Writing a Compelling Narrative for CMS: A State’s Story of Transformation for Rural Health
Every strong Rural Health Transformation (RHT) application tells a story — one that connects data to people, problems to solutions, and policy to purpose.
CMS reviewers won’t just be scoring applications for compliance; they’ll be asking:
Does this state understand its rural health challenges — and can it deliver real transformation?
This fifth post in the RHT Application Roadmap series will help your state write a compelling narrative that answers that question with confidence.
Step 1: Begin With a Powerful Problem Statement
Start by defining the “why.” The problem statement sets the tone and shows CMS that your state recognizes its challenges — and has the insight to address them strategically.
Include:
Clear data on access, workforce, and health outcomes.
Geographic or demographic trends (e.g., hospital closures concentrated in specific regions).
Quotes or stories from rural providers, caregivers, or residents.
Example framing:
“In the past decade, 14 rural hospitals in our state have closed, leaving more than 450,000 residents with no access to inpatient care within a 50-mile radius. The Rural Health Transformation Program offers an opportunity to reverse this trend through innovation, workforce development, and sustainable financing.”
This structure connects urgency, scope, and opportunity in a single paragraph.
Step 2: Articulate a Vision for 2030
CMS wants to see long-term ambition grounded in realism. Your vision statement should describe how rural healthcare will look by the end of the RHT funding period — not just what projects you’ll complete.
Example:
“By 2030, every rural resident in our state will have access to a stable network of primary and emergency care, supported by digital connectivity, trained local caregivers, and equitable reimbursement models that sustain providers.”
Make your vision measurable, time-bound, and aspirational — CMS favors clarity over rhetoric.
Step 3: Define Measurable Objectives
Transformative goals must be concrete. Set objectives that demonstrate forward momentum across CMS’s four pillars:
Sustainability: Reduce the number of financially distressed rural hospitals by 30% by FY 2030.
Equity: Decrease the gap in behavioral health access between rural and urban residents by 25%.
Workforce: Increase the number of licensed nurses and direct care workers practicing in rural areas by 20%.
Innovation: Expand telehealth adoption to 90% of rural primary care clinics.
Each objective should have a baseline (where you are) and a target (where you plan to be).
Step 4: Outline Your Core Strategies
Strategies explain how you’ll achieve your objectives. Link policy levers and programmatic actions to measurable outcomes.
Examples:
Workforce Stability: Launch rural training and apprenticeship pipelines through community colleges.
Financial Resilience: Transition rural hospitals into hybrid emergency and outpatient models.
Digital Equity: Invest in broadband expansion and telehealth training for residents and providers.
Cross-Sector Partnerships: Integrate Medicaid, public health, and workforce initiatives into a unified transformation plan.
These strategies should feel achievable, data-driven, and scalable — showing CMS that your state can deliver.
Step 5: Describe the Expected Outcomes
Outcomes are the “so what” of your plan — what success will mean for rural communities, the workforce, and the state as a whole.
Quantitative outcomes demonstrate accountability:
X% increase in rural residents with a primary care provider.
X% reduction in avoidable hospitalizations.
X% improvement in broadband-enabled health access.
Qualitative outcomes show human impact:
Fewer families forced to travel long distances for care.
More older adults able to age in place with autonomy and safety.
Stronger partnerships between providers, caregivers, and communities.
Include both. Numbers show rigor; stories show heart.
Step 6: Weave the Narrative Together
A strong application narrative should flow like a story:
The Challenge: What rural health looks like today.
The Vision: What transformation will achieve by 2030.
The Plan: How policies and programs connect to outcomes.
The Impact: How communities, providers, and economies will benefit.
Keep paragraphs short, use active voice, and avoid jargon. CMS reviewers may read dozens of applications a day — clarity is your greatest advantage.
Step 7: Align the Story With CMS Priorities
Your narrative should reflect CMS’s overarching priorities:
Equity: Address disparities and show inclusion of underserved populations.
Innovation: Highlight replicable, scalable solutions.
Integration: Demonstrate cross-agency and cross-sector collaboration.
Sustainability: Explain how results will continue beyond FY 2030 funding.
Explicitly reference these terms — CMS reviewers will be scanning for them.
The Bottom Line
A powerful RHT application reads like a blueprint and a promise. It proves your state understands its rural health landscape, values its partners, and has a credible plan to build lasting change.
By combining data, vision, and authentic storytelling, you can move your application from compliance to conviction — and from submission to success.
Call to Action
State RHT Teams: Begin drafting your narrative framework now — even if your data collection is still in progress.
Policy and Communications Staff: Align messaging to CMS’s four pillars; consistency matters.
Providers and Advocates: Contribute real-world stories that illustrate what transformation means in practice.
The story your state tells today will shape rural care for the next decade. Make it bold, grounded, and unforgettable.
