Program Overview
The Federal Rural Health Transformation Program (RHTP), established under Public Law 119-21 and the One Big Beautiful Bill Act, provides $50 billion in federal support to the 50 U.S. states from FY2026 to FY2030 to advance rural health system improvements. Currently in the application and early implementation phase, RHTP emphasizes evidence-based interventions, innovative care models, technology adoption, workforce development, and sustainable access to care. States must use funds for at least three approved purposes such as prevention, training, technology innovation, or workforce recruitment, submit comprehensive transformation plans, demonstrate measurable progress, and comply with annual reporting. Implementation is structured, tracks multiple key initiatives, and emphasizes measurable outcomes, accountability, and coordination to address rural health care challenges. Current structured plan tracks 14 key initiatives and 18 strategic goals.
Updated
County-level estimates averaged across Federal — % of adults 18+ unless noted. Delta vs US county average shown in red/green.
46,345,066 rural residents
AI source: US - 2025 - Tracking State Preparation for the RHTP
AI auto-updated Sep 12, 2026
API refreshed May 8, 2026
Key signals are summarized here. Open the source for the supporting detail.
The Rural Health Transformation Program was officially launched in September 2026 with federal funding announcements and guidance issued to states. Initial state and provider award announcements have been made for specific projects in Mississippi, Kansas, North Carolina, Vermont, West Virginia, New Mexico, Connecticut, South Carolina, Iowa, South Dakota, Arkansas, Delaware, Missouri, and additional states. States are now authorized to begin implementation planning and rollout activities using awarded federal funds. Program funding of $50 billion will be distributed over five years, targeting technology, workforce, and care model innovations.
The Federal RHTP strategy directs $50 billion from FY2026–FY2030 to support state-led rural health transformation plans employing evidence-based interventions—focusing on prevention, chronic disease management, workforce recruitment and retention, technology adoption, and care model innovation. States must address at least three core priorities, enforce 5-year rural workforce service commitments, ensure robust reporting, and maintain strong fiscal and programmatic oversight. Funding is distributed annually, with 50% allocated equally among approved states and 50% based on rural population and provider factors, ensuring meaningful and measurable investment in rural health outcomes.
Model
Federally funded, state-driven transformation requiring multi-year rural health plans targeting at least three approved priority areas—such as prevention, workforce recruitment, technology adoption, or innovative care models—using evidence-based, outcomes-driven approaches. States are required to engage stakeholders, conduct annual and quarterly reporting, enforce workforce service commitments, execute state policy actions, and plan for sustainability as ongoing funding conditions.
Key Initiatives (14)
Timeline: FY2026–FY2030 (state applications due by November 2025; budget period 1 begins 12/29/2025; annual and quarterly funding and progress reporting required; most SPA technical score factor deadlines by end of CY2027, remainder by end of CY2028)
Focus on evidence-based interventions to improve prevention and management of chronic diseases across rural areas.
Supporting opioid and other substance use disorder treatment services as well as mental health care is required.
States are to bolster rural workforce pipelines and require multi-year service commitments to improve provider access.
Centers for Medicare & Medicaid Services (CMS)
Due Nov 5, 2025
3 related documents
US - 2026 - CMS RHTP
US - 2026 - CMS Releases RHT Funding Opportunity
SHVS regulatory analysis of the NOFO
US - 2025 - CMS Releases RHT Funding Opportunity
SHVS regulatory analysis of the NOFO (duplicate URL variant)
Health Resources and Services Administration (HRSA), Federal Office of Rural Health Policy (FORHP)
Due Aug 12, 2026
1 related document
Federal Notice Of Funding Opportunity Application Due 08/12/2026 Federal Office Of Rural Health Policy Delta States Rural Development Network Program RHTP
Official NOFO PDF
Centers for Medicare & Medicaid Services (CMS)
Due May 15, 2026
2 related documents
US - 2026 - CMS RHTP
US - 2026 - CMS RHTP
Centers for Medicare & Medicaid Services (CMS)
Due Mar 1, 2026
2 related documents
US - 2026 - CMS RHTP
Centers for Medicare & Medicaid Services (CMS)
Due Dec 31, 2025
1 related document
US - 2026 - CMS RHTP
The Rural Health Transformation Program is a new $50 billion federal fund to support rural health improvements. States are actively gathering public input and legislative participation to shape their applications. The funds will address multiple rural health priorities including workforce, technology, and innovative care models. Event schedule: - Federal Application Deadline - 11/05/2023 - Suggested Letter of Intent Deadline - 09/30/2023
Event Schedule
Core Initiatives
The Trump Administration announced a $120 million federal investment to expand maternal and infant health services and increase primary care access in rural America through the Rural Health Transformation Program. This reflects a strong federal commitment to improving rural health infrastructure and outcomes.
