Rural Health Transformation Initiative-Statewide Analysis

 Rural Health Transformation Program

As promised, this is the follow-up to this month’s article on the vulnerability of hospitals across the United States because of the federal Medicaid cutbacks. (Winter, 2026)This article reviews all fifty abstracts submitted to the Centers for Medicare and Medicaid for the Rural Health Transformation grants. (Centers for Medicare and Medicaid, 2026) Rural healthcare does impact about half of the U.S. population, and it is difficult to resource because of population and geographical limitations.

As a plaster to the hemorrhaging from the trillion-dollar Medicaid reduction at the federal level, the Trump Administration is offering a one-time 50-billion-dollar five-year federal grant administered by the Centers for Medicare and Medicaid. All state submissions for the RHI grants were reviewed. Many states did not provide any specific details on how they intend to use the funds, measurable targets, or other details. Further, states which are not rural, such as Delaware, applied for the grant, it would be more prudent to allocate funds based on the proportion of state population that is actually rural. States which did not provide detailed proposals for use of the RHI Grants such as measurable targets and budgets for programs included: Connecticut, Georgia, Idaho, Illinois, Maryland, New York, Oklahoma, South Carolina South Dakota, Texas, and Utah.

After reading the proposals for each state, the most interesting proposals include:

1.       Maine tied its grant request to achievement of specific patient health outcomes

2.       Proposals to build more patient care capacity by loosening licensure for pharmacists, physician assistants, and community health workers.

3.       Investment in school-based health centers, yes to school nurses and counselors

4.       Establishing regional rural care collaborations, for data sharing and resourcing

5.       Creative proposals on non-urgent medical transport and mobile clinics

Best In Class-States which submitted concrete proposals and budgets for ways to improve rural health care include; Hawaii, Iowa, Nevada, New Mexico, Pennsylvania, Rhode Island, Vermont, Virginia, and Wyoming. The table below highlights each state’s summary response to the request for a proposal for the RHT grant funding.

