HHS Region 6 · Texas Health and Human Services Commission (HHSC) Rural Health and Flex Program
Program Overview
The Texas Rural Health Transformation Program (RHTP), administered by Texas Health and Human Services Commission as Rural Texas Strong, is actively implementing targeted initiatives to strengthen rural healthcare capacity. Initiatives include hospital improvement grants, workforce development, telehealth expansion, infrastructure upgrades, and technology modernization, with current efforts managed under strict reporting and performance monitoring requirements to ensure sustainable, high-quality care. Current structured plan tracks 6 key initiatives and 27 strategic goals.
Updated
County-level estimates averaged across Texas — % of adults 18+ unless noted. Delta vs US county average shown in red/green.
pp = percentage points vs US county average
County Drilldown (254)
| County | Pop | Poverty | Uninsured |
|---|---|---|---|
| Harris County | 4,838,303 | 16.3% | 13.1% |
| Dallas County | 2,621,179 | 13.9% | 10.8% |
| Tarrant County | 2,167,390 | 11.1% | 8.2% |
| Bexar County | 2,067,341 | 14.6% | 11.2% |
| Travis County | 1,330,015 | 10.9% | 7.1% |
| Collin County | 1,163,337 | 6.2% | 4.7% |
| Denton County | 979,561 | 7.1% | 4.4% |
| Fort Bend County | 893,767 | 7.6% | 6.5% |
| Hidalgo County | 891,977 | 26.7% | 23.3% |
| El Paso County | 870,779 | 18.7% | 16.3% |
| Montgomery County | 684,432 | 9.4% | 7.3% |
| Williamson County | 672,688 | 6.4% | 4.4% |
AI source: TX - 2026 - Save the Date: Rural Texas Strong Public Forum in Nacogdoches
AI auto-updated Nov 11, 2026
API refreshed May 7, 2026
GuideGetting ready for Year 2 in Texas?How to prepare for RHTP Year 2 funding →
Source: CMS State Data Maps ↗ · checked Nov 11, 2026
Federal awards to date: $563,295,386.36 (Year 1 $281.3M + Year 2 $282.0M)
Initiatives (6)
CMS stages run from Stage 0 (planning) to Stage 5 (full implementation). Complete In progress Not started
Key signals are summarized here. Open the source for the supporting detail.
Centers for Medicare & Medicaid Services (CMS)
Grouped files
No related documents
No linked documents found.
Centers for Medicare & Medicaid Services (CMS)
Due Nov 5, 2025
12 related documents
2,895,576 rural residents
As of late October 2026, Texas has moved several Rural Texas Strong Program applications to 'Intent to Award' and begun executing subrecipient contracts, signaling active local program implementation. Multiple grant opportunities are open or recently closed, with funding pipelines confirmed and contract execution underway. Efforts include grants supporting prevention, workforce, rural hospitals, and infrastructure, but there is no evidence of program expansion or a shift to the scaling phase yet. State opportunities: 1 active (1 upcoming, 5 past/closed), $7.7M listed funding. State opportunities: 1 active (1 upcoming, 5 past/closed), $7.7M listed funding. Key opportunities: Rural Texas Strong Program – Initiative 2: Rural Texas Patients in the Driver’s Seat (HHS0017518); The Rural Texas Strong Program – Initiative 1 (Part 2): Make Rural Texans Healthy Again; The Rural Texas Strong Program – Initiative 6 (Part 1): Infrastructure and Capital Investments for Rural Texas. Strategy alignment: supports telehealth, prevention, workforce priorities.
Texas continues implementing the Rural Texas Strong strategy within the Rural Health Transformation Program (RHTP), focusing on targeted rural health modernization through sustained CMS funding. Transparent contract execution and weekly 'Intent to Award' updates ensure rigorous oversight. Technology improvements, facility upgrades, workforce development, consumer-facing health initiatives, and cybersecurity remain central priorities, staged through 2026–2027.
Model
Multi-initiative, HHSC-administered Texas model, distributing RHTP funding through coordinated rounds for chronic disease prevention, telehealth and AI expansion, patient engagement technology, workforce development, infrastructure upgrades, HIT/cybersecurity enhancements, and emergency preparedness, with all contract applicants required to comply with data use agreements and regular reporting.
