The $50 Billion Rural Health Transformation Program: What Providers Can Do Before Nov. 5, 2025
Why the RHT program is a once-in-a-generation opportunity
CMS created the Rural Health Transformation (RHT) program to address structural weaknesses in rural healthcare: workforce shortages, outdated technology, gaps in behavioral health, and hospitals struggling to keep their doors open. The program directs $10 billion per year from FY2026-FY2030, a scale unprecedented in federal rural health funding.
The RHT program was introduced because rural health systems have been under sustained stress for decades. Over 140 rural hospitals have closed since 2010, and many more remain financially fragile. Patients in rural areas face higher rates of chronic disease, mental health challenges, and maternal mortality compared to their urban counterparts. Workforce shortages compound the crisis: many counties have no practicing obstetrician, psychiatrist, or cardiologist, leaving primary care physicians to stretch beyond capacity.
The program explicitly prioritizes the use and promotion of technology-driven solutions that improve prevention and management of chronic diseases, which are key components of CCM. It supports innovative care models that include remote monitoring, telehealth, artificial intelligence, and digital health tools designed to enhance chronic disease management in rural areas.
CMS and Congress recognized that piecemeal grants and incremental adjustments were not enough. The Big Beautiful Bill Act, passed in 2025, provided the statutory authority and initial appropriation for the RHT program. Its intent was clear: to create a single, coordinated, transformative funding mechanism to help states reconfigure rural care delivery at scale, rather than through fragmented programs. The rationale behind the program is threefold:
- Stabilization – prevent further closures of rural hospitals and clinics by providing baseline infrastructure funding.
- Modernization – invest in technology, telehealth, cybersecurity, and data capacity so rural providers are not left behind.
- Transformation – support states in redesigning care models to emphasize prevention, behavioral health, and right-sized services aligned to population needs.
By linking directly to CMS’s policy priorities and the Big Beautiful Bill Act’s mandate, the RHT program represents a special convergence of political will, funding scale, and urgency. It is not just about keeping doors open; it is about building a resilient rural health ecosystem that can thrive in the decades ahead.
For providers, this goes beyond short-term grants: is about ensuring survival and sustainability. Rural hospitals and clinics are closing at alarming rates. Workforce pipelines are thinning. Telehealth adoption remains uneven. The RHT program recognizes that rural communities need long-term transformation, not just stopgaps, and it provides resources to build the infrastructure for a more resilient future. In other words, RHT is a mandate to build a resilient rural ecosystem that can thrive over the next decade: clinically, operationally, and financially.
Who can benefit from sub-awards
States will be the direct recipients of funding, but providers will be central to carrying out projects. Likely sub-awardees include:
- Critical Access Hospitals (CAHs) seeking to upgrade facilities, expand telehealth, or stabilize finances.
- Rural health clinics (RHCs) and Federally Qualified Health Centers (FQHCs) that provide essential frontline care.
- Community hospitals and integrated health systems that serve rural catchment areas.
- Behavioral health and substance use disorder (SUD) providers, given the urgent need for mental health and opioid response services.
- Emergency medical services (EMS) and community paramedicine programs, vital in areas with long distances between care sites.
- Public health departments, academic medical centers, and universities, which may lead workforce training or research partnerships.
- Independent medical practices can benefit if their state allocates RHT funds to support rural healthcare infrastructure, technology upgrades, workforce development, chronic care management, and remote patient monitoring initiatives that include or support these providers.
In short, nearly every type of rural provider can play a role, but only if they are included in their state’s plan.
How the funding will be distributed
CMS will allocate funding in two ways:
If all 50 states are approved, the baseline equal-share funding would equate to about $100 million per state per year between FY2026 and FY2030. CMS will evaluate applications made by states on factors such as rural population size, number of rural healthcare facilities, commitment to infrastructure, and the quality of the proposed projects. Importantly, at least 25% of approved states must receive part of the competitive funding, ensuring broad distribution.
Awards will be announced by December 31, 2025, and cooperative agreements will begin in fiscal year 2026.
What providers can do before November 5, 2025
Even though providers cannot apply directly, they can influence their state’s submission by taking immediate steps:
- Engage the governor’s office and state health department. Governors must designate a lead state agency to submit the application, and a letter of support from the governor is required. Providers should be in contact now to advocate for their priorities.
- Develop ready-to-go project proposals. Projects must align with CMS’s approved uses, including: building and retaining the healthcare workforce with service commitments, strengthening prevention and chronic disease management, expanding behavioral health and SUD services, upgrading technology and cybersecurity, expanding telehealth and remote patient monitoring (RPM), “right-sizing” services to fit local population needs.
- Form coalitions. States will prefer projects that demonstrate collaboration among hospitals, clinics, EMS, public health agencies, and community organizations.
- Define measurable outcomes. States will need to show CMS how projects will improve access, reduce hospital closures, and sustain gains beyond the five-year funding period.
Providers who take these steps now will be better positioned to receive sub-awards when funding begins.
