Rural Health Transformation Program Applications Awarded: Overview of State Funding

At the end of December 2025, the Center for Medicare and Medicaid Services (CMS) awarded funding to all 50 states that submitted Rural Health Transformation Program (RHTP) applications. The program’s $50 billion investment will be distributed to states over five years, $10 billion per year from 2026 through 2030, to support states in redesigning and strengthening rural health care delivery systems. 

As noted in the PCG Health Policy News December edition, PCG’s subject matter experts have been monitoring the RHTP since the initiative was announced, compiling a comprehensive summary of all publicly available state applications. This resource outlines key proposed rural health policy strategies, performance metrics, and the diverse state‑level approaches.  

While every approved state received a baseline award of $100 million for the first year, additional funding amounts were determined using a factor scoring formula. This formula incorporated: 

• Rural Facility and Population Score: A measure of each state’s rural population and rural health needs 

• Technical Score: CMS’s evaluation of each state’s proposed project design, implementation feasibility, and anticipated impact 

• State Policy Action Factors: Metrics that aim to capture whether a State has broadly supportive State policies towards rural health  

With CMS funding now awarded, implementation efforts are beginning to take shape. Many states are in the process of establishing new offices, cross‑agency task forces, or dedicated rural health transformation units to oversee planning, stakeholder engagement, data reporting, and financial management of these funds. 

In several cases, including in Maryland and Alaska, states are initiating early partnerships with local hospitals, community health centers, critical access facilities, behavioral health providers, and rural community organizations to ensure alignment between state‑level strategy and community needs. This foundational work is critical, as the first year of the RHTP focuses heavily on capacity building, infrastructure planning, and workforce stabilization, before shifting to broader delivery system transformation in future program years. 

As states gear up for the Rural Health Transformation Program, evaluation has never mattered more. With $50 billion at stake and heightened CMS accountability, states must design evaluation and monitoring strategies that prove impact, ensure financial sustainability, and support compliance reporting. In next month’s issue of HPN, we explore how advances in AI, public dataset integration, and modern evaluation methods can help states accelerate insights, de‑risk compliance, and demonstrate lasting improvements in rural health—while meeting the demands of a new era of federal health evaluation. 

PCG subject matter experts are happy to answer any questions states may have on RHTP implementation support. As always, email us at healthpolicynews@pcgus.com.  

Please see below for the full RHTP amounts awarded to each state and how the amount awarded by CMS could translate to the impact on the rural population of the state.   

*Source: CMS Announces $50 Billion in Awards to Strengthen Rural Health in All 50 States | CMS