There’s been plenty of conversation about how much Rural Health Transformation Program (RHTP) funding states are receiving and where that money is going. But there’s another part of the conversation we’re especially interested in: What happens to these projects when the funding runs out?
With the second year of RHTP funding now announced, states and rural healthcare organizations have an incredible opportunity to make investments that could benefit their communities for years to come.
It’s worth thinking about what comes next while there’s still time to make decisions that will shape these projects five or even ten years down the road.
After all, the real value of RHTP won’t be measured by how much money gets spent. It’ll be measured by what rural communities can keep long after the funding ends.
And that’s something hospitals can start planning for today.
When Does RHTP Funding End?
The Rural Health Transformation Program provides $50 billion in federal funding over five years, with $10 billion awarded annually from fiscal year 2026 through 2030.
Although the final round of funding will be awarded in 2030, states have additional time to spend certain funds. All RHTP dollars must be spent by September 30, 2032, and individual awards have their own spending deadlines.
That may sound like plenty of time, but five years can go by quickly when you’re building a new program or making changes across a hospital.
Think about a rural hospital that uses RHTP funding to expand telehealth services. The grant might help purchase equipment and get the program running, but what about the ongoing technology costs? Who will support the program once the initial funding is gone?
These are questions worth asking early, while hospitals still have the flexibility to plan for what comes next.
And there’s good reason to start now. CMS has made long-term sustainability planning part of how it evaluates states’ implementation progress. The expectation is that these investments will do more than meet short-term goals. They’ll help rural communities build on the progress they’ve made.
What Makes an RHTP Project Sustainable?
A successful RHTP project doesn’t have to end when its grant funding does.
That’s the idea behind sustainability. It’s about making investments that rural hospitals can keep building on, even when the original funding source is no longer available. And sustainability can look different depending on the project.
For a hospital working to reduce claim denials, it might mean putting better processes in place that help prevent lost revenue year after year. For a community expanding access to specialty care, it could mean establishing partnerships that make those services easier to maintain over time.
Not every project will generate revenue, nor should that be the expectation. Some of the most important investments in rural healthcare are about keeping essential services available to the people who need them. What matters is having a realistic plan for how the work will continue.
That means looking beyond what it takes to launch a project and considering what the hospital will need to keep it going. The earlier those conversations happen, the more opportunities there are to make adjustments while funding is still available.
Financial Stability Starts With Knowing Where You Stand
Before a rural hospital can decide where to invest, it helps to have a clear picture of its finances today.
That might sound obvious, but there’s often more to the story than what shows up on a financial statement. A hospital may know its operating margin is tight without knowing exactly how much revenue is being lost to preventable claim denials or whether certain services are being reimbursed appropriately.
Those details can make a big difference when deciding how to use RHTP funding.
Start With a Baseline
Let’s say a hospital wants to invest in new technology to improve its revenue cycle. Before moving forward, it would be helpful to understand where the biggest problems are occurring and how much they’re costing the hospital. That information can help leadership choose a solution that addresses an actual need rather than making an investment based on assumptions.
It also gives the hospital something to measure against. If the goal is to reduce denials:
- What does the denial rate look like today?
- How much revenue is tied up in those claims?
Once changes are made, the hospital can compare its results to that starting point and see whether the investment is making a difference.
This is one of the things we’ve seen through our work with rural hospitals. Sometimes, a closer look at the data reveals opportunities that weren’t immediately apparent. And when hospital teams understand what’s happening behind the numbers, they’re in a much better position to make improvements that can continue paying off long after the initial project is complete.
How Can Rural Hospitals Make RHTP Projects Last?
There’s no single formula for making an RHTP project sustainable. What works for one rural hospital may not work for another, especially when their financial situations and community needs differ so much.
Still, there are a few things every hospital can consider as projects get underway.
1. Look Beyond the Initial Investment
Getting a project off the ground is exciting, especially when grant funding makes something possible that a hospital has wanted to do for years. But the initial investment is only part of the cost.
A new technology platform may come with annual subscription fees. Expanding a service line could mean hiring additional staff or purchasing supplies long after the grant ends.
Understanding those expenses early gives hospitals time to explore how they’ll cover them. It may even influence which projects they pursue or how they choose to implement them.