State	Grant Proposal
Alabama	Focused on maternal & fetal health, digital obstetric aids, telerobotic ultrasounds, increase rural training pipelines through simulation programs, mobile cancer screening
Alaska	Pay for value-promoting fiscally sustainable programs, payment innovation, Healthy Beginnings- to support maternal and child health
Arizona	Subsidizing EMR licensing, leveraging shared networks, reducing back office overhead(staff)
Arkansas	Improved coordination of care access through PACT
California	Create regional hub and spoke networks, OB Nest for prenatal & remote patient monitoring
Colorado	Pledged to run the RHI program and keep administrative costs below 3%, light on details
Connecticut	Generic proposal, no specific targets or budgets
Delaware	Create a state-run medical school with a primary rural healthcare track, train here-stay here, expand medical students, PA’s, NPs, and community health workers
Florida	Improve access for urban-led rural health centers, paramedicine using tele-health for remote monitoring, lifestyle focused initiatives
Georgia	Generic proposal, no specific targets or budgets
Hawaii	Create-statewide digital connection, expand EMS services, community paramedics, expand medical model for post-acute care, allocation of a fund for innovative value-based care models
Idaho	Generic proposal, no specific targets or budgets
Illinois	Generic proposal, no specific targets or budgets
Indiana	60% of funding to be allocated to regional grants
Kansas	Accountable food partnership, remote patient monitoring services, new transportation models, cost effective reforms
Kentucky	41.6% of population is rural-Expand the number of clinical and nonclinical rural healthcare workers, telehealth, community-based teams, strengthen EMS
Louisianna	Strengthen collaboration among rural hospitals, clinics, EMS, behavioral health, and allied professional networks
Maine	Set performance target for 75% of rural hospitals to achieve operating margins for solvency, reduce hospital re-admission rate by 10%, increase population with controlled-blood-pressure by 10%, reduce the population of adults delaying medical care by 10%
Maryland	Generic proposal, no specific targets or budgets
Massachusetts	7 initiatives including; expand payment methodologies to incorporate value of care and lower cost, support community informed prevention, address gaps in healthcare system
Michigan	Reduce gaps I care through care models that help keep residents close to home
Minnesota	Strengthen & stabilize rural providers through earn-while-you-learn programs-capital investments, sustained access to services
Mississippi	Close the gap between EMS, care management, and value of care
Missouri	Create regional hubs to enhance care coordination, alternative payment methods, modernize operations infrastructure
Montana	Sustainability through partnerships and restructuring, innovative care delivery models to improve access and outcomes
Nebraska	Regionalized rural access hubs, workforce acceleration partnerships, with NE Hospital Assoc, universities, community colleges
Nevada	Leverage physician extenders, 47% of the grant to create a flex fund to bolster modernization of rural systems; 44% to address gaps in workforce funding-education, certification
New Hampshire	Enhance care coordination, reducing use of acute care (ED) setting for care delivery
New Jersey	NJ has a million rural residents-Investing in mobile health care
New Mexico	Established budget for the grant for all criteria including; 31% awarded for community-led efforts, 20% for creation of a rural health sustainability center including technical assistance, operational support, creation of a rural data hub
New York	Only 10% of the population is rural, nothing specific in budgeting RHI initiatives
North Carolina	Catalyze innovative care models, improve patient screening tools, expand behavioral health and substance abuse treatment, create a value-based payment system, deployment of A/I to support real-time clinical decisions, documentation
North Dakota	Established budgets for all components-58% of RHI grant is geared toward transforming care models through mobile clinics, telehealth hubs, enhanced remote patient monitoring
Ohio	Rural health hub, school-based health centers, mobile clinics for vision, hearing, dental care, transformation of emergency care, funding to train rural healthcare workers with 5-year commitments of service, targeted outcome-20% increase in rural healthcare workers by 2031
Oklahoma	No specific budgets for value-based care, regional collaboration, data driven healthcare delivery
Oregon	33% of population is rural-Oregon Healthcare Authority will lead the program; Phase I grant awards will go to community projects that can be completed in two years, Phase II will address longer term collaborations to improve rural health
Pennsylvania	Creates 8 rural care collaboratives, provides upfront scholarships, housing assistance, investments in rural health pipeline, data analytic support for digital care models, dental care through a special care dental center at a state hospital, analysis of alternative payment models
Rhode Island	13 initiatives including: clinical care hubs, expand rural EMS service, community paramedicine, 24X& crisis stabilization center, state sponsored electronic medical record system, triage for tele-dentistry
South Carolina	Generic proposal, no specific targets or budgets, establishing mobile crisis units, rural health system facility upgrades
South Dakota	Implementation of statewide community behavioral health clinics, exploration of new Medicaid payment models
Tennessee	Up to 500 million offered in competitive awards to strengthen rural healthcare-championed by the governor, another 125 million will go to investments in rural hospitals
Texas	No specific budgets outlined, initiatives include; Lonestar advanced A/I telehealth, unified care infrastructure investment
Utah	77% of the state is rural-Program to be run by Department of Health & Human Services for state-no specific budget targets, focused on workforce development and technology innovation
Vermont	Grants will be distributed based on regionalization and care innovation strategies; increasing scope of practice for licensure of physician extenders, pricing transparency and insurance competition (this one has me stumped, insurance companies are not fighting over rural health care)
Virginia	Allocates 28% of total RHI grant to early-stage health technology startups for remote patient monitoring, 13% to fund rural health residencies, 41% to fund hub and spoke models for community health, improved maternal health, mobile health clinics, paramedicine
Washington	Grants to be awarded to public and nonprofit entities; including The Rural Health Redesign Center, The Rural Collaborative, Dept of Health, DSDS, state hospital association, and the University of Washington-no specific budgets listed
West Virginia	Integrating digital and in-person care, connecting community transportation with healthcare, updating payment & data tools, improved care management-no specific budgets listed
Wisconsin	Grant awards-33% to fund and finance health workers, 32% for telehealth innovation, 27% to partnerships transforming care
Wyoming	The least populated state had a very robust response in these priorities:  1) 48% of grant used for critical access hospitals/emergency care 2) Incentivizing small ambulance companies for regional consolidation  3) Create an affordable medical plan for people priced out of insurance  4) 25% of the grant to increase healthcare workforce by loosening scope of practice limitations for PA’s, dental hygienists, pharmacists 5) With 16% of grant allocated between creation of statewide telepsychiatry and crisis intervention program 6) Care management and coordination of nonemergency transportation for patients with chronic diseases

 Wyoming deserves a gold star, not only for their methodology, but their community assessment, and the responsiveness of their RHT grant proposal. The least populated state had one of the most impressive abstracts. My only concern is the target to limit administrative costs for the grant awards to under 1% when 3% is more standard.

It is important to note these are the abstract submissions, which simply means the state is interested in receiving the Rural Health Transformation funding. Full blown proposals and reporting requirements will be made public at some point.

And this is the healthpolicymaven signing off, encouraging you not to sign blanket releases when you agree to an inpatient procedure, do stipulate that for which you agree and decline, based on your medical directive. This article was written by Roberta Winter who received no compensation from any sector for the post.

References

Centers for Medicare and Medicaid. (2026, September 17). RHT Program State Project Abstracts. Retrieved from Centers for Medicare and Medicaid.gov: https://www.cms.gov/files/document/rht-program-state-provided-abstracts.pdf

Winter, R. E. (2026, September 2). Trump Administration Healthcare Cuts-State By State Analysis of Hospital Viability. Retrieved from healthpolicymaven.blogspot.com: https://healthpolicymaven.blogspot.com/2026/09/trump-administration-healthcare-cuts.html