This blog series shares ongoing updates on the Rural Health Transformation Program and what it means for Community Health Centers. Stay tuned for future posts exploring a wide range of related topics and emerging issues.
On December 29, the Centers for Medicare & Medicaid Services (CMS) announced that all states will receive awards under the Rural Health Transformation Program (RHTP). The RHTP will provide states with $50 billion over five years to expand access to care in rural communities, strengthen the rural health workforce, modernize rural facilities and technology, and support innovative models that bring high-quality, dependable care closer to home.
For Community Health Centers (CHCs), the focus now turns to how states will deploy these funds, and how CHCs can position themselves to access and implement these investments.
State Awards and Funding Distributions
In 2026, states will receive first-year RHTP awards from CMS averaging $200 million, with awards ranging from $147 million (New Jersey) to $281 million (Texas). The RHTP funding will average $144 per rural resident over the 5 years of the program. When examining discretionary grant funding per 1,000 rural residents, the distribution varies widely—from $26,611 in Michigan to $662,755 in Alaska. States had up to 30 days to submit revised budgets reflecting their final award amounts, which must be approved by CMS.
States are now advancing procurement processes to distribute RHTP funds to eligible entities. Approaches vary and include:
- Direct allocations by Governors or state agency directors
- Issuance of Requests for Proposals (RFPs)
- Legislative appropriations
In North Dakota, recently enacted legislation appropriated RHTP funds to the Department of Health and Human Services and designated the Bank of North Dakota as administrator of a rural health medical facility infrastructure loan program. This structure provides short-term gap financing to grant recipients and offers a model for states seeking to pair grants with financing tools.
Several states are also leveraging third-party entities to manage funding distribution and oversight. In Rhode Island, a Rural Stakeholder Advisory Committee was established to monitor changes in costs, quality, outcomes, and patient experience, and to guide reinvestment and sustainability strategies. The Committee designated the Rhode Island Health Center Association—the state’s Primary Care Association—to oversee funding allocations to CHCs participating in initiatives such as value-based payment transitions, technology modernization, and mobile health services.
Below (Table 1) is an overview of recent RHTP award announcements and funding opportunities across several states.
Looking Ahead: Positioning Community Health Centers for Success
The $50 billion investment from Congress presents a once-in-a-generation opportunity to reshape rural health care delivery. The choices states make in the months ahead—around procurement strategies, partnerships and performance expectations—will determine whether this funding drives lasting system transformation or short-term gains. For CHCs, this is a pivotal moment to engage early, align strategically and lead collectively.
As states move forward with multiple award pathways, health centers and PCAs should, where appropriate, present a unified and coordinated approach that clearly demonstrates the value of investing in community-based primary care. By showcasing how health center systems collaborate, leverage shared infrastructure, and deliver measurable impact, they can put forward strong, high-impact proposals that position primary care as the foundation of rural transformation. CMS and state leaders are encouraging interested parties to get prepared. This includes regularly checking your state’s RHTP websites for updates, assessing where health centers align with prospective projects, and identifying RFPs/funding opportunities that advance your state’s RHTP goals.
Table 1. Recent RHTP award announcements and funding opportunities across states
| State | Use of Funds |
|---|---|
| IOWA | Gov. Kim Reynolds announced the nation’s first RHTP awards in January, totaling more than $78.6 million. Of that amount, $12.6 million was allocated through the state’s Health Care Workforce Recruitment initiative, which supports the recruitment of highly skilled providers by offering competitive incentives such as recruitment bonuses, relocation assistance, and other strategies designed to make rural practice attractive and sustainable. Among the awardees, the Community Health Centers of Southeastern Iowa received funding for its Des Moines County and Lee County locations to strengthen its pediatric workforce, including recruitment and development of pediatricians (MD/DO) and pediatric physician assistants. |
| OHIO | Ohio’s Department of Health released its first three requests for proposals focused on pharmacy and workforce initiatives. The Pharmacy Initiative RFP will award an estimated $2 million to equip pharmacists with the tools and training needed to operate. The Rural Health Workforce Pipeline; Pathways Upskilling and Retention RFP will provide up to $10 million across two rounds. In partnership with academic and training institutions, projects will support career exploration, community health worker upskilling, education pathways, rural apprenticeships, recruitment and retention incentives, and six-month housing stipends for providers who commit to at least 5 years in rural communities. |
| DELAWARE | Announced multiple RFPs, including an FQHC value-based care (VBC) transformation initiative that will support rural health care providers and FQHCs to move towards VBC, including preparing to take on upside and downside risk and accountability for total cost of care and population health outcomes ($24.322 million). Additional RFPs include competitive awards to support sustainable food-is-medicine initiatives ($1.648 million), start-up costs for the state’s first four-year medical school ($42.5 million), and more. |
| KANSAS | Announced applications for the $44 million Regional Partnership Grant Program (RPGP). The program supports collaborative arrangements among eligible providers to promote preventive care, address the root causes of disease, improve efficiency and sustainability for rural providers, strengthen the health care workforce, advance value-based care models, and encourage the adoption of innovative technologies. Applications are due April 3, 2026. |
| NORTH CAROLINA | Released a Request for Applicants to establish North Carolina Rural Organizations Orchestrating Transformation for Sustainability (“NC ROOTS”) Hubs. These regional organizations will help advance efforts across primary care, behavioral health, workforce development, value-based payment, and digital health, tailoring strategies to the unique needs of their regions. The initiative includes $235,513,062 in total grant funding (approximately $40 million per region), distributed across up to six NC ROOTS Hub Leads. |
| NEBRASKA | Issued an RFP for a Chronic Disease Management Navigation and Education Initiative. Funded projects will expand community-based education, care navigation, and self-management support for individuals living with chronic conditions such as diabetes, cardiovascular disease, asthma, and other long-term health challenges. |
| NEW JERSEY | Released its first round of RFPs, including Preventive Health Initiatives ($8 million), Technology Solutions, Telehealth, and Remote Patient Monitoring ($9 million), Training and Capacity Building ($500,000), and a Rural Health Clinical Workforce and Retention Incentive program ($10 million). |
| SOUTH DAKOTA | Announced their first round of RFPs, which includes investments to expand and strengthen the rural Community Health Worker workforce and to create a population-based alternative payment methodology for primary care. |
RELATED CONTENT
- Community Health Centers Highlighted in the $50 Billion Notice of Funding Opportunity to States for the Rural Health Transformation Program (https://www.nachc.org/community-health-centers-highlighted-in-the-50-billion-notice-of-funding-opportunity-to-states-for-the-rural-health-transformation-program/)
- Rural Health Transformation Program State Applications Include Health Center Investments (https://www.nachc.org/rural-health-transformation-program-state-applications-include-health-centers-investments/)