It is no secret that rural healthcare in the United States needs support. Patients should not have to drive hours to get the care they need, and rural healthcare teams should not have to keep stretching already-limited people and resources just to keep essential services available.
The Rural Health Transformation Program (RHTP) is a real opportunity to address some of those challenges.
And the good news is, no state is figuring this out alone. Across the country, State Offices of Rural Health, providers, and partners are working through many of the same questions: What should we prioritize? How do we turn funding into change? How do we measure whether it is actually working?
That work starts with a shared set of priorities. CMS has organized RHTP around five strategic initiatives that define what the program is ultimately designed to achieve:
Make Rural America Healthy Again
Sustainable Access
Workforce Development
Innovative Care
Tech Innovation
These priorities give states a shared framework, but how they put them into practice can look very different. Below, we break down each initiative and highlight real-world examples of how states are currently approaching them.
1. Make Rural America Healthy Again
Iowa: Put prevention closer to home
This RHTP goal focuses on improving health earlier through prevention, chronic disease management, behavioral health, maternal care, and new access points.
Iowa’s Healthy Hometowns plan shows how prevention can become part of the local care-delivery system. Its Combat Cancer initiative expands access to screenings and follow-up services for several common cancers. Communities of Care supports co-located services, community health workers, and chronic disease prevention. The EMS Community Care Mobile initiative brings prenatal, postpartum, post-discharge, and chronic disease services into rural communities through mobile care and telehealth.
What state leaders can take from it: Connect prevention to the people, organizations, and access points rural residents already use. Screening, navigation, mobile care, and data sharing can work together as one delivery model rather than operating as separate projects.
Read more: Iowa’s Healthy Hometowns Initiative→
2. Sustainable Access
Montana: Pair statewide analysis with facility-level implementation
Sustainable access means helping rural providers remain dependable, long-term access points for care. That requires regional coordination, stronger operations, and financially sustainable care models.
Montana’s Rural Health Center of Excellence is designed to turn statewide analysis into facility-level action. The Center will analyze healthcare supply and demand, develop recommendations for individual facilities and communities, and help participating providers create roadmaps toward positive operating margins. Facilities that implement recommendations and demonstrate improvements in access, quality, and financial performance may also qualify for incentive payments.
Montana is also separating assessment from implementation. A dedicated implementation partner will provide hands-on technical expertise, change management, and operational support to help facilities act on the Center’s recommendations.
What state leaders can take from it: Do not stop at assessment. Give rural providers the data, recommendations, implementation support, and accountability needed to turn an improvement plan into operational change.
3. Workforce Development
Nebraska: Make recruitment support a durable commitment
Rural workforce development includes more than filling open positions. It means building a stable mix of professionals who can meet each community’s needs and support reliable access over time.
Nebraska’s Rural Health Workforce Incentive Program provides incentives to professionals who relocate to rural communities, expand services into rural areas, or remain in their current rural positions. In exchange, participating providers commit to working in a rural Nebraska county for five years.
The program covers a broad range of professionals, including physicians, nurses, EMS professionals, behavioral health providers, pharmacists, therapists, dental professionals, and other members of the rural care team. Requirements also address employer cost-sharing, Medicaid participation, service verification, and repayment when commitments are not fulfilled.
What state leaders can take from it: Define the service need, the length of the commitment, and the evidence required to confirm that care is reaching rural patients. Nebraska’s structure reflects the full range of professionals needed to keep rural services available.
4. Innovative Care
Michigan: Build the infrastructure for coordinated care
Innovative care models depend on providers being able to coordinate services, share information, and connect patients with the right resources.
Michigan’s Interoperability in Action initiative allocates approximately $48.8 million across three areas: rural data governance, data integration and infrastructure, and rural access and connectivity. The largest portion, a $33.3 million infrastructure fund, supports technology adoption, health information exchange, telemedicine, EMS connections, and data-sharing initiatives involving rural healthcare and community organizations.
Michigan is also supporting connections among organizations that have traditionally operated across different systems, including rural clinics, skilled nursing facilities, EMS, public health agencies, social service providers, and community information exchanges.
What state leaders can take from it: Treat data governance, interoperability, and connectivity as part of care delivery. Shared infrastructure makes it easier for providers and community partners to coordinate around the patient and support more flexible care models.
5. Tech Innovation
Wyoming: Require technology to prove its value before scaling
RHTP technology investments are intended to improve access, efficiency, data security, and care delivery. Wyoming’s approach provides a useful example of how states can place practical guardrails around that spending.
Wyoming’s Health Technology Transformation initiative includes a competitive Technology Adoption Challenge. Groups of at least two providers must apply together, contribute part of the purchase price, and explain how the technology will improve coordination, interoperability, access, or administrative efficiency. Applicants must also demonstrate how ongoing maintenance and operating costs will remain sustainable after RHTP funding ends.
Priority areas include home dialysis supported through telehealth, remote patient monitoring, diabetes prevention and management, improved patient-provider communication, and consolidation of back-office functions. Wyoming is also planning shared platforms for tele-specialty care, non-emergency transportation coordination, and centralized billing capacity.
What state leaders can take from it: Put procurement guardrails in place before funding technology. Require a defined rural problem, shared users, clear ownership, measurable outcomes, and a realistic post-grant operating plan.
Turning State RHTP Plans Into Measurable Progress
RHTP is still early, and there is a lot left to figure out. But across the country, states are already turning these goals into real programs, partnerships, and investments.
As Budget Period 1 moves forward, State Offices of Rural Health will need to understand what is working, where implementation is getting stuck, and how investments are affecting rural communities. Just as importantly, states need the data and reporting infrastructure to clearly show that progress back to CMS.
That is where REDi Health can help.
We work alongside State Offices of Rural Health and rural providers to make execution easier to manage, establishing clear baselines and measures to tracking initiatives across organizations and building reporting that shows what is changing.
There may not be one perfect Rural Health Transformation Program playbook yet. But states do not have to build theirs alone. The work happening across the country gives us more to learn from every day, and a real opportunity to make rural healthcare stronger for the communities that depend on it.