This document announces the FY2026 federal grant allocations for all 50 states under the CMS Rural Health Transformation Program, created by the One Big Beautiful Bill Act. Each state's RHTP award, totaling $10 billion across the US, supports rural health transformation initiatives spanning workforce, technology, population health, payment reform, and rural Medicaid.
The program is funded at $50 billion over five fiscal years starting in 2026, with states required to use funds for multiple approved purposes such as chronic disease management, workforce recruitment, and technology advancements. Allocation of funds is split 50% equally among states and 50% based on rural population and health facility factors, with only the 50 U.S. states eligible to receive awards. Event schedule: - Trump Administration Announces $13 Million Investment to Expand Behavioral Healthcare and Create a 24/7 Mobile Crisis Response Service in South Dakota (Press release, , 2026) - September 24 - See more news - Trump Administration Announces $54.6 Million to Fight Chronic Disease, Expand Maternal Healthcare Services, and Build Arkansas’ Rural Health Workforce (Press release, , 2026) - September 24 - See more news - Trump Administration Announces Nearly $23 Million to Modernize Rural Health Centers, Expand Mobile Care, and Make It Easier to Manage Chronic Disease in Delaware (Press release, , 2026) - September 24 - See more news - Trump Administration Announces More Than $45 Million to Upgrade Rural Missouri Hospitals, Connect Families to Rapid Psychiatric Consultations and Maternal Care, and Train More EMS Professionals Across Missouri (Press... - Trump Administration Announces $74 Million to Expand Specialty, Maternal, and Behavioral Healthcare Across Rural New Mexico (Press release, , 2026) - September 21 - See more news
Event Schedule
Core Initiatives
The document provides a national overview of state preparations for the RHTP following its establishment in budget legislation. It outlines the funding structure, application process, and strategic considerations for states developing rural health transformation plans. It also references a map tracking state actions as of January 12, 2026. Event schedule: - NOFO release - 09/15/2025 - Application deadline - 11/05/2025 - Award announcement deadline - 12/31/2025
Event Schedule
Core Initiatives
This fact sheet provides guidance on allowable and unallowable uses of Category B Provider Payments under the Rural Health Transformation Program. It outlines restrictions, sustainability requirements, and the 15% cap on Category B funding, as well as allowable example expenditures tied to state RHT transformation plan initiatives. The document clarifies payment models and directs states to ensure RHTP funds do not duplicate existing programs.
This document provides an overview of the Rural Health Transformation Program (RHTP), a $50 billion initiative created by the One Big Beautiful Bill Act to transform care and improve outcomes in rural communities. It summarizes eligible use of funds, program strategic goals, and application requirements, and provides a timeline for application and awardee selection. Key goals include prevention and chronic disease management, workforce development, behavioral health, and technology advancement.
This independent analysis estimates the distribution and impact of 75% of RHTP funds as currently defined, showing substantial misalignment between formula-based funding and states' rural health needs. The report finds RHTP allocations are unlikely to offset projected Medicaid cuts and that only a minority of states receive funds that match their anticipated reductions. States with substantial hospital bed losses and certain rural demographics receive modestly higher funding. Findings are based on publicly available formulas, state applications, and federal datasets. Event schedule: - CMS Application Submission Deadline for Technical Score - 11/2025 - Report Submission to Senator Ron Wyden's Office - December 4, 2025
Event Schedule
Core Initiatives
This FAQ provides comprehensive post-award operational guidance for states implementing the RHTP, covering budget processes, workforce commitments, state policy actions, and required oversight. It clarifies service commitment rules, permissible use of funds, payment reform opportunities, and reporting/monitoring requirements. Emphasis is placed on accountability, compliance, and flexibility within federal and state program structures. Event schedule: - Budget Period 1 Start Date - 12/29/2025 - SPA technical score factor deadlines (most) - End of Calendar Year 2027 - SPA technical score factor deadlines (B.2 & B.4) - End of Calendar Year 2028 - Updated document date - 2026-09-23 - Updated document date - 2026-04-09
Event Schedule
Core Initiatives
Reference: Trump Administration Announces 167 Million Build Rural Care Sites Upgrade Health Technology Link: https://www.cms.gov/newsroom/press-releases/trump-administration-announces-167-million-build-rural-care-sites-upgrade-health-technology
Reference: Trump Administration Announces 50 Million Optimize Care Delivery Improve Rural Hospital Link: https://www.cms.gov/newsroom/press-releases/trump-administration-announces-50-million-optimize-care-delivery-improve-rural-hospital
2032-10-01
Return of Unused Funds
Any unused RHTP funds leftover as of this date will be returned to the Treasury.
