Building a Stakeholder Engagement Strategy That Wins CMS Approval for Rural Health Transformation
The Rural Health Transformation (RHT) Program is more than funding — it’s about trust, collaboration, and credibility. States that treat stakeholder engagement as a box to check will fall behind. States that treat it as a foundation will rise to the top of CMS’s approval list.
CMS has made it clear: successful applications must demonstrate inclusive, well-documented stakeholder engagement. That means showing that the plan was built with communities, not for them.
This installment of the RHT Application Roadmap series outlines how states can build a meaningful engagement strategy that strengthens their application — and their long-term transformation success.
Step 1: Identify Your Core Partners
A strong engagement strategy begins with knowing who must be at the table. Every state will differ, but CMS expects broad representation across sectors and geography.
Include:
Hospitals and critical access facilities
Federally Qualified Health Centers (FQHCs) and rural clinics
Home- and community-based services (HCBS) and LTSS providers
Tribal and Indigenous health authorities
Behavioral and mental health providers
Public health departments and local boards of health
Workforce development and higher education partners
Consumer and caregiver advocacy organizations
Tip: Include partners that reflect diversity in geography, population, and service type. A mix of large systems and small providers shows CMS that transformation will reach the full rural continuum of care.
Step 2: Design an Engagement Timeline
CMS reviewers look for evidence that engagement was both early and ongoing. Plan for three clear phases:
Listening and Discovery (September)
Conduct listening sessions, surveys, and stakeholder calls.
Gather pain points, priorities, and success stories.
Use this feedback to shape the initial application framework.
Draft Review and Refinement (October)
Circulate draft sections for stakeholder comment.
Incorporate feasible recommendations and document how input shaped revisions.
Endorsement and Submission (Late October–November)
Secure letters of support and formal resolutions from major partners.
Summarize engagement efforts and outcomes in an appendix.
Step 3: Use Multiple Channels for Inclusion
Equity in engagement is as important as equity in outcomes. Ensure that input is accessible and representative:
Host virtual and in-person sessions to reach rural regions with limited broadband.
Provide materials in multiple languages.
Schedule meetings outside of traditional business hours for working caregivers and providers.
Partner with regional councils or associations to reach smaller or underrepresented organizations.
Documentation matters. CMS reviewers will look for meeting summaries, attendance records, and written evidence of outreach to underserved or hard-to-reach groups.
Step 4: Document, Document, Document
In CMS’s eyes, “If it’s not documented, it didn’t happen.”
Create a simple engagement documentation package that includes:
List of stakeholder meetings (date, format, topic, attendance)
Summary of key feedback themes
How feedback influenced the application draft
Letters of support and coalition statements
Photos or sign-in sheets from public sessions (if available)
Bundle this documentation as an appendix to your application. It’s tangible proof of collaboration and readiness.
Step 5: Engage the Right Voices for Long-Term Impact
While CMS requires engagement during application development, states should also design engagement structures that last beyond the grant period.
Options include:
Establishing a Rural Transformation Advisory Council to guide implementation and evaluation.
Partnering with state universities or workforce boards for ongoing research and analysis.
Embedding community representatives in decision-making to maintain trust and transparency.
Long-term engagement builds credibility — not just with CMS, but with the communities that will ultimately benefit.
Step 6: Align Engagement With the State’s Narrative
Stakeholder engagement isn’t a stand-alone task — it strengthens the story your state tells. Use the feedback you gather to:
Illustrate real challenges with lived experience quotes.
Demonstrate how local voices shaped the vision and goals.
Show CMS that transformation efforts reflect on-the-ground realities.
When engagement aligns with the narrative, your application feels authentic, data-informed, and community-driven — exactly what CMS wants to fund.
The Bottom Line
Stakeholder engagement is the backbone of a competitive RHT application. It demonstrates readiness, equity, and collaboration — the qualities that separate strong submissions from generic ones.
States that engage early and deeply will build plans that are not only CMS-approved but community-endorsed.
Call to Action
State RHT Teams: Publish your engagement schedule and open public comment immediately.
Providers and Associations: Participate actively and bring your data, stories, and ideas to the table.
Advocates and Caregivers: Ensure the voices of those receiving care — not just those delivering it — are heard.
Meaningful engagement takes time. But in the eyes of CMS, it’s the difference between a plan on paper and a transformation in motion.
