Arizona

Arizona was awarded $166M per year for the Rural Health Transformation Program, supporting initiatives in workforce development, access, chronic disease, behavioral health, and rural health system resilience. The state focuses on enhancing maternal and fetal health, upskilling providers, and expanding chronic disease prevention. Multiple statewide strategies address health infrastructure, care access, and workforce capacity in rural and Tribal communities. Key contacts: Sheila Sjolander sheila.sjolander@azdhs.gov Event schedule: - RHTP Application Submission Date - 11/05/2025 - MT - Arizona Department of Health Services - Arizona Rural Health Conference - 06/03/2026 - MT - Arizona (venue unspecified) - Maternal Mental Health Advisory Committee Report Due - 12/31/2026 - MT - Arizona - Behavioral Health Loan Repayment Program Supplement Application Opens - 08/01/2026 - MT - Arizona - Behavioral Health Loan Repayment Program Supplement Application Closes - 08/31/2026 - MT - Arizona

Arizona was awarded $166,988,956 in federal funds under RHTP to strengthen rural healthcare. Strategic focus areas include telehealth expansion, workforce development, EHR upgrades, and grants for behavioral health, chronic disease, and maternal health. The program phases include setup, implementation, and continuous improvement with ongoing stakeholder engagement.

This Notice of Funding Opportunity (NOFO) invites all U.S. States to apply for participation in the $50 billion Rural Health Transformation Program. The program will invest in rural health system transformation across five budget periods (2026-2030), supporting innovative care delivery models, workforce development, quality improvement, and technology upgrades to improve rural healthcare outcomes. Key contacts: MAHARural@cms.hhs.gov; Grants@cms.hhs.gov; Grants@cms.hhs.gov Event schedule: - Informational program introduction applicant webinar - September 19, 2025 - ET - program website - Informational program introduction applicant webinar - September 25, 2025 - ET - program website - Optional letter of intent deadline - September 30, 2025 - ET - Application submission deadline - November 5, 2025 - 11:59 PM ET - Expected award date - December 31, 2025 - Expected earliest start date - December 31, 2025 - Optional letter of intent due - 2025-09-30 - 23:59 ET - Application due - 2025-11-05 - 23:59 ET

The AHCCCS Division of Behavioral Health and Housing (DBHH) manages federal grants, including RHTP, with a focus on supporting integrated systems of care, crisis services, and housing initiatives. Funding is distributed to contracted health plans and tribal partners throughout Arizona. The grants are designed to enhance access to behavioral health and substance use disorder services across rural regions. Event schedule: - Application deadline: , 2026 - July 17 - Expected Award Date: 9/1/2026

Arizona is planning to apply for up to $500 million over five years from the new federal Rural Health Transformation Program. The opportunity emphasizes technology, workforce, and quality improvement for rural hospitals and health providers. Final CMS decisions are due by December 31, 2025, with implementation to follow if approved. Key contacts: Dan Derksen, MD; Bryna Koch, DrPH Event schedule: - Deadline for CMS approval or denial of State RHTP proposals - 12/31/2025

Arizona RHTP was awarded $166.9 million for rural health transformation initiatives, including $43.1 million for workforce development. The program is aligned to CMS priorities and targets recruitment, training, and retention of rural and tribal health professionals. Priority activities include clinical rotations, residency slots, financial incentives, and expansion of healthcare programs across educational institutions and provider sites. Key contacts: Mary Foote Mary.Foote@oeo.az.gov Event schedule: - Procurement Release - Spring 2026 - All Budget Year 1 Subawards Executed by - October 30, 2026

This brief summarizes key maternal health gaps and opportunities in rural Arizona under the Rural Health Transformation Program authority. It identifies the highest maternal mortality rates among rural American Indian women, critical rural workforce shortages, limited hospital access to obstetrics, and outlines policy, payment, telehealth, and workforce strategies for transformation. It directly references new RHTP flexibilities under H.R.1 for expanding rural maternal health and outlines concrete recommendations for sustainable service access. Event schedule: - H.R.1 (OBBBA) Signed into Law - 07/04/2025 - Nationwide - Toolkit Published/Updated - 10/22/2025 - Arizona Center for Rural Health

This nationwide CMS summary profiles FY26 RHTP applications from Alabama through Louisiana. All states focus on multi-year, comprehensive rural health transformation. Major themes include maternal health, chronic disease management, workforce growth, telehealth and technology, and value-based care adoption. Explicit investment proposals by state are included, with most states committing to provider incentives, regional partnerships, and infrastructure expansion.

The AHCCCS 2025-2029 Strategic Plan emphasizes advancing whole-person care, reducing the uninsured rate, and improving provider satisfaction. Notable initiatives include the H2O program to connect housing and health resources and a modernization of the Medicaid Enterprise System to strengthen fraud, waste, and abuse oversight. Stakeholder engagement and data-driven targeting underpin efforts to enhance health outcomes for rural and Medicaid populations.

