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.









