Rural Health Transformation Program

The Centers for Medicare & Medicaid Services (CMS), within the U.S. Department of Health and Human Services, has released the Rural Health Transformation Program (RHT Program) under opportunity number CMS-RHT-26-001. This cooperative agreement program is authorized under Section 71401 of Public Law 119-21 and aims to transform healthcare delivery in rural communities across the United States. Congress has appropriated $50 billion over five budget periods from fiscal year 2026 through fiscal year 2030 to support state-level initiatives that address longstanding challenges in rural healthcare. Funding will be distributed through both baseline allocations to approved states and workload-based allocations tied to technical and rural facility scoring. The purpose of the RHT Program is to improve healthcare access, quality, and outcomes in rural areas through innovation, workforce development, strategic partnerships, and technology investment. States are expected to help rural communities achieve specific goals: expanding preventative care and chronic disease management, supporting sustainable rural healthcare access, strengthening the rural healthcare workforce, fostering innovative care models, and leveraging technology to improve delivery and data security. States must use awarded funds for at least three of the permissible uses outlined in statute, including prevention and chronic disease management, provider payments, consumer technology solutions, workforce recruitment, information technology upgrades, behavioral health access, and infrastructure improvements. The program is exclusively open to the 50 U.S. states. Neither the District of Columbia nor U.S. territories are eligible. Only a state government agency or office designated by the governor may apply, and each application must include a governor’s endorsement letter. Applications must be submitted by the designated lead state agency, such as a department of health or Medicaid agency, and must include commitments to stakeholder engagement and adherence to statutory spending rules. States may subaward or contract with partners such as universities, local health departments, or provider associations, but the state remains the prime awardee responsible to CMS. Applications are due by November 5, 2025, at 11:59 p.m. Eastern Time, and must be submitted through Grants.gov. An optional letter of intent is due by September 30, 2025, to MAHARural@cms.hhs.gov. Informational webinars for applicants will be held on September 19 and September 25, 2025. The expected award date is December 31, 2025, which is also the earliest possible start date for funded projects. States must be registered with SAM.gov and Grants.gov before applying, a process that can take several weeks to complete. Required application materials include a project narrative of up to 60 pages, a budget narrative of up to 20 pages, and several attachments including the governor’s endorsement, an indirect cost rate agreement if applicable, and a program duplication assessment. Funding will be distributed equally across states as baseline funding and supplemented with workload-based allocations determined by state-specific data, application quality, and policy commitments. Approved states will receive their funding in five budget periods, with each year’s funds required to be spent by the end of the subsequent fiscal year. Cooperative agreements will involve active CMS oversight, including monthly meetings, required performance reporting, and compliance with restrictions such as prohibitions on new construction, lobbying activities, or supplanting existing funding. Administrative costs are capped at 10 percent of a state’s total budget. Awardees must comply with federal regulations including 2 CFR Part 200 and Part 300 and will be subject to progress reviews and reporting requirements throughout the program’s duration. Applications will be reviewed for completeness, responsiveness, and merit. States must demonstrate how proposed initiatives will address at least three approved uses of funds and comply with program spending restrictions. Technical scores will be based on both data-driven metrics and qualitative assessments of program design, sustainability, and policy commitments. States that commit to legislative or regulatory changes can receive conditional credit toward workload funding, provided those changes are finalized by December 31, 2027 (or December 31, 2028 for certain policy factors). CMS retains discretion to adjust funding amounts, withhold payments for noncompliance, and redistribute unspent or unobligated funds. For program and eligibility questions, states may contact MAHARural@cms.hhs.gov. For financial and budget-related questions, inquiries may be sent to Grants@cms.hhs.gov. Grants.gov technical support is available at 1-800-518-4726 or support@grants.gov. Applicants are encouraged to carefully review all application requirements, as incomplete or noncompliant applications will not be considered. The program is a one-time opportunity with no recurring cycles indicated in the notice of funding opportunity.