Montana's Rural Health Transformation Program: Where Things Stand
Montana is entering the implementation phase of the Rural Health Transformation Program (RHTP), a five-year, $50 billion federal initiative created by H.R. 1, the One Big Beautiful Bill Act. Montana’s fiscal year 2026 award is $233,509,359, the fourth-highest amount awarded to any state, and the state could receive more than $1.2 billion over the life of the program.
At the center of Montana’s strategy is the Rural Health Center of Excellence (CoE), which will use facility-level data to develop recommendations, support operational improvements, and help administer financial incentives tied to measurable outcomes. On July 17, 2026, the Montana Hospital Association (MHA) announced that ten hospitals leaders had been appointed to the CoE Advisory Council, marking another significant milestone as the program moves from planning toward implementation.
The Money Behind RHTP
The Centers for Medicare & Medicaid Services (CMS) announced on December 29, 2025, that all 50 states would receive RHTP funding. Montana’s FY26 award of $233.5 million trails only Alaska, Texas, and California. Given Montana’s rural landscape and the program’s funding structure, the state could receive more than $1.2 billion over the five-year life of the initiative.
The funding stems from H.R.1, passed in July 2025, which established a $50 billion investment in rural healthcare nationwide. Half of the funding is distributed evenly among states with approved applications, while the remaining funds are awarded at CMS’s discretion. Montana submitted its application in November 2025 and received approval the following month.
Where the Center of Excellence Fits
DPHHS organized its RHTP plan into five initiatives. The Center of Excellence falls under Initiative 2, Sustainable Access, the largest of the five initiatives by funding. Its purpose is to strengthen rural healthcare by combining facility-level analytics, regional collaboration, and operational improvement strategies that help preserve access to care across the state.
The Center of Excellence is expected to:
- Analyze rural health supply and demand using facility-level data.
- Develop recommendations tailored to individual hospitals and communities.
- Help facilities build a path toward long-term financial sustainability.
- Support a voluntary incentive program that rewards measurable improvements.
Rather than serving as a single project, the CoE is designed to become the operational hub that helps Montana’s rural healthcare organizations identify opportunities, prioritize improvements, and measure progress over time.
Who's Now Steering It
On July 17, MHA President Ed Buttrey announced that DPHHS had appointed ten hospital leaders to the Center of Excellence Advisory Council, each serving an initial two-year term:
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John Goodnow, FACHE, CEO of Benefis Health System (Great Falls)
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Lee Boyles, President of Intermountain Health Montana and Wyoming (Billings)
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Kathryn Bertany, MD, MBA, CEO of Bozeman Health (Bozeman)
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James Duncan, President Emeritus of Billings Clinic Foundation (Billings)
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Parker Powell, CEO of Glendive Medical Center (Glendive)
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Abby Lotz, CEO of Beartooth Billings Clinic (Red Lodge)
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Greg Hanson, MD, CEO of Clark Fork Valley Hospital (Plains)
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Nickolas Dirkes, CEO of Frances Mahon Deaconess Hospital (Glasgow)
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Steve Todd, CEO of St. Luke Community Healthcare (Ronan)
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Kevin Harada, MD, President and CEO of Northern Montana Health Care (Havre)
Ed Buttrey also serves on the council as the Statewide Hospital Organization Representative in a non-voting capacity.
Together, the council will help ensure that Initiative 2 remains grounded in the realities of delivering rural healthcare, bringing the perspective of hospitals, health systems, and critical access facilities into the program as it continues to develop.
How Implementation is Taking Shape
DPHHS structured Initiative 2 around two complementary efforts.
The first focuses on assessment—using facility-level data and statewide analysis to identify opportunities, develop recommendations, and guide improvement efforts through the Center of Excellence.
The second focuses on implementation—helping hospitals turn those recommendations into meaningful operational change through technical assistance, workflow improvements, and on-the-ground support.
The implementation scope has been awarded to a consortium that includes the Montana Hospital Association, Montana Medical Association, Montana Primary Care Association, and Montana Health Network. Through its nonprofit arm, the Montana Hospital Research & Education Foundation (MHREF), MHA is expected to play a significant role in helping hospitals implement the recommendations developed through the assessment process.
The assessment entity responsible for developing those recommendations has not yet been publicly identified, meaning portions of the Center of Excellence structure are still being finalized. As those remaining pieces come together, hospitals can expect additional guidance on how recommendations, implementation support, and incentive opportunities will work together.
What Hospitals Are Being Asked to Do Right Now
While the remaining pieces of the Center of Excellence are being finalized, DPHHS has already begun laying the groundwork for implementation.
MHA has encouraged member hospitals to begin reporting daily census data, which will support the Center of Excellence’s statewide supply-and-demand analysis. The Department of Labor and Industry has also conducted workforce development stakeholder outreach, while DPHHS recently opened rural EMS equipment grants to support broader transformation efforts.
MHA also has an August stakeholder advisory meeting scheduled, providing another opportunity for healthcare leaders to stay informed as the program continues to evolve.
The Takeaway
Montana has moved beyond planning and into the early stages of implementing one of the nation’s largest rural health investments. Leadership structures are being established, implementation partners have been identified, and the remaining assessment components are still coming together.
For hospitals, this is an excellent time to become familiar with how the program is evolving, ensure foundational data and reporting processes are in place, and begin thinking about where opportunities for operational improvement may exist. As recommendations, technical assistance, and incentive opportunities begin rolling out, facilities that understand the program and engage early will be well positioned to make the most of the resources available through Montana’s Rural Health Transformation Program.