Key Initiatives (6)CMS official list ↗
Supporting activities (20)
• Direct startup and competitive grants to rural hospital districts and hospital authorities
• Accelerated investments in rural health workforce recruitment, training, and retention programs, including competitive rounds, workforce grants, interagency agreements, and small town healthcare team initiatives
Timeline: CMS application submitted November 3, 2025; revised submissions December 2025–August 2026; CMS Notice of Award December 29, 2025; Budget Period 1 approved April 7, 2026. Initiative launches and application deadlines staged across May–December 2026, with initiative contracts executed July 2026–May 2027; funding continues annually through FY2030. Performance targets set through 2031. Specific rounds and deadlines for chronic disease, maternal health, workforce, pediatric telehealth, infrastructure, and mobile stroke units occur in 2026–2027. 'Intent to Award' lists are updated weekly as contracts move to execution.
Infrastructure and Capital Improvement for Rural Texas
Lone Star Advanced AI and Telehealth
Make Rural Texans Healthy Again
Rural Texas Patients in the Driver's Seat
The Next Generation of the Small Town Doctor and Team
Unified Care Infrastructure and Rural Cyber Protection
State Policy Action commitments (2 of 19)
Texas rural communities face shortages in medical staff, particularly primary care providers, prompting targeted recruitment and training efforts.
Rural hospitals require capital investment to modernize facilities and resources, addressing healthcare access gaps in underserved areas.
Emphasis on recruiting and retaining rural health workers through scholarships, training, and relocation support.
TX - 2026 - Rural Texas Strong (RHTP)
Guidance / reference (not standalone opportunity)
TX - 2026 - The Rural Texas Strong Program – Initiative 1 (Part 2): Make Rural Texas Healthy Again
Auto-linked process guidance fallback (1%)
TX - 2025 - Notice of Award Dec. 29, 2025
Migrated from duplicate federal row
TX - 2025 - One Big Beautiful Bill Act (OBBBA) RHTP – Rural Texas Strong
Auto-grouped context match (38%)
TX - 2026 - Budget Period 1 Notice of Award
Auto-grouped context match (37%)
TX - 2026 - Texas RHTP
Revised Budget Period 1 Budget Narrative
TX - 2026 - Rural Texas Strong Program: Intent to Award List as of 10/8/26
Texas Rural Texas Strong intent-to-award list
TX - 2026 - Rural Texas Strong Program (RHTP)
Texas award recipients
TX - 2026 - HHSC PCS Grant Award HHS0016568 - Texas Nurse-Family Partnership (TNFP) Program
Award evidence — reconciled 2026-09-27
TX - 2026 - HHSC PCS Grant Award - HHS0015358
Award evidence — reconciled 2026-09-27
TX - 2026 - HHSC PCS Grant Award - HHS0016121
Award evidence — reconciled 2026-09-27
TX - 2028 - HHSC Rural Texas Strong Budget Narrative Budget Period 2
Texas Rural Texas Strong Budget Period 2 narrative
Texas Health and Human Services Commission
Grouped files
1 related document
TX - 2026 - Initiative 2: Rural Texas Patients in the Driver’s Seat is coming soon
Primary source
Texas Health and Human Services Commission (HHSC)
Due Sep 28, 2026
24 related documents
TX - 2026 - HHS0017579 PCS 121 Solicitation Addendum Acknowledgement_ Addendum 2 PDF
Auto-linked by identifier (package file)
Texas Health and Human Services Commission (HHSC) — Office of Rural Hospital Finance
Due Aug 26, 2026
13 related documents
TX - 2026 - HHSC Grant Agreement, Contract No. HHS00999999
Auto-grouped context match (45%)
By budget period: BP1 $680.6M (from the award date, the source's publish date, or RCJ having recorded the award before Budget Period 2 began)
| FY↓ | Awardee↕ | Amount↕ | Activity↕ | Source |
|---|---|---|---|---|
| 2026BP1 | Crane County Hospital District Rural Texas Strong (Texas RHTP), Initiative 4.1 | $725K | — | |
| 2026BP1 | Crane County Hospital District Rural Texas Strong (Texas RHTP), Initiative 1.1 | $3.5M | — | |
| 2026BP1 | Crane County Hospital District Rural Texas Strong (Texas RHTP), Initiative 1.2 | $6.8M | — | |
| 2026BP1 | Fisher County Hospital District Rural Texas Strong (Texas RHTP), Initiative 1.2 | $7.5M | — | |
| 2026BP1 | Fisher County Hospital District Rural Texas Strong (Texas RHTP), Initiative 6.1 | $2.0M | — | |
| 2026BP1 | Fisher County Hospital District Rural Texas Strong (Texas RHTP), Initiative 4.1 | $725K | — | |
| 2026BP1 | CAHRMC Rural Texas Strong (Texas RHTP), Initiative 4.1 | $511K | — | |
| 2026BP1 | CAHRMC Rural Texas Strong (Texas RHTP), Initiative 6.1 | $2.0M | — | |
| 2026BP1 | CAHRMC Rural Texas Strong (Texas RHTP), Initiative 1.2 | $7.5M | — | |
