From Planning to Action: Tracking Which State Agencies Are Leading RHTP Implementation

Rebecca Lopez, Jamila McLean, and Heather Howard, State Health and Value Strategies

In response to the rural health crisis and concerns about the impact of Medicaid cuts in H.R. 1, budget reconciliation legislation enacted in July 2025, Congress included $50 billion for a Rural Health Transformation Program (RHTP). Administered by the Centers for Medicare and Medicaid Services (CMS), the program will distribute $10 billion annually from 2026 through 2030 to empower states to strengthen rural communities by transforming the healthcare delivery ecosystem. Half of the payments will be distributed equally across states with an approved Rural Health Transformation Plan, while the remaining 50% will be distributed to states at the discretion of CMS. While temporary, time-limited funding cannot supplant the deep cuts in H.R.1, the RHTP nonetheless presents an opportunity for states to secure federal funding to support investments in rural healthcare.

Prior to CMS’ release of the RHTP Notice of Funding Opportunity (NOFO) on September 15, SHVS tracked state actions to develop transformation plans and prepare RHTP applications. These efforts included issuing Requests for Information, conducting stakeholder outreach, and engaging in other activities to educate the public and solicit input. Applications were due on November 5, and most states subsequently publicly announced their submissions and/or released their full RHTP application materials or summary documents.

SHVS’ review of publicly available materials found that:

1. States generally aligned their submissions with the five RHTP strategic goals established by CMS: (1) Make Rural America Healthy Again; (2) Sustainable Access; (3) Workforce Development; (4) Innovative Care; and (5) Technology Innovation.
2. Most states adopted a broad, flexible approach in defining proposed activities, identifying a wide range of potential initiatives rather than committing to a limited set of narrowly defined interventions.

On December 29, 2025, CMS announced state award allocations for the RHTP and released a consolidated summary of each state’s application. Award amounts were determined based on multiple factors, including measures of rurality and a state’s commitment to adopting Make America Healthy Again policies, such as implementation of SNAP food restriction waivers. Overall, Texas ($281,319,361), Alaska ($272,174,856), and California ($233,639,308) received the largest total awards, while New Jersey ($147,250,806), Connecticut ($154,249,106), and Rhode Island ($156,169,931) received the smallest. However, a KFF analysis of awards per rural resident found that Rhode Island ($6,305), New Jersey ($1,068), and Alaska ($989) received the highest per person, while Texas ($66), Ohio ($69), and North Carolina ($72) received the lowest.

What’s Next for States?

States have already begun taking steps to implement RHTP activities. Several states including Alaska, Colorado, Georgia, Virginia, and West Virginia are hiring new staff to support planning, oversight, and program execution. The Michigan Department of Health and Human Services, is seeking applicants to serve on their Rural Health Transformation Advisory Council. The New Jersey Department of Health has released their Rural Health Transformation Program 2026: Advancing Technology, Prevention, and Workforce Capacity Request for Applications (RFA), which will distribute a portion of the state’s RHTP funding to eligible entities including healthcare providers, community-based organizations, and tribal organizations. At the same time, CMS has the establishment of the Office of Rural Health Transformation (ORHT) within the Center for Medicaid and CHIP Services (CMCS), which will oversee the overall RHT Program.

As states transition from planning to implementation, success will depend on their ability to efficiently and effectively collaborate across state agencies and with a broad range of stakeholders. The map below examines which state agencies are designated to lead RHTP implementation^[1] and identifies whether states have established dedicated public-facing websites to promote transparency and accountability as implementation progresses.

About the Agency Classifications

The implementing agency for each state’s RHTP was identified through a review of publicly available materials, including CMS Project Abstracts, state RHTP applications, gubernatorial endorsement letters, and official state RHTP websites. Medicaid designations were used when implementation was led by the Medicaid agency or Medicaid division; Department of Health designations were used when leadership rested with a health department or an integrated health and human services agency acting at the departmental level. States were classified as Medicaid and Department of Health when application materials explicitly described joint or co-leadership, or when both functions are formally integrated within a single department. Additional categories (e.g., Central Administrative / Executive Agency or Governor’s Office) were used when leadership was clearly vested outside Medicaid or health services structures.

State officials are encouraged to contact us with clarifications or corrections to ensure this information remains accurate.

Map updated as of: 5/1/2026

[1] Agency designations reflect an interpretation of publicly available materials and do not represent official state or federal determinations. State officials are encouraged to contact us to share updates or clarifications.