On September 15, 2025, the Centers for Medicare & Medicaid Services (CMS) unveiled a significant Notice of Funding Opportunity (NOFO) to establish the Rural Health Transformation Program (RHTP), as mandated by the One Big Beautiful Bill Act (OBBBA). This initiative will allocate $50 billion over five fiscal years (2026-2030) to eligible states that meet specified requirements outlined by CMS. The RHTP aims to strengthen rural healthcare systems by providing a structured framework through which states can submit applications detailing their Rural Health Transformation Plans (RHT Plans).
I. Background of the RHT Program
The $50 billion allocation is aimed at enhancing health access and outcomes for underserved rural populations. Notably, the OBBBA sets forth minimum criteria that each RHT Plan must meet. Crucial components include:
- A clear outline of how the state intends to improve access to health services.
- Improvement of healthcare outcomes within rural communities.
- Metrics for evaluating success, which will aid in future funding distribution.
II. Key Components of the RHT Plan Requirements
As part of the application process, states are required to focus on five strategic goals identified by CMS. Each proposed initiative in the RHT Plan must align with at least one of these goals:
1. Making Rural America Healthy Again:
This goal emphasizes promoting preventive health services and addressing disease root causes to cultivate healthier rural communities.
2. Sustainable Access:
Funding under this goal will support initiatives aimed at improving the efficiency and sustainability of rural healthcare providers, ensuring long-term accessibility.
3. Workforce Development:
To address persistent workforce shortages, RHTP aims at attracting and retaining highly skilled healthcare professionals in rural areas through targeted recruitment and retention strategies.
4. Innovative Care:
The program encourages the development of innovative healthcare models that enhance health outcomes and optimize care delivery.
5. Tech Innovation:
This goal fosters the integration of technology to promote efficient healthcare delivery, data sharing, and access to digital health resources.
III. The Role of Stakeholders
CMS has acknowledged the importance of including various stakeholders in the application process. States must ensure collaboration with key entities, including:
- State health agencies and Medicaid departments.
- Tribal health organizations and rural health advocates.
Stakeholder involvement is not just a formality; states must provide evidence of engagement and support from these groups as part of their application.
IV. Outcomes, Implementation Plans, and Sustainability
Each initiative in the RHT Plan must outline at least four quantifiable metrics to assess impact, covering aspects like access to care, quality of health outcomes, financial sustainability, and workforce metrics. In addition, states must present:
- Implementation Plans: Detailed timelines and governance structures will be required for each initiative.
- Sustainability Strategies: Proposals must demonstrate how the changes will be maintained beyond the funding period.
- Program Duplication Assessments: States need to clarify that RHTP funds will not simply replace existing funding.
V. Evaluation Criteria for Fund Distribution
The funding distribution will follow a two-tiered approach:
- Baseline Funding: Allocated equally among all approved states.
- Workload Funding: Allocated based on metrics related to rural population size and facility counts.
CMS will employ a comprehensive scoring system incorporating both Rural Facility and Population Scores and Technical Scores, assigning points based on various criteria to evaluate applications.
VI. Opportunities for Eligible Providers
Importantly, the RHTP opens funding avenues for all 50 states, regardless of their rural health infrastructure’s size. A range of providers—from urban hospitals to telehealth services—can benefit from the program. Eligible initiatives might include:
- Collaborative care models among healthcare providers.
- Integrated health systems that focus on preventive care and chronic disease management.
This expanded eligibility aims to foster innovative care solutions that address rural health disparities more effectively.
VII. Timeline for Application
The application window is open from September 15 to November 5, 2025. This represents the singular opportunity for states to secure funding within the RHT program over its five-year lifespan. Award announcements are expected by December 31, 2025.
Conclusion
The launch of the RHT Program represents a transformative step in addressing the critical healthcare needs of rural communities across the United States. With a structured plan that includes significant funding, strategic goals, and comprehensive stakeholder engagement, the RHTP aims to revitalize rural healthcare. States are encouraged to leverage this opportunity for innovative projects that improve access and health outcomes for their rural populations.
As application deadlines approach, stakeholders must actively participate in the planning and application processes to ensure that the diverse needs of rural communities are adequately met. The success of this initiative will greatly depend on the collaborative efforts of state governments, healthcare providers, and community stakeholders.
In summary, the RHT Program encapsulates a visionary approach to strengthen rural health systems, and its implementation will necessitate careful planning, engagement, and an unwavering commitment to improving healthcare access and quality in underserved areas.