2032-09-30
Final Expenditure Deadline
All RHTP funds must be expended by September 30, 2032.
2031-02-27
Final Report Due
Overall, cumulative program report covering FY26 to FY31 is due.
2030
Program Funding End
RHTP federal funding runs through FY2030.
2028
Redistribution
Redistribution of unused state allotments for RHTP begins.
2028-03-31
Unused Funds Redistribution
CMS will annually redistribute unused funds by this date.
2028-03-31
Redistribution Assessment Begins
CMS to determine unexpended/unobligated funds for redistribution annually beginning 2028.
2027-09-30
Funds Expire for FY2026 Allotments
Funds distributed in FY2026 must be used by the end of FY2027.
2027-08-30
Annual Report #2 Due
Second annual report is due, covering the following 12-month reporting period.
2026-11-29
Quarterly Report #1 Due
First quarterly report for the RHT Program is due.
2026-09-30
Budget Period 1 Spending Deadline
Recipients have until September 30, 2026, to spend Budget Period 1 awarded funding
2026-08-30
Annual Report #1 Due
First annual RHT Program report is due, covering a 7-month period.
US RHTP site updated — 1 new, 2 existing source(s) refreshed
US RHTP site updated — 1 new doc(s)
US RHTP site updated — 1 new doc(s)
US canonical state summary updated: progressSummary updated · transformationStrategy updated · strategicGoals updated
US - 2025 - Rural Healthcare Capital Funding Analysis
Spreadsheets, data exports, and reference documents — available for download but excluded from the main activity feed. Showing the 40 most recent of 115.
US - 2026 - Trump Administration Announces 50 Million Optimize Care Delivery Improve Rural Hospital
US - 2026 - Trump Administration Announces 167 Million Build Rural Care Sites Upgrade Health Technology
US - 2026 - Trump Administration Announces Nearly 17 Million Adopt Emerging Healthcare Technologies Improve
US - 2010 - state profile tool grant program
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US - 2026 - Trump Administration Announces 76 Million Strengthen Regional Coordination Modernize Healthcare
US - 2026 - Press Releases
US - 2026 - CMS Rhtp Funding Press Campaign Draws Cynicism Patient Advocates
US - 2026 - ACC Warns PFS Proposals Could Stifle State Digital Health Investments
US - 2026 - Health Transformation Program (RHTP) to the Centers for Medicare and
US - 2026 - CMS Touts Digital Health Rhtp Investments Eight States
US - 2026 - Program (RHTP) investments at the seven-month mark on the basis of
US - 2026 - Trump Administration Announces 93 3 Million Expand Telehealth Services Advance Surgical Robotics
US - 2026 - Transformation funds because they lack the administrative resources to
US - 2026 - BPC Congress CMS Should Bolster Rural Health Workforce AID Rhtp Implementation
US - 2026 - Medicaid Adult Core Set Quality Measures by State
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US - 2010 - Federal RHTP 2010
US - 2017 - Federal RHTP 2017
US - 2020 - All-State Medicaid & CHIP Call June 23, 2020
US - 2001 - Federal RHTP 2001
CMS Medicaid/CHIP Risk Assessment Excel Template
XLSX
US - 2020 - All-State Medicaid & CHIP Call June 16, 2020
US - 2021 - Federal Sho 21 002 RHTP 2021
US - 2020 - Federal Sho20004 RHTP 2020
US - 2021 - Federal Questions Questions 10 RHTP
US - 2021 - Research Summary for Pediatric Vaccines HHS COVID-19 Public Education Campaign 3
US - 2015 - Federal FAQ 01 16 2015 RHTP
US - 2016 - Federal RHTP 2016
US - 2021 - Federal Sho22002 RHTP 2021
US - 2021 - Federal RHTP 2021
US - 2021 - Federal Sho 21 003 RHTP 2021
US - 2021 - Federal RHTP 2021
US - 2016 - Federal Smd16010 RHTP 2016
US - 2019 - Federal RHTP 2019
US - 2018 - Federal Sho18008 RHTP 2018
US - 2013 - Federal CIB 01 24 13 RHTP 2013
US - 2026 - Unmc Dentistry Using Federal Funds to Address Rural Needs
