The Rural Health Transformation Program: What States Need to Know Now

This fall marks one of the most consequential opportunities for states to strengthen rural health systems in decades. The One Big Beautiful Bill Act established the Rural Health Transformation (RHT) Program, a $50 billion investment designed to stabilize and modernize care delivery in rural communities between FY 2026 and FY 2030.

But here’s the catch: states must act fast.

Key Deadlines Every State Needs to Track

• September 30, 2025 – Optional Letter of Intent (LOI) due

• November 5, 2025 – Full application deadline

• December 31, 2025 – CMS must approve or deny all state applications

That means in less than 100 days, states need to organize their data, engage stakeholders, and prepare compelling applications that not only secure funding, but also set a sustainable course for rural health delivery for the next five years.

Key Deadlines Every State Needs to Track

September 30, 2025 – Optional Letter of Intent (LOI) due

• What it is: The LOI is not binding, but it signals a state’s intent to apply and helps CMS gauge the volume of submissions.

• Why it matters: States that file an LOI show seriousness and can get on CMS’s radar early, which may help with technical assistance or clarifying questions.

• Recommendation: Even if your state isn’t 100% ready, file the LOI. It buys credibility and keeps the door open while internal planning continues.

November 5, 2025 – Full application deadline

• What it is: The comprehensive submission outlining the state’s Rural Health Transformation plan — including data, stakeholder input, goals, and implementation strategies.

• Why it matters: This is the one and only chance to secure funding for FY 2026–2030. Late submissions will not be accepted.

• Recommendation: Build a clear project management timeline now. Use September for stakeholder listening, October for drafting and refining, and early November for executive review. Don’t leave approvals to the last week.

December 31, 2025 – CMS must approve or deny all state applications

• What it is: Federal law requires CMS to issue decisions by year’s end. Approvals trigger the first wave of funding allocations in FY 2026.

• Why it matters: This quick turnaround means states won’t have a long negotiation window. Applications must be strong and compliant upfront — CMS will not have time for back-and-forth revisions.

• Recommendation: Submit an application that is “CMS-ready” on day one. That means:

  • Aligning with CMS guidance language

  • Backing claims with data (workforce numbers, closure trends, access disparities)

  • Demonstrating stakeholder engagement (letters of support, meeting summaries)

  • Outlining sustainability beyond federal funding

Why It Matters

Rural health systems are under pressure. Workforce shortages, hospital closures, limited access to specialty care, and geographic isolation all combine to threaten health outcomes for millions of Americans. This new program is designed to be more than a temporary lifeline — it’s an invitation to rethink rural health infrastructure, financing, and workforce strategies.

The funding isn’t just about plugging financial gaps. CMS is looking for transformative plans that address:

• Stabilization of rural hospitals and clinics

• Expansion of telehealth and broadband-enabled care

• Strengthening the direct care workforce pipeline

• Equity-focused strategies for underserved populations, including tribal and agricultural communities

• Integration with Medicaid transformation and other state health initiatives

Every State Has a Stake — Even California

When people think “rural,” they don’t often picture California. Yet with nearly two million rural residents, California’s rural population is larger than the entire state population of West Virginia. The difference? In California, those residents make up only about 5% of the population, compared with West Virginia’s 55%.

That’s the dual lens states need to apply:

• Absolute numbers (how many people are impacted)

• Percentage of population (how deeply rural dynamics shape the state’s health landscape)

Both perspectives matter — and both can make a strong case to CMS if supported with data and stakeholder voices.

The Bottom Line

The Rural Health Transformation Program represents a once-in-a-generation chance to stabilize and reimagine care in rural communities. The clock is already ticking: applications are due in early November, and CMS will make decisions before the year ends.

For states, the question isn’t whether rural transformation is needed — it’s whether leaders can mobilize quickly enough to seize this opportunity.

Call to Action: How You Can Get Involved

For providers, policymakers, and health tech leaders, the time to act is now:

• Engage your state health agency — Ask if your state plans to submit an application and how stakeholders can contribute.

• Share your data and stories — Rural transformation plans are strongest when they combine hard numbers with lived experiences from providers, caregivers, and communities.

• Form coalitions — Partner with hospitals, long-term services and supports providers, and technology vendors to show CMS a united, forward-looking vision.

• Seek expert guidance — Crafting a compelling application takes strategy, alignment, and the ability to translate community needs into CMS-ready language.

If your state is preparing an application, or if your organization wants to ensure its voice is represented, I can help you navigate this process. Let’s make sure this unprecedented investment leads to lasting transformation.