| 2026BP1 | El Campo Memorial Hospital Rural Texas Strong (Texas RHTP), Initiative 1.2 | $7.4M | — |
Texas HHSC will host a public forum on August 19 in Big Spring to discuss the Rural Texas Strong plan, a statewide strategy for rural health transformation. The plan is funded by CMS with an initial award of over $281 million. Key initiatives include wellness and nutrition, health technology, telehealth, workforce strengthening, cybersecurity, and equipment upgrades. Key contacts: Rural Texas Strong ruraltexasstrong@hhs.texas.gov Event schedule: - Public Forum - 08/19/2024 - 3:00 PM - 7:00 PM CT - Big Spring City Hall council chambers, 307 E. Fourth St. - Formal Presentation - 08/19/2024 - 3:30 PM CT - Big Spring City Hall council chambers - Formal Presentation - 08/19/2024 - 6:30 PM CT - Big Spring City Hall council chambers
Event Schedule
Contacts
Core Initiatives
Texas HHSC announced 'Intent to Award' for Rural Texas Strong grants to dozens of rural hospital districts and providers. Contracts are pending execution. The multi-phase awards respond to high rural health needs. Event schedule: - Intent to Award List Published - 11/05/2026
Event Schedule
Core Initiatives
This solicitation seeks proposals from rural hospitals in Texas to implement innovative, community-based prevention and wellness programs targeting diabetes, obesity, cardiovascular disease, and chronic respiratory disease. Eligible activities include equipment purchases, community wellness centers, pop-up food markets, primary care access, transportation, telehealth/remote monitoring, and technology for health coverage facilitation. State performance targets include measurable reductions in diabetes-related ER visits and increased diabetes and obesity education and management participation. Event schedule: - All grant-funded activities must be completed by - 09/30/2031
Event Schedule
Core Initiatives
This grant guidance from Texas HHSC details the scope, requirements, and eligible activities for the Rural Texas Strong Initiative 6, focused on infrastructure improvements, equipment, renovation, and workforce-enabling capital investments. It sets out strict reporting, performance monitoring, and compliance standards, with an explicit expectation that all facility improvements support sustainable, high-quality healthcare delivery in rural Texas. Prohibited uses of funds and administrative requirements are extensively outlined to ensure fiscal and operational integrity. Event schedule: - Project Completion Deadline - 09/30/2028
Event Schedule
Core Initiatives
This annual report workbook provides states with standardized guidance and forms for reporting RHT Program progress, milestones, policy actions, and fund expenditures. It details checkpoint evidence requirements and implementation stages, ensuring program accountability and compliance with CMS requirements. The report also collects rural area definitions and sustainability updates to inform the program's impact.
Core Initiatives
This document lists rural hospitals and hospital districts within Texas relevant to rural health transformation efforts. No award amounts or program details are provided.
The Texas application, titled 'Rural Texas Strong: Supporting Health and Wellness,' requests federal funding for chronic disease prevention, consumer health technology, AI and telehealth deployment, workforce recruitment and training, cybersecurity, and rural hospital equipment upgrades. HHSC engaged in extensive public input with over 300 written comments and multiple regional meetings. CMS notification of funding approval is expected by December 31, 2025. Event schedule: - RHTP Application Submission - November 6, 2025 - Austin, Texas - CMS Funding Notification - December 31, 2025
This document announces a public forum for the Rural Texas Strong plan to share information, answer questions, and engage East Texas communities. The event is designed to foster feedback and involvement in ongoing rural health transformation efforts. Event schedule: - Rural Texas Strong Public Forum - 12/09/2026 - 3:00 PM to 6:30 PM - C.L. Simon Recreation Center, 1112 North St., Nacogdoches, TX
Event Schedule
This is the supplemental budget and contact form template for RFA #HHS0017436, supporting a Texas program likely related to health transformation funding for rural entities. It covers budget and contact details required for applicants, including supplementary instructions for personnel, travel, equipment, supplies, contractual, and other costs.