Event schedule: - AHCCCS Population as of , 1985 – 2025 2,500,000 2,000,000 1,500,000 1,000,000 500,000 0 - July 1 - 1115 Demonstration Waiver Renewal - Current 1115 Waiver Overview ● Arizona’s current 1115 Waiver was last approved for a five-year extension on , 2022. This waiver is valid until September 30, 2027. ● This extension continued many longstanding AHCCCS programs including Integrated Managed Care through: ○ AHCCCS Complete Care (ACC); ○ the Arizona Long Term Care System (ALTCS); ○ the Comprehensive Health Plan (CHP) for children in foster care and; ○ Regional Behavioral Health Agreements (RBHAs) which provide integrated care for individuals with a Serious Mental Illness (SMI) - October 14 - Current 1115 Waiver Overview ● In addition to continuing many longstanding programs, AHCCCS also received approval on a variety of new programs: ○ Targeted Investments (TI) 2.0, ○ KidsCare Eligibility Expansion, ○ Parents as Paid Caregivers, ○ YATI Continuous Eligibility, ○ Traditional Healing services, and ○ Pre-release services. - 1115 Waiver Renewal – , 2027 ● To renew the 1115 authority, AHCCCS must submit a renewal application to CMS by September 30, 2026 to prepare for a 10/1/27 launch of the next waiver period. ● This renewal application must include any existing programs under the waiver and any new programs the state wishes to pursue or continue. ● AHCCCS is now in the final drafting stages of its 1115 Waiver Renewal and will be starting public comment in July . - Oct. 1 - Whole Person Care - Reentry Waiver Services Overview ● On , 2024, CMS granted approval to provide limited coverage for services furnished to Medicaid eligible incarcerated individuals for up to 90 days immediately prior to their expected dates of release. ● Covered services include: o Case Management o Medication Assisted Treatment (MAT) Services o 30-day Supply of Prescription Medications o Practitioner Office Visit o Peer Support Services - December 27 - Combatting & Preventing Fraud, Waste and Abuse - What H.R.1 Means for Arizona Public Law No. 119-21 - Signed July 4, 2025 | 12 Sections Directly Impact AHCCCS Work Requirements – Jan 1, 2027 6-month Redeterminations – Jan 1, 2027 Expansion adults 19-64 must document 80+hrs/month of All expansion adults must renew eligibility 2x/year instead of qualifying activity or earn $580+/month. New applicants will annually. AHCCCS must also implement eligibility changes for need to comply 1 month prior to application and renewals will certain immigrants beginning Oct 2026. need any 1 month before redetermination. AHCCCS outreach begins Summer 2026; federal guidance expected June 2026. NO Arizona Expansion FMAP Cut Provider Tax & SDP Cuts – Up to $2.4B CORRECTION : HR1 does not reduce Arizona’s 90% federal Hospital assessment rate drops from 6% to 3.5% by FY2032 match (FMAP) for expansion adults. Section 1114 only ends a (phased 0.5%/year from FY2028). State Directed Payments temporary 5% bonus for states that expanded Medicare after reduced 10pts/year until capped at 100% Medicare March 2021. Arizona’s expansion began in 2014 so our 90% rate beginning Jan 2028 . Combined these changes could match remains intact. remove roughly $2.4B from AZ healthcare system by 2032. - Arizona's Rural Health Exposure 786,000 Arizonans depend on a healthcare system H.R.1 will stress – rural communities carry the greatest risk 786K 20 miles 338,332 1:50,000 Arizonans in rural Average distance to nearest Arizonans live in 1 of 7 100% Behavioral Health Providers to communities (11% of state) hospital in rural AZ Rural Counties Residents in some Rural Areas County Population Covered by AHCCCS Why This Matters for Providers • Rural hospitals rely on Medicaid for Apache 45.2% 40 – 60%+ of revenue in some AZ Navajo 42.2% Counties Santa Cruz 40.9% • Fewer commercial payers to offset Medicaid cuts Graham 39.0% • 44% of rural hospitals nationally La Paz 33.9% already at negative margins Gila 21.3% • Coverage loss leads to Greenlee 15.4% uncompensated care 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% - Work Requirements in Rural Arizona 80 hours per month starting , 2026 – AHCCCS begins outreach Summer 2026 Who is Exempt in Arizona Rural AZ Barriers to Compliance • American Indian/Alaska Native Sparce Qualifying Employment • Disabled Veterans with total disability rating Seasonal and part-time work often does not meet 80 hour • Caregivers for child age <13 or person with disability thresholds. Rural AZ labor markets have narrow qualifying job • Former foster youth age <26 pools. • Medically Frail Transportation & Distance • Pregnant or within 12 months postpartum No/limited public transit. No/limited in person support leads • Already meeting requirements through SNAP or to severe documentation burden. TANF Broadband & Digital Literacy Gaps • Incarcerated or recently released Rural AZ has disproportionally low broadband access. Online • Short-term hardship: hospitalization, declared reporting systems assume connectivity that does no exist in disaster, high-unemployment area many rural and tribal areas. AHCCCS will contact members to explain requirements & options via mail, phone, text, and online. Reporting via HEAplus, phone, or in-person. - Jan 1 - Work Requirement Member Impacts Population Source: https://www.azahcccs.gov/Resources/Downloads/PopulationStatistics/PopulationbyCategory04062026.pdf Population Source: https://www.azahcccs.gov/Resources/Downloads/PopulationStatistics/PopulationbyCategory04062026.pdf *In ter nal Data Estimates as of Ma rch 20 26 *In ter nal Data Estimates as of Ma rch 20 26 Pre-decisional and iterative. The information shared by AHC CCS is prelim inary and intended solely to support internal state plan ning and readiness activities related to M edicaid comm unity engagement requirements. Policies, requirem ents, and implementati on approaches rem ain subject to change pending final federal direction. AH CCC S anticipates receiving official guidance from the Centers for Medicare & Medicaid Services (C MS) in June 2026, w hich will inform final policy and operational decisions. - RHTP Implementation Timeline , 2026 Revised Budget Submitted to CMS Feb-Mar 2026 CMS Review Period (Up to 45 Days) Implementation Begins Mar-Apr 2026 Fund Release & Grant Office Established ISAs with OEO and ADHS Executed May-July 2026 First RGA Solicitations Released Grant Awards Issued June-Sept 2026 Budget Year 1 Annual Report Due Aug Oct 2026 All Y1 Funds Obligated Continued investment, performance reporting, Through 2030 compliance monitoring - Jan 30 - RHTP Resources The following resource materials are intended to help you develop a more comprehensive understanding of RHTP and provide latest updates: Resource Material Link to Resource Material Description Centers for Medicare & Medicaid Rural Health Transformation (RHT) Details the CMS initiative, including program Services (CMS): Rural Health Program | CMS intent, structure, and shares important dates Transformation Program Webpage State of Arizona’s AZ RHTP Arizona Rural Health Transformation Provides detailed updates regarding the AZ RHTP Website Program (RHTP) award. CMS RHTP Frequently Asked Clarifies items outlined in the NOFO and answers Rural Health Transformation FAQs Questions (FAQs) key questions from respondents Arizona Center for Rural Health Coordinates statewide rural health initiatives, Home | Center For Rural Health (AzCRH), University of Arizona including leadership in research and advocacy