How RHT connects with Chronic Care Management (CCM) and Remote Patient Monitoring (RPM)
The RHT program is not just about bricks-and-mortar infrastructure; it is equally about building systems of care that keep rural patients healthier over time. Two of CMS’s most impactful existing programs Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) are natural complements to RHT investments:
Chronic Care Management (CCM). Rural patients are more likely to have multiple chronic conditions such as diabetes, hypertension, COPD, and heart failure. CCM reimburses providers for delivering structured, non-face-to-face care coordination to these patients every month. With RHT funding, states can build out the workforce and IT infrastructure that makes CCM feasible at scale in rural areas. For example, a rural health clinic might use sub-award dollars to hire additional care managers, embed care planning templates into the EHR, and connect patients with pharmacists and social workers. These investments would allow clinics to bill consistently for CCM while dramatically improving chronic disease outcomes.
Remote Patient Monitoring (RPM). Rural patients often live far from clinics or hospitals, making regular monitoring challenging. RPM allows providers to track physiologic data (like blood pressure, weight, oxygen saturation, glucose) from home. RHT funds can underwrite the device procurement, broadband access, and platform integration needed to make RPM programs reliable in rural geographies. Imagine a Critical Access Hospital partnering with Lara Health: patients with heart failure are given cellular-enabled scales and blood pressure cuffs, care coordinators monitor readings daily, and early fluid retention is addressed before it leads to an ER visit. Without RHT support, such infrastructure would be slower to roll-out.
CCM and RPM are both reimbursable under existing CMS CPT codes, but many rural providers lack resources and staffing to run them effectively. The RHT program creates the runway for providers to build these capabilities and sustain them with new reimbursement revenue. Lara Health’s platform, which integrates CCM and RPM workflows, can help states and providers translate federal grants into lasting value.
CMS expectations for Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) under the Rural Health Transformation (RHT) Program include (amongst other things):
- Promoting evidence-based chronic disease management and technology-driven solutions for prevention and management, which includes CCM and RPM.
- Encouraging investments in consumer-facing and provider-facing technology solutions such as remote patient monitoring systems to better track patient health outside traditional clinical settings.
- Supporting value-based care models that leverage RPM and CCM to achieve better health outcomes and more efficient care delivery for rural populations.
- Incentivizing training and technical assistance for technology-enabled solutions such as remote monitoring, artificial intelligence, and other advanced technologies.
- Improving prevention, chronic disease management, and fostering tech innovations including consumer-facing and provider technologies.
- Promoting evidence-based interventions for chronic disease and technology adoption, specifically listing remote monitoring as an eligible technology.
- Addressing workforce challenges by recruiting and retaining clinical workforce capable of delivering technology-integrated care including CCM and RPM.
- States must invest in at least three approved uses, including chronic disease management and technology-enabled care solutions such as RPM.
- Funding may be used for provider training and technical assistance to implement remote monitoring and other digital health technologies.
By weaving CCM and RPM into their RHT proposals, providers can show CMS they are committed to outcome-driven transformation that aligns with national policy priorities.
Timeline for states and providers (and getting involved after the awards)
The RHT program follows a tight timeline. Providers who understand the milestones will be better positioned to act:
- September–October 2025: States prepare applications. Providers must engage their governor’s office and state health department now.
- November 5, 2025: Final deadline for state applications to CMS. No extensions will be granted.
- December 31, 2025: CMS announces award decisions, identifying approved states and competitive funding allocations.
- Early 2026: States finalize cooperative agreements with CMS and begin planning for sub-awards. Providers should prepare detailed project plans, budgets, and compliance infrastructure.
- FY2026–FY2030: Funds are distributed annually. Providers will be expected to deliver services, report metrics, and demonstrate impact. States will submit annual reports, and CMS may adjust competitive allocations based on performance.
For providers, the window of influence is right now through November 5. Once states submit, it may be too late / harder to shape priorities.
Getting involved after the awards: Even if a provider is not named in the initial state application, there will be post-award opportunities. States typically distribute funds via sub-awards, RFPs, or direct agreements tied to the state plan. Providers should monitor state procurement portals, maintain contact with the designated state lead, and have shovel-ready proposals (with budgets, metrics, and governance) to compete for mid-cycle or subsequent-year opportunities. Providers that can demonstrate measurable impact quickly may also be included in later-year reallocations, as CMS will rescore states annually.
States likely to be prominent beneficiaries
While all 50 states are eligible, some are particularly well-positioned to benefit due to their large rural populations, high rates of hospital closures, and systemic workforce shortages. Based on rural demographics and need, the following 25 states are likely to be prominent beneficiaries:
Texas – Largest rural population in the U.S., with persistent hospital closures in frontier regions.
Georgia – Among the highest number of rural hospital closures in the past decade.
Mississippi – High burden of chronic disease and workforce shortages.
Alabama – Rural access issues and gaps in maternal care.
Kentucky – Large Appalachian rural population and opioid crisis impact.