Document is a generic DocuSign email notification from Texas HHSC related to a Rural Health Transformation Program document; no substantive award or program content.
2030
Complete all 2030 milestones
Provide evidence that all milestones scheduled for completion by 2030 have been completed.
September 30, 2028
Project activities completion deadline
All grantee activities must be completed by September 30, 2028.
Q2 2028
Complete Q2 2028 milestones
Provide evidence that all milestones scheduled for completion by Q2 2028 have been completed, unless CMS has approved an adjustment.
TX - 2026 - Save the Date: Rural Texas Strong Public Forum in Nacogdoches
Nov 10, 2026 19:04
·EmailTX RHTP site updated — 4 new, 1 existing source(s) refreshed
TX RHTP site updated — 1 new, 1 existing source(s) refreshed
TX - 2026 - Initiative 2: Rural Texas Patients in the Driver’s Seat is coming soon
Nov 6, 2026 19:20
·EmailTX RHTP site updated — 1 new, 1 existing source(s) refreshed
Spreadsheets, data exports, and reference documents — available for download but excluded from the main activity feed. Showing the 40 most recent of 966.
TX - 2026 - Exhibit D, HHS Additional Provisions Grant Funding
TX - 2026 - Exhibit C 2, Texas HHS System Data Use Agreement Attachment 2 Security and Privacy Inquiry (SPI)
TX - 2024 - Exhibit B, HHS Uniform Terms and Conditions Grant, , Effective September 2024
Exhibit J, HHS Additional Provisions– Grant Fund V 1.0
Exhibit E HHS Additional Provisions Grant Funding V.1.0
Attachment A Statement Of Work
TX - 2026 - Form G, Performance Measures
XLSX
Exhibit G Evaluation Tool V1.6mr CQC7.18 09.02
Attachment A 3, Example SBHCC Report
TX - 2026 - Attachment A 2 Example Project Expenditure Report
XLSX
Exhibit K, HHS Additional Provisions Grant Funding Version 1.0
TX - 2026 - Exhibit D 2, Data Use Agreement Attachment 2, Security and Privacy Inquiry (SPI)
TX - 2026 - Exhibit E, Budget Template
XLSX
TX - 2026 - Form L, Psychiatric Emergency Flowchart
DOCX
TX - 2026 - HHS0014534 Exhibit K Assurances Non Construction Programs
TX - 2026 - HHS0014534 Form F Tx HHS System Indirect Costs Rate (ICR) Questionnaire
TX - 2026 - HHS0015344 Exhibit D 3 HHS Spi 1
HHS0015344 EXHIBIT C HHS Additional Provisions Grant Funding
TX - 2026 - Exhibit H, Assurances Non Construction Programs
Exhibit C, HHS Additional Provisions Version 1.0
TX - 2026 - Exhibit H FY24 Estimated Budget Workbook
XLSX
Form D, Financial Management And Administrative Questionnaire CQC 11.4.24
DOCX
TX - 2026 - HHS0015344 EXHIBIT K Certfication Lobbying
TX - 2026 - Attachment B 1 Additional Documentation
DOCX
TX - 2022 - HHS0015344 Exhibit I HHS Ffata Certification Form August 2022
HHS0015344 EXHIBIT F Exceptions Form 2020
DOCX
HHS0016961 Exhibit C HHS Additional Provisions Grant Funding Final 6.1.26
HHS0016961 Appendix G DSHS TBHIVSTD Local Responsible Party (LRP) Handbook V.2 2019
HHS0016961 Appendix F Clinical Quality Management Policy Clarification Notice
HHS0016961 Appendix E HRSA Trafficking In Persons Award Terms And Conditions
How Apply Enrollment
HTML
2015 2020 Dietary Guidelines
SB00030F
TX - 2026 - HHS0014211 - Grant Awarded
XLSX
TX - 2026 - HHS0014610 - Grant Awarded
XLSX
TX - 2026 - HHS0014609 - HHS Award Notice
XLSX
TX - 2026 - HHS0014956_Attachment 1 to Addendum 5_Facilities Licensed Psychiatric Beds (excel)
XLSX
TX - 2026 - HHS0015357 - Grant Awarded
XLSX
TX - 2026 - HHS0015344 HHS Award Notice (FINAL)
XLSX
TX - 2026 - Attachment to ADDENDUM 6 - Exhibit H FY2026 BCCS Budget Workbook (revised)
XLSX
TX - 2026 - HHS0017579 Attachment to Addendum 2- HHS Responses to Questions PDF
Auto-linked by identifier (package file)
Comprehensive Rehabilitation Services Mobile Stroke Unit (MSU)
Auto-linked by identifier (package file)
TX - 2026 - HHS0017579 Attachment to Addendum 1 pdf
