Five Lessons for States Preparing Rural Health Transformation Applications
With the Rural Health Transformation (RHT) Program application deadline just weeks away, November 5, 2025, states face a daunting challenge: how to prepare a CMS-ready application that secures their share of $50 billion in funding.
From my work helping providers and policymakers align strategy with policy change, I’ve distilled five key lessons states should prioritize as they craft their submissions.
1. Engage Stakeholders Early and Often
Rural transformation cannot succeed without buy-in from those who deliver and rely on care every day. Hospitals, federally qualified health centers, long-term services and supports providers, tribal health authorities, and community leaders all need to see their voices reflected in the application.
Best practice: Document stakeholder engagement with letters of support, meeting summaries, and clear evidence of inclusion.
Why it matters: CMS will look for proof that the plan is grounded in community needs, not just written at a state agency desk.
2. Lead With Data
A compelling application tells a story supported by facts. States should marshal data that highlights:
Rural population size and percentage
Hospital and clinic closure trends
Provider shortages (physicians, nurses, direct care workforce)
Health disparities and outcomes by region, race, and income
Pro tip: Pair data with local stories. Numbers grab attention, but lived experiences make the case undeniable.
3. Frame Transformation Around Equity
Rural doesn’t mean monolithic. Many rural communities include underserved groups — tribal nations, agricultural and migrant workers, older adults, and residents facing poverty or broadband gaps. CMS is clear: equity-focused strategies strengthen applications.
Highlight populations most at risk of poor access or outcomes
Describe how funding will reduce inequities and expand opportunity
Link transformation goals to CMS’s broader health equity framework
4. Align With Existing Medicaid and State Initiatives
Strong applications don’t reinvent the wheel — they build on what’s already working.
If your state has a Section 1115 waiver, value-based care pilots, or rural innovation projects, show how RHT will accelerate or scale them.
Position RHT as part of a cohesive long-term vision rather than a standalone program.
Why this works: CMS wants sustainability. Applications that integrate RHT into broader state strategies stand out.
5. Build for Sustainability Beyond 2030
The $50 billion in federal support is temporary. States must show how transformation will last after the funding ends.
Outline workforce pipelines, not just workforce subsidies
Plan for diversified revenue streams for rural hospitals and clinics
Invest in technology (telehealth, remote monitoring) that can scale without ongoing grants
Include evaluation and continuous improvement processes
The Bottom Line
The RHT Program isn’t just another grant opportunity — it’s a mandate to rethink the structure of rural healthcare delivery. States that move quickly, engage deeply, and plan sustainably will be best positioned to secure funding and deliver lasting impact.
The deadline is fast approaching. These five lessons can help states not only apply, but apply with confidence.
Call to Action
If you’re a state leader, provider, or health tech partner:
Ask now if your state has filed an LOI or launched stakeholder engagement.
Offer your expertise — data, community connections, or innovative solutions that could strengthen the application.
Seek guidance if your organization needs help framing impact, aligning with CMS priorities, or demonstrating sustainability.
This is the moment to turn policy into action. The communities who depend on rural healthcare are counting on it.
