Sustainability and Evaluation: Planning Beyond 2030 for Rural Health Transformation
The Rural Health Transformation (RHT) Program goes beyond stabilizing today’s rural healthcare infrastructure—it endeavors to design infrastructure improvements for lasting stability.
By 2030, when federal funding ends, CMS expects states to have built models that can stand on their own. That means sustainable financing, stable workforce pipelines, and measurable improvements in access, quality, and health outcomes.
This sixth post in the RHT Application Roadmap series explains how to plan for the long term—so your state’s transformation doesn’t stop when the funding does.
Step 1: Build Sustainability Into the Foundation
CMS reviewers know that pilot projects are easy to start and hard to sustain. That’s why successful applications weave sustainability into every objective rather than include it as a separate standalone element.
Ask these questions as you plan:
How will we continue this work after FY 2030?
What partnerships, policies, or revenue streams can extend success?
What capacity must we build now to maintain programs later?
Practical examples:
Align RHT goals with your Medicaid Section 1115 waiver or value-based payment initiatives.
Create public-private partnerships that allow hospitals, health tech vendors, and community-based providers to co-fund ongoing projects.
Integrate state workforce incentives (loan repayment, apprenticeships, continuing education) into long-term training pipelines.
When CMS sees sustainability threaded throughout your plan, they see readiness—not dependency.
Step 2: Secure Diverse and Durable Funding Streams
States that rely solely on RHT dollars will face a fiscal cliff. Instead, build a layered financing strategy that combines:
Federal sources: RHT, Medicaid, HRSA, USDA rural broadband, and CDC public health grants.
State funds: General revenue, state workforce programs, or regional innovation grants.
Private and philanthropic investments: Rural hospital networks, foundations, and health system partnerships.
Shared savings models: Use value-based care structures to reinvest cost savings into rural infrastructure and workforce development.
Pro tip: Document early MOUs or letters of intent from partners willing to sustain programs post-2030—these show CMS that long-term funding conversations are already underway.
Step 3: Design a Measurable Evaluation Framework
CMS wants results, not rhetoric. Evaluation must be integrated, continuous, and transparent.
Include three types of measures:
(1) Access Metrics
% of rural residents with a primary care provider
Average distance or travel time to care
Telehealth utilization rates
(2) Workforce Metrics
Vacancy and turnover rates among rural providers and direct care staff
Number of new workers trained through RHT-supported programs
Retention rates at 12 and 24 months
(3) Health and Equity Metrics
Rates of preventable hospitalizations
Behavioral health access disparities (rural vs. urban)
Broadband-enabled health participation across demographic groups
Tip: Set baselines now. The same metrics you include in your landscape assessment (from Post 2, Assessing Your Rural Health Landscape: Data Every State Needs) should form the foundation of your evaluation plan.
Step 4: Commit to Continuous Quality Improvement (CQI)
Evaluation shouldn’t be static or punitive—it should drive improvement. Adopt a CQI framework to adjust your strategy as new data emerges.
Key practices:
Quarterly review meetings with state and regional partners.
Annual “Rural Health Progress Reports” shared publicly.
Dashboards that track performance in real time.
Mechanisms to identify underperforming regions and reallocate resources proactively.
CMS values transparency. A clear CQI framework signals a mature, accountable approach to transformation.
Step 5: Empower Local Ownership
Sustainability grows from within communities. States should plan for local transition of ownership over time by:
Training regional health coalitions to manage ongoing projects.
Embedding rural health coordinators within county or regional agencies.
Equipping community-based providers to collect and use their own data.
When communities help measure and maintain progress, transformation becomes a shared responsibility—not just a state mandate.
Step 6: Connect Outcomes to Broader State Goals
RHT success should advance larger statewide strategies for health, equity, and economic development.
Show CMS how RHT connects to:
Workforce and education initiatives (e.g., community college programs, high school career pathways).
Economic resilience plans (rural job creation, telework, local business support).
Health equity blueprints (addressing disparities among tribal, agricultural, and aging populations).
Framing RHT within a broader policy ecosystem shows alignment, leverage, and vision.
The Bottom Line
Sustainability and evaluation are essential to providing proof that transformation is real. CMS wants to fund states that not only act boldly but think beyond the grant cycle.
When your plan demonstrates clear metrics, transparent evaluation, diversified funding, and local ownership, it tells reviewers:
This is a transformation that will last.
Call to Action
State RHT Teams: Begin developing your sustainability narrative and evaluation framework now.
Finance and Medicaid Leads: Identify complementary funding streams to carry initiatives forward post-2030.
Providers and Regional Partners: Volunteer to pilot dashboards, participate in CQI cycles, and help design realistic performance measures.
The best time to plan for sustainability is before the first dollar is spent. The RHT Program can transform rural healthcare—but only if states build systems designed to endure.