Auto-linked by identifier (package file)
TX - 2026 - HHS0017579 PCS 121 Solicitation Addendum Acknowledgement Addendum 1 PDF
Auto-linked by identifier (package file)
TX - 2026 - HHS007579 Exhibits and Forms.zip
Exhibits and Forms Archive
TX - 2026 - HHS0017579 Comprehensive Rehabilitation Services Mobile Stroke Unit (MSU).pdf
Controlling RFA
Exhibit C - HHS Additional Provisions - Grant Funding, version V1.0.pdf
RFA Package File
Texas EXHIBIT E EXCEPTIONS RHTP Document
RFA Package File
Texas Exhibit D Evaluation Tool RHTP 2023 Document
RFA Package File
Texas Form B-1 Governmental Entity RHTP Document
RFA Package File
Texas Exhibit F Narrative Proposal RHTP Document
RFA Package File
TX - 2026 - Face Page Application Form for HHSC RFA
RFA Package File
Texas FORM B-2 RHTP Document
RFA Package File
Texas Exhibit A HHS Solicitation Affirmations V 2.10 RHTP Guidance
RFA Package File
Texas Form F Applicant Experience Administering RHTP 2018 Application
RFA Package File
Texas Form D Tx HHS System Indirect Costs Rate (ICR) Questionnaire RHTP Document
RFA Package File
Texas Form G Audited Financial Statements RHTP 2024 Document
RFA Package File
Texas Form E Internal Controls Questionnaire RHTP Guidance
RFA Package File
TX - 2027 - Requested Budget Template for RFA HHS0017579
RFA Package File
Texas Exhibit B HHS Uniform Terms And Conditions Grant V 3.5 RHTP 2024 Guidance
RFA Package File
Texas Exhibit G HHS Online Bid Room Information RHTP Document
RFA Package File
TX - 2005 - Conflict of Interest, Contract, and Litigation History Form for RHTP Application
RFA Package File
TX - 2026 - Open Grant Opportunties (RFA) Procurement Number
Primary source
TX - 2031 - Attachment A - Scope of Grant Project for Rural Texas Strong Program Initiative 4
Sample grant agreement - Attachment A, Scope of Grant Project (Initiative 4.2, HHS0017618)
Texas Initiative 4.2 Att B Categorical Budgets SAMPLE RHTP 2026 Document
Sample grant agreement - Attachment B, Categorical Budgets (Initiative 4.2, HHS0017618)
TX - 2026 - Contract Routing and Execution Instructions for Awardees
Awardee contract execution - Contract Routing and Execution Instructions (HHSC)
TX - 2026 - Docusign Grant Agreement Example
Awardee contract execution - Docusign grant agreement example (HHSC)
TX - 2026 - Sample Contract_Initiatives Att A and B
Awardee contract execution - Sample contract, Initiatives Attachments A and B (ZIP)
TX - 2026 - Sample Initiatives_Att C to J
Awardee contract execution - Sample contract, Attachments C to J (ZIP)
TX - 2026 - The Rural Texas Strong Program - Initiative 4 (Round 2): The Next Generation of the Small Town Doctor and Team
Primary source
TX - 2026 - Exhibit G, Federal Funding Accountability and Transparency Act (FFATA) Certification (RFA No. HHS0017618)
Exhibit G, Federal Funding Accountability and Transparency Act (FFATA) Certification
TX - 2026 - Exhibit I, Grants Management System (GMS) External Portal Information (RFA No. HHS0017618)
Exhibit I, Grants Management System (GMS) External Portal Information
TX - 2026 - Exhibit J, Texas Uniform General Conditions for Construction Contracts and 2025 Supplemental General Conditions (RFA No. HHS0017618)
Exhibit J, Texas Uniform General Conditions for Construction Contracts and 2025 Supplemental General Conditions
TX - 2026 - Exhibit L, Solicitation Form - Questions and Requests for Clarification (RFA No. HHS0017618)
Exhibit L, Solicitation Form - Questions and Requests for Clarification
TX - 2024 - Rural Texas Strong Initiative 4, Round 2 Posting
Round 2 posting notification
Texas Health and Human Services Commission advanced multiple rural hospital grants to 'Awarded' status as of October 2026. Awarded entities support transformation of rural hospital services and infrastructure. Intent to Award contracts are pending execution and reviewed weekly. Event schedule: - Intent to Award Status Date - 10/29/2026