West Virginia – High rates of chronic disease and behavioral health needs.
Oklahoma – Broad rural geography with limited hospital access.
Montana – Large frontier counties with sparse provider coverage.
North Carolina – Significant rural health disparities and hospital closures.
Arkansas – Chronic disease prevalence and rural poverty contributing to poor outcomes.
South Carolina – Rural maternal health access issues and provider shortages.
Tennessee – Multiple rural hospital closures and high rates of chronic disease.
Missouri – Rural hospitals under financial strain and gaps in behavioral health access.
Louisiana – High poverty rates and fragile rural hospital systems.
North Dakota – Large rural and tribal populations with limited access to specialty care.
South Dakota – Frontier geography, aging population, and hospital access challenges.
Nebraska – Workforce shortages in frontier counties and behavioral health service gaps.
Kansas – Long-standing rural hospital closures and chronic disease burdens.
Idaho – Rapidly growing rural population and limited hospital infrastructure.
Alaska – Extreme geography, indigenous health disparities, and limited healthcare infrastructure.
Wyoming – Sparse population; small facilities at risk.
New Mexico – Large tribal/frontier mix; access gaps.
Arizona – Rural/tribal disparities; maternal care deserts.
Maine – Aging, dispersed population; thin provider base.
Indiana – Rural counties with closures and high chronic disease.
These states will not be the only beneficiaries (many other states can still benefit meaningfully if they submit strong, needs-driven proposals), but their challenges align closely with CMS’s goals for the RHT program. Providers in these states should be especially proactive in engaging with their state leadership.
Once states secure approval, sub-awards will flow to local providers. To prepare, providers should:
- Plan for staffing. Workforce initiatives may require new coordinators, care managers, or IT specialists.
- Select technology partners. Platforms must support data integration, compliance, and outcome reporting.
- Prepare for reporting. CMS requires annual updates; providers should invest in dashboards and analytics.
- Build sustainability. By FY2030, federal funds will taper. Programs must transition into value-based care, alternative payment models, or local financing streams.
As a leading technology vendor, Lara Health can help providers align with state proposals by offering tools that integrate remote monitoring, chronic care management, and compliance automation. These capabilities give states confidence that funded projects can scale and sustain.
For providers, sub-awards could finance workforce pipelines, behavioral health expansion, or digital transformation projects. Beyond direct dollars, participation improves positioning in value-based care, reduces preventable costs, and builds infrastructure that pays dividends long after the program ends. Importantly, by investing in CCM and RPM, providers can leverage RHT funds to create ongoing reimbursement streams that extend well beyond the grant period.
Compliance and audit readiness
CMS will require states and, by extension, providers to demonstrate:
- Clear documentation of how funds are spent.
- Adherence to HIPAA and federal cybersecurity standards.
- Annual reporting of patient outcomes and program impact.
- Financial tracking to separate RHT dollars from other revenue streams.
Lara Health simplifies compliance with built-in audit tools, secure data systems, and automated reporting that makes accountability straightforward for both states and providers.
The RHT program funds innovations, digital health tools, and workforce development specifically aimed at improving chronic disease management and remotely monitoring patients in rural settings, thereby reducing health disparities and improving outcomes. As such, RPM and CCM are core elements of the innovative care models and technological advances the RHT Program strives to implement and fund in rural healthcare delivery: Lara Health platform can be a true enabler of rural healthcare transformation at scale.
Our platform unifies Chronic Care Management, Remote Patient Monitoring, and telehealth workflows; automates documentation and time capture; streamlines care-plan templates and patient engagement; and equips leaders with dashboards that map directly to state and CMS metrics. We provide an audit-ready trail (privacy, security, role-based access), help craft logic models and outcome frameworks for state proposals, and support device logistics and broadband-light configurations for frontier areas.
Contact Lara Health to see how we can help you turn RHT plans into measurable, compliant, and sustainable improvements for your rural communities.
FAQs
Who can apply directly to CMS for RHT funding?
Only states can apply toCMS. Providers must work with their state to be included, or receive sub-awards.
Which providers are eligible for sub-awards?
Critical Access Hospitals, RHCs, FQHCs, community hospitals, behavioral health providers, EMS, independent practices, and public health agencies are all likely to be eligible.
What is the deadline?
State applications must be submitted by November 5, 2025, with awards announced by December 31, 2025. Once states secure approval, sub-awards will flow to local providers.
What are approved uses of funds?
Workforce development, chronic care management, behavioral health, technology and cybersecurity upgrades, telehealth, RPM, and right-sizing services.
How long will funding last?
Funds will be distributed annually from FY2026 through FY2030, with annual reporting and progress reviews.
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Sources:
CMS. “CMS Launches Landmark $50 Billion Rural Health Transformation Program.” 2025.
CMS. “Rural Health Transformation Program NOFO and Guidance.” 2025.
U.S. House Energy & Commerce Committee. “CMS Releases Guidance on Rural Health Transformation (RHT) Program Funding.” 2025.
