically left on the margins.

 

Advisory Councils and Stakeholder Engagement

 

Advisory councils and stakeholder engagement are foundational elements of the Rural Health Transformation Program’s approach to rural health transformation. The program establishes advisory councils composed of community partners, healthcare providers, and representatives from rural facilities to guide the application process, set funding priorities, and shape program development. These councils play a critical role in recommending eligible project types and providing input on program evaluation, ensuring that the voices of rural communities are heard at every stage.

Stakeholder engagement is further supported through regular webinars, meetings, and written guidance, creating multiple avenues for input and collaboration. By actively involving stakeholders, the RHTP ensures that the funding opportunity is responsive to the real needs of rural communities and that health outcomes are improved through inclusive, community-driven strategies.

 

Health Equity Means Including People with IDD

 

Health equity is central to CMS’s work and to the spirit of RHTP. But equity cannot be achieved if one of the most medically at-risk populations is missing from the design, implementation, and evaluation of rural health transformation strategies.

People with IDD deserve:

• Access to IDD-competent support and preventive screening
• Coordinated services across healthcare and support systems
• A workforce that understands their unique needs
• Sustainable rural systems—including inclusive rural health care and strong rural hospitals—that support both clinical and disability services

This is what meaningful inclusion looks like. And it’s what #IDDinRHTP is driving toward.

 

Lessons Learned and Future Directions

 

The Rural Health Transformation Program has already yielded important lessons about what it takes to drive meaningful change in rural healthcare. Key insights include the value of collaborative approaches, the transformative potential of tech innovation, and the critical role of advisory councils in guiding program priorities. The program has also highlighted the ongoing need for technical assistance, sustained funding opportunities, and robust stakeholder engagement to support rural healthcare providers and facilities.

Looking ahead, the RHTP remains committed to its strategic goals: improving access to care, reducing health disparities, and enhancing the quality of health care in rural areas. By building on these lessons learned and continuing to innovate, the program can ensure that rural health transformation is both effective and sustainable. As rural communities evolve, the RHTP will adapt to meet new challenges, always focused on improving health outcomes and the well-being of rural Americans.

 

A Call to Action for States and Stakeholders

The Rural Health Transformation Program is unprecedented in scale and ambition. But it will only succeed if the transformation is truly inclusive.

States must include people with IDD in their RHTP plans—not as an afterthought, but as an intentional, core component of prevention, workforce, and measurement strategies. This includes targeted efforts to improve access for people with IDD in rural areas.

For rural health equity, sustainability, and outcomes that matter, this is essential. States and stakeholders must also promote efficient health care delivery as part of inclusive rural health transformation.

Because transformation isn’t transformation unless it works for everyone.

 

#IDDinRHTP: Disability inclusion is rural health transformation.