The Rural Health Transformation Fund (RHTF) is a $50 billion federal initiative aimed at reshaping how care is delivered in rural communities. Spread across five years (FY 2026–2030), these funds are allocated to states, not individual providers — meaning states act as the primary grantees and decision-makers.
Over the next five years it will shape how the government responds to the needs of rural healthcare. With the legislation passed, the question now is: what can your organization do to work within this framework?
How the fund works
Eligibility starts at the state level: only states may apply directly for RHT funds through a cooperative agreement with CMS. Once awarded, each state can partner with rural providers, health systems, or regional coalitions to implement transformation strategies. Eligible provider types will vary by state, but typically include critical access hospitals, rural health clinics, behavioral health providers, and FQHCs.
The timeline is urgent. States must submit applications by November 5, 2025, with planning and implementation phases following close behind. Providers must engage early, before plans are finalized, to ensure their needs are represented.
CMS will evaluate state applications based on rural need, equity goals, stakeholder engagement, readiness to implement, and the long-term viability of proposed models. Proposals that center patient access, cross-sector collaboration, and measurable impact will be more competitive.
“We have been connecting with customers across all healthcare settings to see what actions they are taking, and it’s probably no surprise to hear that it’s a lot of what many providers already do regularly,” said Candace Wallace, Chief Customer Officer at Relias. “We see organizations leaning into activities that impact the bottom line or the top line, focusing on efficiency efforts and controlling spend, while also thinking about opportunities to grow revenue through opening new service lines and focusing on growing the patient populations they serve.”
Why provider organizations should engage early
For rural health and behavioral health providers, early engagement in their state’s Rural Health Transformation Fund (RHTF) planning isn’t just beneficial — it’s essential. With states serving as the gatekeepers of this $50 billion federal opportunity, organizations that wait on the sidelines may find themselves left out of critical funding and policy decisions.
The biggest risk? Being excluded from the state’s plans for funding. If your organization’s needs, services, or community aren’t reflected in the initial plan, you may not qualify for funding — or may be expected to operate within models that don’t fit your realities. States determine who is eligible, what types of care models are prioritized, and which investments are allowable. If you’re not at the table when those decisions are made, they’ll be made without your input.
By engaging early, providers can help shape the priorities, definitions, and metrics that will guide funding over the next five years. This includes everything from how rural need is calculated to what counts as “innovative care,” which services are reimbursed, and how success is measured. