October 30 is almost here, and states participating in the Rural Health Transformation Program (RHTP) are approaching an important deadline. It’s the final day to obligate Year 1 funding, marking a major milestone in the program’s first year.
Over the past several months, states have been working to turn their RHTP plans into funded projects. Now, as Year 1 comes to a close, we’re beginning to see those investments take shape and what they could mean for rural hospitals and their communities.
But meeting the deadline is only part of the story.
What we’re especially interested in is what happens next. How can states and rural healthcare organizations make the most of these investments? And how can the work happening today help hospitals stay financially strong long after the funding ends?
With Year 2 right around the corner, there’s a lot to look forward to. Let’s take a look at where things stand, what the October 30 deadline means, and how states and rural facilities can make these dollars count.
What Is the October 30 RHTP Deadline?
October 30, 2026, marks the end of the first RHTP budget period and the deadline for states to obligate their Year 1 funding.
An obligation commits funding for an approved purpose, such as a contract, grant award, or other qualifying agreement. It doesn’t necessarily mean the money has already been spent or that a rural hospital has received its share.
That distinction matters because RHTP has several deadlines that affect how states manage their funding.
Date | What Happens |
October 30, 2026 | Deadline for states to obligate Year 1 funding |
October 31, 2026 | Deadline for CMS to announce Year 2 awards |
September 30, 2027 | Deadline to expand Year 1 funds |
March 31, 2028 | Statutory redistribution process begins for certain unused Year 1 funds |
Sources: KFF and Pennsylvania DHS.
If your hospital hasn’t received RHTP funding yet, don’t count yourself out. October 30 is the deadline for states to commit their Year 1 dollars, but it doesn’t mean every funding opportunity closes that day. Check in with your state to see what’s still available and what opportunities might be coming in Year 2.
The important thing is knowing where your state stands and how your organization can participate.
RHTP Dollars Are on the Move
We’re getting a better picture of where RHTP funding is going as states announce new projects and move ahead with their first-year investments.
CMS released its first nationwide obligation report on October 9. While the report covers activity only through July 31, it showed that states had committed approximately $4 billion of their $10 billion in Year 1 funding.
Since then, we’ve seen more progress.
Iowa announced on October 9 that it had fully obligated its $209 million Year 1 award. That funding is supporting projects ranging from advanced surgical equipment and maternal health telehealth to workforce development and improved technology for rural providers.
West Virginia has also been announcing new awards, including nearly $2.2 million on October 13 to help community health centers improve patient care and reduce administrative work.
And there’s more to come. CMS expects to update its nationwide figures after states submit their next quarterly reports on November 30.
What Rural Hospital Leaders Can Do Before October 30
We’ve had a lot of conversations with rural healthcare leaders about RHTP this year, and there’s a mix of excitement and understandable concern.
There’s excitement about what new funding could make possible. At the same time, many leaders are wondering whether those dollars will reach their facilities, how they’ll manage another project with an already busy team, and whether the investments will be enough to make a lasting difference.
Those are important questions.
As KFF explains, the Medicaid reductions in the same federal law extend beyond the five-year RHTP funding period. That makes it especially important to invest in projects that can strengthen rural healthcare organizations for the long term.
Whether your facility has already received funding or is still exploring opportunities, there are a few things worth doing now.
1. Connecting With Your State's RHTP Team
If you haven’t connected with the people overseeing RHTP in your state, now is a good time.
Find out which initiatives are moving forward, whether additional opportunities are available, and what your organization should be preparing for next.
It’s also an opportunity to share what your facility actually needs.
State plans outline broad priorities, but rural hospitals know their day-to-day challenges. Maybe recurring denials are taking time away from an already stretched revenue cycle team. Maybe your chargemaster hasn’t been reviewed in years. Or perhaps you have data available but need help turning it into information your team can use.
Bringing those needs into the conversation, along with a clear picture of the potential impact, can help state teams understand where an investment could make a difference.
Even if your state’s Year 1 funding is already committed, those conversations can help prepare your facility for Year 2.
2. Know Your Numbers Before You Ask for Funding
One of the most valuable things a rural hospital can bring into an RHTP conversation is a clear understanding of where it stands today.
And that doesn’t necessarily mean collecting more data.
Many rural hospitals already have valuable information sitting in their financial and operational systems. The opportunity is in analyzing that information to identify where improvements could make the biggest difference.
Take denials, for example. Your hospital may know how much revenue is being denied, but do you know what’s causing those denials or where they’re starting? Or when was the last time someone took a close look at your chargemaster to see whether your charges still make sense?
There are opportunities on the clinical and operational side, too. Looking at how patients use your services, which departments are seeing the most demand, and where patients may be going without care can help your team decide where to focus its resources.
Having that baseline makes it easier to build a specific funding request. Instead of simply asking for support to improve financial performance, a hospital can identify a particular challenge, explain its impact, and describe what success would look like.
It also gives the team a way to measure progress once the project begins.
Titusville Area Hospital, a 25-bed critical access hospital in northwest Pennsylvania, hadn’t done a full chargemaster review in over a decade. Through the Pennsylvania Office of Rural Health, its team worked with ours to compare charges against the fee schedules of its two largest commercial payers. The review projected about $200,000 a year in net revenue, 4 times the $50,000 its CEO had hoped for (read Titusville’s story).
You don’t have to wait until funding is approved to start digging into your data. The more you know about where your hospital stands today, the better prepared you’ll be to make a case for funding in Year 2.
