Background on the RHT Program
The Rural Health Transformation (RHT) Program created under H.R. 1, is a federal initiative to strengthen healthcare in rural America. It provides $50B over five years (2026–2030) to expand access, improve quality, and drive better outcomes for rural communities.
The program focuses on:
- Expanding access to care and preventative services
- Promoting sustainable health systems
- Developing and retaining the healthcare workforce
- Encouraging innovative care models
- Advancing technology and digital health solutions
States receive RHT funding by applying for cooperative agreements and submitting rural transformation plans tailored to local needs. Approved funds are distributed annually, with half split evenly across states and the other half allocated per CMS’s discretion considering factors such as state policy objectives and the expected impact of initiatives. Sellers Dorsey prepared a Year 1 snapshot of each state’s initiatives and award amounts, available for download here.
What’s Happening Now
CMS – Staffing Up and Finalizing Agreements
Since CMS announced the RHT awards on December 29, 2025, states have been busy preparing to implement their plans, beginning with the procurement process. In January, CMS began engaging with states to update their budgets and project plans to reflect the actual dollar amounts awarded, with final revisions due to CMS on January 30, 2026. From there, CMS has 30 days to respond to the revisions and work with awardees to enter into a cooperative agreement. As CMS staffs up its Office of Rural Health Transformation, it already has issued first-year RHT funding to a few states, including Florida, Iowa, and Georgia. Others continue to engage with CMS as it finalizes cooperative agreements with all remaining states.
States – Transitioning from Planning to Implementation
Currently, states are making their RHT Programs operational or are determining how to do so. States must work diligently to meet RHT Program timelines for using funds and reporting on their performance. The RHT Program has five budget periods, and states have until the end of the following fiscal year to spend funds awarded in each budget period. Funds awarded in the first budget period (FY 2026) may be spent through September 30, 2027, but the annual progress reporting deadline for program year 1 is August 31, 2026.
RHT Program Spending and Reporting Timeline
State RHT plans target several key areas, including technology modernization, behavioral health, value-based care, and primary care access. To support the many RHT initiatives that align with program objectives, states need to establish structures and processes to demonstrate impact and support robust reporting.
Governance. The lead agency for a state’s RHT Program can vary, which can shape how dollars will be awarded. Recognizing a short planning and procurement timeline, to establish their RHT offices, many states are leveraging existing cross-functional state scaffolding, Project Management Offices (PMOs), and governance structures. For example, Kansas used its existing Rural Health Innovation Alliance as the state advisory board, which enabled the state to prioritize high-impact initiatives that could launch quickly and support meeting RHT reporting requirements.
Sub-Awarding. Some states expedited their processes by leveraging existing procurement channels. For example, Texas’s RHT guidance explicitly routes all RHT vendor outreach through public channels and the state’s Electronic State Business Daily (ESBD) System, which supports moving quickly while ensuring transparency and predictability for potential applicants and stakeholders at large.
So far, we have seen five states issue RFPs for their RHT Programs, and a few others, such as Montana and Nevada, have announced forthcoming RFPs or RFAs. Sellers Dorsey is tracking procurement and sub-award developments, as well as RHT governance and operational structures, to assist our clients in identifying potential opportunities to partner with states and other stakeholders.
Gearing up to meet requirements. The RHT Program requires compliance and reporting to CMS. The RHT Notice of Funding Opportunity (NOFO) defines the programs’ substantial reporting requirements, which include progress reports, evidence of results, and workplan updates among other elements. More information on reporting can be found on CMS’s Post-Award Reporting Requirements page.
Awardees are also required to submit an annual non-competing continuation (NCC) application to receive funding for subsequent budget years. The NCC is due approximately 60 days before the end of each budget period end date.
The receipt of future funding is dependent on meeting expected goals, which has created urgency for states to receive their funding, obligate the funds, and show improvements per their project plans through RHT reporting requirements. While states are busy preparing their procurements and establishing their RHT Programs, their Year-2 RHT applications and annual progress reports are due to CMS this summer.
Additionally, any unexpended or unobligated funds will be redistributed in the nearest fiscal year possible in the same manner as outlined in the NOFO. CMS will begin reviewing state progress in late summer and announce 2027 funding levels by the end of October.
Providers and Stakeholders –Exploring Pathways to Engagement
While we wait for states to announce their funding opportunities, there are steps providers and potential sub-awardees can take to be prepared.
Early-stage planning. States are encouraging providers, vendors, regional and rural hospitals, and other potential sub-awardees to get ready. For example, in recent webinars, RHT staff from Oklahoma and Utah encouraged stakeholders to check their websites regularly for updates, review their project plans, and consider how their organizations can help meet the states’ RHT goals. States with more detailed plans have proposed budgets, which can help potential sub-awardees begin planning their responses to future RFPs/RFIs. Interested stakeholders can find State RHT plan summaries and links to each state’s plan and RHT site here.
Governance participation. Stakeholders are also crucial to the governance and oversight of RHT Programs. Most states have identified local or regional advisory committees to oversee the program. Throughout January and February, Colorado and Michigan have sought members to join their RHT advisory councils, and Colorado recently finalized its advisory council’s plan. We expect more states to publicly announce calls for applications or announce when their advisory councils have formed.
Operational roles. Unique opportunities exist for certain rural providers. For example, hub-and-spoke networks, mobile units, chronic disease programs, and maternal health services – anchored in FQHCs and RHCs – are included in many proposals. For example, California plans to build regional care collaboratives linking rural hospitals and FQHCs.
Sellers Dorsey can help maximize RHT readiness and participation
With RHT dollars beginning to flow from CMS to states, the first wave of program initiatives is soon to be realized. State RHT plans address an array of issues, such as technology and data modernization (all states address this in at least one way), behavioral health and SUD treatment (over 30 states), sustainability through value-based care (about 30), and primary care access and/or FQHC networks (about half), among others. These topics are of particular interest to our clients and will be explored in more detail in the future.
The success of RHT Programs depends on readiness, compliance, and the ability to demonstrate measurable results. Providers and other stakeholders must actively engage with state RHT Program leaders and demonstrate alignment with broader rural health goals while adapting to evolving policy contexts. At the same time, organizations need to focus on internal readiness for execution, including building the systems, processes, and insights needed to deliver impact and maintain funding.
Sellers Dorsey partners with states and providers to deliver expert consulting and technology-driven solutions that support operational readiness and long-term sustainability. We offer:
- Deep Healthcare Expertise: Decades of experience in Medicaid, rural health, and payment reform.
- Analytics + Technology: Advanced tools and dashboards to monitor outcomes and optimize performance.
- Proven Results: Trusted partner to states and health systems nationwide.