2. Focus on Improvements That Keep Creating Value
Some investments can strengthen a hospital’s finances well beyond the funding period.
Take revenue cycle improvements. If a hospital identifies why certain claims are repeatedly denied and makes changes to prevent those denials, the benefits can continue long after the original project is finished.
The same thinking can apply to improving charge capture or finding ways to reduce unnecessary administrative work.
The opportunity is to use RHTP funding to address problems that have been costing hospitals money or staff time for years.
3. Give Your Team the Tools That Last
Even the best project can lose momentum if the people responsible for it aren’t prepared to take over.
That’s why it’s important to involve hospital staff throughout the process, rather than waiting until the project is nearly finished to figure out who will maintain it.
Training matters, but so does making sure new processes fit into the team’s everyday work. At Blue Mountain Hospital, for example, training materials developed during its denials improvement work became a resource for onboarding new employees. Instead of starting from scratch each time someone joined the team, the hospital had something it could continue using.
For rural hospitals where employees already wear multiple hats, having those resources in place can make it much easier to maintain improvements over time.
Related: Reducing Denials, Redefining Culture: The Blue Mountain Hospital Case Study
4. Measure Progress While There's Still Time to Adjust
One of the biggest advantages of tracking results throughout a project is that hospitals don’t have to wait until the funding ends to find out whether something worked.
If a new process isn’t producing the expected improvement, there’s an opportunity to understand why and make changes.
And when something is working well, having the numbers to back it up can help hospital leaders make the case for continuing the investment.
That information is also valuable when reporting on RHTP progress. Rather than simply showing that grant dollars were spent, hospitals can demonstrate what those dollars helped accomplish.
What Does RHTP Sustainability Look Like in Practice?
We’ve seen firsthand how a relatively small project can make a meaningful difference for a rural hospital.
Blue Mountain Hospital, an 11-bed Critical Access Hospital in Utah, worked with REDi Health to take a closer look at its revenue cycle data. In the process, our team identified a Medicaid reimbursement issue that had been costing the hospital money.
Addressing the issue helped Blue Mountain recover more than $1 million in Medicaid reimbursement. For a small rural hospital, that’s a significant amount of money that can help support its operations and the care it provides to its community.
But there’s another part of this story we think is just as important. The hospital continued working with REDi after the initial funding ended, building on what the team had learned rather than treating the project as a one-time effort.
Although this project wasn’t funded through RHTP, it offers a useful example of what’s possible when hospitals use outside funding to uncover opportunities they can continue acting on.
And that’s worth keeping in mind as rural hospitals decide on their RHTP investments. Sometimes, the greatest value comes from solving a problem that would otherwise continue costing the hospital money year after year.
Related: What Happens After the Funding Ends? Lessons from Rural Utah
Questions to Ask Before Your Next RHTP Investment
As rural hospitals and state leaders move forward with RHTP projects, it’s worth taking some time to think about what success will look like beyond the grant period.
Here are a few questions to bring into those conversations:
- What will it cost to keep this project running? Consider ongoing expenses like staffing, maintenance, and technology subscriptions.
- Who will take ownership of the work? Make sure someone on the hospital’s team has the knowledge and resources to keep things moving.
- How will we know it’s making a difference? Decide what to measure before the project begins so you can track progress along the way.
- Can the benefits help support the ongoing costs? Look at whether the project could improve reimbursement, reduce expenses, or create opportunities for additional funding.
- What happens if the funding isn’t renewed? Think through what it would take to continue the work and whether adjustments might be needed.
Hospitals don’t need to have every answer figured out on day one. But asking these questions early can help them make the most of the funding available and avoid surprises down the road.
The Real Opportunity Is What Happens After the Funding
RHTP is giving rural hospitals the chance to tackle projects they’ve wanted to pursue for years, and we’re excited to see what each of you will accomplish!
We’d love to see hospitals look back on this funding as the start of something that made a lasting difference in their communities. With the right planning, there’s a real opportunity to make that happen.
At REDi Health, we enjoy helping rural hospitals strengthen their finances and make better use of their data to improve the care for rural communities. If you’re planning an RHTP project or already have one underway, we’d love to hear what you’re working on and see where we might be able to help.
