How the Rural Health Transformation Program works
The eleven approved uses of funds, the two halves of the $50 billion, all sixteen scored factors with their weights, and why the score is recalculated every year.
All 50 states hold an award. $10 billion obligated for FY2026.
What the Rural Health Transformation Program is
A $50 billion federal program authorized by Section 71401 of Public Law 119-21 and administered by CMS. It distributes $10 billion a year from federal fiscal year 2026 through 2030. CMS approved applications from all 50 states in December 2025.
Who can apply
Only states, and the single window closed on 5 November 2025. Health systems and technology companies cannot apply to CMS. They participate as subrecipients of a state award, as subcontractors to an awardee, or through state procurement.
How the money splits
The scored half is recalculated every year. Only the blue quarter is genuinely within a state's control.
What it can pay for
Eleven approved Use of Funds categories, A through K. A state must carry out at least three. Provider payments under category B are capped at 15 percent of the annual award and cannot replace insurance-reimbursable payment.
The eleven approved uses of funds
Category D matters more than it looks. Training and technical assistance is an approved use, so the planning, the workshop and the solution architecture that help an organization adopt technology can be paid for out of the grant rather than out of operating margin.
The five goals every initiative is measured against
CMS names five strategic goals in the funding opportunity, and every approved use of funds is aligned to them. An initiative that cannot be traced to one of these is hard to defend at review.
Make rural America healthy again
Prevention, chronic disease management, behavioral health and prenatal care, using evidence-based, outcomes-driven interventions.
Where we help
Predictive intervention platforms that turn claims and clinical data into action, and SDOH data unified from hundreds of sources.
Sustainable access
Rural facilities working together, or with regional systems, to share or coordinate operations, technology, primary and specialty care, and emergency services.
Where we help
Multi-tenant platforms that let many organizations share one solution, and virtual coverage that pools scarce clinicians across sites.
Workforce development
Recruiting and retaining clinicians, and helping rural providers practice at the top of their license.
Where we help
Ambient documentation and assessment support that give hours back per clinician, measured rather than promised.
Innovative care
New care models and payment mechanisms that reduce cost, improve quality, and shift care to lower cost settings.
Where we help
Risk adjustment accuracy, value-based care analytics, and treat-in-place models that keep care in the lowest appropriate setting.
Tech innovation
Remote care, data sharing, cybersecurity, and access to digital health tools for rural facilities, providers and patients.
Where we help
The three technology factors CMS scores, all of which we have built and run in production.
Source: Centers for Medicare & Medicaid Services, Rural Health Transformation Program Notice of Funding Opportunity, CMS-RHT-26-001.
How RHTP funding is scored, and why that repeats every year
Workload funding is allocated by points. Half of those points come from rural score factors, which are fixed data a state cannot change: rural population, rural facility share, uncompensated care, land area, Medicaid DSH hospitals. The other half is the technical score, and it is earned.
Where the technical points actually are
Each bar is a factor, sized by its weight. CMS classifies every factor as data-driven, initiative-based, or a state policy action. Blue is initiative-based, meaning it is earned by proposing initiatives and then following through on them. Gray is a policy action a legislature takes.
Technical score factors, full table
| Group | Factors and weights | Group total |
|---|---|---|
| Population health | Clinical infrastructure 3.75 · health and lifestyle 3.75 · SNAP waivers 3.75 · nutrition CME 1.75 | 13.00% |
| Provider networks | Rural partnerships 3.75 · emergency medical services 3.75 · certificate of need 1.75 | 9.25% |
| Workforce | Talent recruitment 3.75 · interstate licensure compacts 1.75 · scope of practice 1.75 | 7.25% |
| Payment and integration | Medicaid value-based incentives 3.75 · dual eligibles 3.75 · short-term limited duration insurance 1.75 | 9.25% |
| Technology and access | Remote care services 3.75 · data infrastructure 3.75 · consumer-facing technology 3.75 | 11.25% |
Technology and access is the only group in which all three factors carry the maximum weight, and all three are initiative-based. Each factor is scored out of 100 across all 50 states, and a state’s award equals its share of the total points earned by every approved state, so this is a relative competition rather than a fixed entitlement.
The part most people miss
Technical scores are recalculated annually. States begin at 50 percent on initiative-based factors and earn the remainder by implementing their initiatives and meeting milestones. CMS may reduce, withhold or recover funds used inconsistently with what the state described in its application.
A state that does not deliver what it promised receives less the following year. Delivery is not a compliance task at the end of the grant. It is what protects the next allocation.
Unspent money leaves the state
Funds a state has not spent by the end of the following fiscal year are redistributed to other states. Money earmarked but not actually paid out does not count as spent.
It is a relative competition
Each factor is scored out of 100 across all 50 states. A state receives its share of the total points earned by every approved state, so standing still is losing ground.
It is a cooperative agreement
Not a hand-off grant. CMS stays substantially involved after award and may be in contact monthly or more often.
Primary sources worth reading
Everything on this page traces to a primary source. Third-party trackers of this program lag by weeks and have been wrong on state totals and administering agencies, so we use them for documents and never for numbers.
Federal
- CMS Rural Health Transformation Program overviewThe program home page, guidance and fact sheets
- Notice of Funding Opportunity, CMS-RHT-26-001The source document. Scoring tables, the eleven uses of funds, redistribution rules, and the eight example initiatives in the appendix. Assistance Listing 93.798
- CMS applicant webinar presentationScoring methodology and use of funds, as CMS presented it
- CMS Interoperability FrameworkThe criteria for a CMS-Aligned Network. FHIR, USCDI v3, IAL2 and AAL2 identity. Several criteria in effect since 4 July 2026
- Category B fact sheet, provider paymentsWhere the 15 percent cap is defined
- Category E fact sheet, workforceService commitment requirements
Analysis and state programs
- Bipartisan Policy Center NOFO explainerThe clearest public breakdown of the scoring weights
- NRHA state RFP trackerWhere every state stands in its RHTP procurement, with links to the actual solicitations. The single most useful place to find your state's open opportunities. Verify status with the state before relying on it
- Rural Health Information HubPer-state funding pages and rural designations
- Georgia Department of Community HealthAdministers Georgia's GREAT Health program
- Florida Agency for Health Care AdministrationYear 1 awardee list, 81 awards across four regions
- Alabama ADECAProgram timeline and the Year 2 calendar
Last reviewed 16 August 2026. This program changes weekly and we update this page as state announcements land.
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