AzSHIP supports 14 of Arizona's 17 Critical Access Hospitals with funds focused on fiscal and quality improvement across value-based purchasing, accountable care organizations/shared savings, and prospective payment systems. The 2025 program emphasizes telehealth and health information technology training investments compared to prior years. Key contacts: Melissa Quezada melissaquezada@arizona.edu; Brianna Rooney, DrPH bcrooney@arizona.edu

Arizona's Rural Health Transformation Program for fiscal year 2026 proposes a total budget of approximately $167 million, with significant investments in workforce expansion, health priorities including behavioral health, maternal-fetal health, and chronic disease, and accessibility improvements such as telehealth and technology upgrades. Event schedule: - Document submission date - 01/30/2026

AHCCCS updated the Rural Health Transformation Program timeline to delay funding opportunities from April to June 2026, with grant awards starting in June 2026 and continuing on a rolling basis. The program remains fully funded with no changes to scope or long-term goals, aiming for effective rural health investments across Arizona. Key contacts: RHTP@azahcccs.gov Event schedule: - Funding opportunities release start - June 2026 - Arizona - Budget Year 1 funding obligated by - 10/30/2026 - Arizona - Budget Year 1 funds expended by - 09/30/2027 - Arizona - Program implementation and scaling through - 2030 - Arizona

The plan includes $57 million per year for five years to grow and retain the rural health workforce; $45 million per year to enhance access through telehealth, mobile clinics, and care coordination; $27 million per year for behavioral health, maternal-fetal health, and chronic illness initiatives; and $51 million per year to subsidize rural providers' fixed costs and reduce administrative burdens. The program was developed in consultation with a broad coalition of rural health stakeholders and focuses on workforce strategy, health care access, key health priorities, and resiliency.

Arizona’s RHTP focuses on four strategic goals: Rural Health Workforce Development, Priority Health Initiatives, Expanding Access to Care, and Strengthening Rural Health Systems, funded through targeted yearly investments. The program prioritizes Tribal Nations, rural providers, and community organizations with competitive and direct grant opportunities starting in Spring 2026 and full Year 1 commitment by October 2026. Key partners include 22 Federally recognized Tribal Nations, rural hospitals and clinics, universities, local health departments, and state agencies.