The Rural Health Transformation Program (RHTP), created under the One Big Beautiful Bill Act (Public Law No. 119-21), is a major new federal initiative to strengthen rural healthcare delivery and stabilize essential services. NRHA developed this document to provide a picture of how states are designing and initially budgeting their transformation strategies. 

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All information summarized in this document is drawn from state applications and other publicly available sources. In some cases, it reflects NRHA’s best interpretation of partial or variable information provided by states. As of December 29th, 2025, CMS has announced the RHTP FY2026 funding-level awards for each state. State activities summarized in this brief do not reflect CMS funding decisions and therefore may change. Find CMS’ state application abstracts here and state spotlights here.

Early trends show strong focus on health workforce stabilization, prevention and CDM, and VBP and innovative care models. Many states focus on strengthening rural systems for resilience through hospital sustainability, EMS modernization, mobile and community-based service delivery, and models with regional support and local delivery. Technology modernization through consumer-facing tools, telehealth, interoperability, and cybersecurity are common across states. Almost every state includes behavioral health access and SUD treatment as a priority. Across states, RHTP proposals emphasize strengthening the rural care infrastructure, building local partnerships, and addressing long-standing gaps in access.

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