US - 2026 - AHA CMS Should Remove Rhtp Funding Caps
US - 2026 - Rural Health Transformation Program Reporting
US - 2026 - 2026 08 05 AHA Comments Rural Health Transformation Program
US - 2018 - Federal QSO18 24 ESRD RHTP 2018
US - 2026 - CMS RHTP
The Rural Health Transformation Roundup, first edition from CMS, introduces key state initiatives funded under the RHTP for 2026. Georgia launched a new mobile dental unit for adults with IDD in 26 rural counties, funded by RHTP. Recent federal-to-state RHTP awards were announced in New York, Michigan, Rhode Island, Indiana, Hawaii, and Arkansas for technology modernization, workforce development, EMS upgrades, telehealth, and maternal/infant health initiatives. Event schedule: - Roundup publication date - 09/09/2026
Event Schedule
Core Initiatives
Core Initiatives
CMS issued the Rural Health Transformation Program NOFO on September 15, 2025, for states to apply for federal funds under H.R.1. The program offers $10 billion annually from 2026 through 2030 to support rural health investments. Funding allocation involves both equal distribution and discretionary awards by CMS. Event schedule: - , 2025 • By Anne Karl, Avi Herring, Liz Osius, and Jacob Rains, Manatt Health - September 17 - Download the Materials - On , the Centers for Medicare & Medicaid Services (CMS) released new information to states on the implementation of… - September 8 - -
Event Schedule
Core Initiatives
CMS released a Notice of Funding Opportunity on September 15, 2025 for the Rural Health Transformation Program, part of a $50 billion federal initiative. The program will distribute $10 billion annually from 2026 through 2030 to support rural healthcare transformation plans. Event schedule: - NOFO Release Date - 09/15/2025
Event Schedule
Core Initiatives
This CMS guidance defines the scope, definitions, and application of Category E (Workforce) for Rural Health Transformation Program funding. It clarifies eligible workforce recruitment and retention activities, eligibility standards for various roles such as LPNs, PMHNPs, community paramedics, CHWs, and doulas, and the applicability and enforcement of 5-year rural service commitments. States are provided with decision criteria, common questions, and requirements for tracking, enforcing, and forgiving service obligations.
Core Initiatives
This fact sheet summarizes allowable and unallowable uses of Rural Health Transformation Program Category J funds for capital expenditures and infrastructure in rural health facilities. Examples of eligible expenses include minor renovations, equipment upgrades, repairs, accessibility improvements, and safety/security enhancements. Major construction or cosmetic upgrades are explicitly excluded, and total Category J spending cannot exceed 20% of a state’s RHTP award per budget period.
Core Initiatives
Event Schedule
Core Initiatives
This summary outlines the Rural Health Transformation Program (RHTP) established by the OBBBA, appropriating $50 billion in federal funding to all 50 states from FY2026 to FY2030. It describes the distribution mechanism, allowable activities, and strategic goals of RHTP, designed to stabilize and strengthen rural hospitals, support workforce, and promote technology-driven solutions for rural communities.
Event Schedule
Core Initiatives
This policy paper analyzes capital access challenges facing rural hospitals and other rural health facilities. It presents an overview of major capital funding programs and historical trends, emphasizing the complexity of blended financing and persistent access barriers. The report highlights the importance of technical assistance, partnerships, and varied funding streams for sustaining and modernizing rural healthcare infrastructure.
Core Initiatives