How States Can Position Themselves for Rural Health Transformation Success
The Rural Health Transformation (RHT) Program is one of the most significant federal investments in rural care in a generation. With $50 billion available through FY 2030, this initiative gives states the chance to stabilize hospitals, expand access, and build the workforce rural communities need to thrive.
But funding isn’t guaranteed. CMS will only approve applications that demonstrate strategic alignment, stakeholder engagement, and measurable, sustainable outcomes. That means states need to move fast — and with focus.
This first installment of the RHT Application Roadmap series covers how states can position themselves for success before the November 5, 2025 submission deadline.
Step 1: Start With a Clear Purpose
Every strong application begins with a unifying purpose:
“How will this funding transform the health and resilience of our rural communities?”
Your state’s purpose statement should:
Anchor the plan in CMS priorities — sustainability, equity, workforce, and innovation.
Reflect measurable impact (e.g., hospital stabilization, broadband-enabled telehealth for health equity and access, workforce recruitment and sustainability).
Show that transformation isn’t just about short-term fixes but long-term infrastructure for care and community health.
Step 2: Profile Your Rural Landscape
Before designing solutions, states must understand who and where their rural residents are. Use both:
Absolute population counts (how many people live in rural areas)
Percent of total population (how deeply rural dynamics shape the system)
Example: Texas has more than 4.7 million rural residents, while Maine’s population is 62 percent rural. Both have strong cases to make — one based on scale, the other on intensity.
Include quick-reference facts in your executive summary:
Number and percentage of rural residents
Hospital and clinic distribution
Key chronic health conditions
Broadband access levels
This data grounds your narrative in evidence — and helps reviewers see the need immediately.
Step 3: Set High-Level Goals That Align With CMS
CMS is clear: this funding is meant to transform, not patch. Your high-level goals should fall within four pillars:
Sustainability – Ensure financial stability for rural facilities and provider networks.
Equity – Reduce disparities among rural residents, especially tribal, agricultural, and older populations.
Workforce – Build training, recruitment, and retention pipelines for clinical and direct care staff.
Innovation – Invest in telehealth, data infrastructure, and care coordination models that expand access.
Use these categories as anchors in both your executive summary and narrative sections.
Step 4: Build Cross-Agency Alignment Early
The best RHT applications won’t come from a single department. Success requires a whole-of-state approach:
Health departments lead strategy and data analysis.
Medicaid agencies align funding streams and waivers.
Workforce and higher-ed partners strengthen training capacity.
Economic development offices link health transformation to rural job creation.
A short alignment statement in your executive summary demonstrates readiness and collaboration — two traits CMS values highly.
Step 5: Establish a Clear Communication Framework
In every great application, clarity equals credibility. Create a brief, cohesive executive summary that quickly tells CMS reviewers:
What problem the state will solve.
Who will benefit.
How results will be measured.
Aim for one page that can stand alone — concise, data-rich, and framed around impact by 2030.
The Bottom Line
Positioning for success means acting now. By clarifying purpose, defining the rural landscape, aligning goals with CMS, and building partnerships early, states can ensure their RHT application moves from eligible to exemplary.
The states that prepare early will not only secure funding — they’ll shape the next decade of rural health policy.
Call to Action
State leaders: Convene your cross-agency team this week and outline your RHT purpose statement.
Providers and associations: Offer data, stories, and local insight that illustrate what transformation means on the ground.
Partners and innovators: Reach out to state agencies with solutions that align with CMS’s four pillars.
The application window is short, with less than 30 days until the deadline, but the opportunity is historic. Let’s make sure every state enters the race ready to win.