Event Schedule
Core Initiatives
This document lists rural Texas hospitals, clinics, and local health providers advanced to 'Intent to Award' status for the Rural Texas Strong grant program as of October 23, 2026. Awards are not considered final until contract execution, and updates are provided weekly. Multiple providers across Texas have been recommended for funding to strengthen rural health infrastructure. Event schedule: - Intent to Award List Updated - 10/23/2026
Event Schedule
Core Initiatives
This is a sample Texas HHSC RHTP grant agreement showing structure, spending periods, and award compliance details. It summarizes federal funding allocations, reporting requirements, reimbursement procedures, and administrative contacts for a Grantee selected via HHSC RFA. No actual Grantee or award amount is specified. Key contacts: Chris Clark christopher.clark@cms.hhs.gov
Contacts
Core Initiatives
This application outlines the Rural Texas Strong Program Initiative 4, which funds eligible rural healthcare providers to recruit, train, and retain clinicians in rural communities. Key approaches include local high school career pipelines, scholarships, relocation/signing bonuses, and creation of new rural residency or fellowship programs. The initiative requires measurable outcomes, rigorous reporting, and strong partnership frameworks while ensuring long-term sustainability and retention. Event schedule: - Grant Term End - 04/30/2031
Event Schedule
Core Initiatives
This questionnaire outlines financial management and administrative standards required of grantees for Texas HHSC-funded awards, including rural health transformation. It ensures organizations have compliant accounting systems, procedures, and controls for handling funds, reporting, and personnel time. Signed attestation by an authorized person is required prior to award acceptance.
Core Initiatives
Budget Period 2 of the Rural Texas Strong Program allocates over $281 million in RHTP funding across six core initiatives targeting population health, workforce, health IT, unified care, and infrastructure in rural Texas. Competitive subawards and direct contracts are provided to hospital districts, rural hospitals, healthcare networks, the Texas Board of Nursing, and DSHS to drive outcomes in diabetes, behavioral health, patient access, and care coordination. Subrecipient names and itemized budgets will be finalized following procurement and application processes. Event schedule: - Budget Period 2 Start - 10/31/2026 - Budget Period 2 End - 10/30/2027 - Period of Performance for Initiative 5 Part 1 – GLO IAC - 2026-09-30 - Texas - Anticipated Project Period for Initiative 5 Part 2 - Competitive - 2031-09-30 - Texas - Period of Performance for Initiative 6 Part 1 – Open to all providers - 2028-09-30 - Texas - Period of Performance for Initiative 6 Part 1 – DSHS AMBUS IAC - 2028-09-30 - Texas - Period of Performance for Grants Management System Technical Support contract - 2027-08-31 - Texas - Period of Performance for DSHS BRFSS Survey Tool Oversampling IAC - 2031-09-30 - Texas
Event Schedule
Core Initiatives
Event Schedule
Core Initiatives
The Trump Administration has announced $78 million in Rural Health Transformation Program (RHTP) funding for 216 rural healthcare providers in Texas under the Rural Texas Strong initiative. This investment, made possible by the Working Families Tax Cuts Act, targets chronic disease prevention, workforce recruitment and retention, and facility and equipment upgrades to improve healthcare outcomes and access in rural communities. Key focus areas include modernizing technology and advancing innovative care and payment models.