3. Understand the Reporting Requirements Before You Begin
RHTP is about more than distributing funding. States also must show how they use those investments and what they accomplish.
That means reporting will be an important part of many funded projects.
Before starting a new initiative, ask your state team or funding partner what information your facility will need to provide, how often you’ll report, and what support will be available.
It’s worth discussing how you’ll measure progress, too.
If your project is focused on reducing denials, for example, you’ll want to understand your current denial rate and track what changes over time. If you’re investing in operational improvements, consider how you’ll measure the effect on staff workflows and efficiency.
The goal is to make reporting a natural part of the project rather than another major responsibility added to your team’s workload.
How States Can Make RHTP Investments Count
State RHTP teams have had an enormous amount to accomplish in a relatively short period.
Since the first awards were announced in December 2025, states have developed funding opportunities, reviewed proposals, coordinated partners, and prepared projects for implementation.
All of that work is happening while rural healthcare organizations face real financial and operational pressures.
A lot is riding on these investments, and we appreciate the work state teams are doing to move them forward.
As Year 1 wraps up, we see a few opportunities to help make those investments especially valuable.
1. Choose Projects That Can Demonstrate Results
RHTP reporting isn’t just about showing that money was spent. States will also need to demonstrate progress toward their program goals.
Pennsylvania’s Year 1 program overview, for example, describes how performance reporting will factor into future funding decisions.
Projects with a clear starting point and measurable goals can make that work easier.
For a revenue cycle initiative, that might mean establishing a baseline for denials, identifying recurring causes, implementing process improvements, and tracking whether those changes reduce avoidable denials.
But financial results aren’t the only measure of success.
A project that helps staff better understand their data, strengthens collaboration between departments, or gives a hospital tools it can continue using after the engagement also creates meaningful value.
Those improvements can support future financial, operational, and clinical initiatives, extending the benefits beyond a single project.
The Pennsylvania Office of Rural Health’s chargemaster project with Titusville Area Hospital shows what that can look like. Weekly working calls caught a critical access reimbursement issue early enough to change course, and the hospital uploaded the final file straight into its system with no line-by-line entry. Jill Neely, Titusville’s VP of Revenue Cycle, summed it up: “It was such an easy process” (Titusville’s story).
2. Make It Easier for Rural Facilities to Participate
One thing we’ve learned from working alongside rural hospitals is that a great project still needs to fit the facility’s realities.
Rural teams are often balancing several responsibilities at once. Even when leaders are excited about an opportunity, finding time to manage another initiative can be difficult.
That’s why the way a project is implemented matters.
Consider how much work the facility will need to take on, what resources a partner can provide, and whether the project includes hands-on support rather than simply delivering findings.
A statewide financial improvement initiative might involve several rural hospitals, each with different systems and priorities. Instead of asking every facility to develop its own approach from scratch, a project partner can move in step with your teams from digging into the data through implementation.
That gives hospital teams more time to focus on the decisions and changes that require their expertise.
It’s also worth thinking about what happens when the project ends. Will staff understand how to continue monitoring performance? Will they have processes in place to respond when new challenges appear?
A successful project should make the work easier today while helping facilities become more confident and capable over time.
3. Work With Partners Who Understand Rural Healthcare
Rural hospitals operate differently from large health systems, and those differences matter when you’re planning a project.
Staffing, reimbursement structures, technology, available resources, and community needs can all influence how work gets done.
A partner with rural healthcare experience can spot those challenges early and help develop an approach that works for the organization.
For state offices supporting multiple facilities, that experience becomes even more valuable. A project may have shared goals across a group of hospitals, but each facility will have its own needs, starting point, and opportunities for improvement.
The strongest partnerships accommodate those differences while helping organizations move toward measurable progress.
And ideally, they leave hospital teams with more than a completed project. They leave them with knowledge, tools, and confidence they can apply to the next challenge.
What Happens After the October 30 RHTP Deadline?
October 30 is an important milestone, but there’s still plenty of work ahead.
CMS must announce Year 2 awards by October 31, and states will continue implementing projects, managing their funding, and reporting on progress.
If your hospital hasn’t received funding yet, stay in touch with your state’s RHTP team. There may be additional opportunities in Year 2, and now is a good time to start those conversations about what your hospital needs and how funding could help.
And as Year 1 projects begin producing results, we’ll have an even better understanding of what’s working.
That’s what we’re particularly excited to follow.
Which investments are helping hospitals strengthen their financial sustainability? Where are organizations finding opportunities they didn’t know existed? And how are teams using what they’ve learned to make improvements that continue beyond the funding period?
Those stories will help shape the next four years of rural health transformation.
Make RHTP Funding Count Beyond Year 1
October 30 is an exciting milestone for RHTP, and we’re looking forward to seeing what states and rural hospitals accomplish with these investments.
We’re hopeful that RHTP projects will produce long-lasting impacts. Today’s work can help hospitals strengthen their finances, support their teams, and keep caring for their communities long after the funding ends.
We’ve seen what’s possible firsthand at REDi Health. Some of the rural hospitals we’ve worked with already had the data they needed but hadn’t had the time or resources to really dig into it. By looking more closely together, we’ve found opportunities to increase revenue, tackle recurring challenges, and make improvements that can benefit the hospital for years to come.
That’s what we hope to see more of as RHTP moves forward, and we can’t wait to see what rural healthcare teams accomplish next.
Whether you’re finalizing Year 1 investments or planning for Year 2, we’d love to help you make the most of the opportunity.
Connect with the REDi Health team to talk about projects that can strengthen your organization’s financial sustainability long after the funding ends.
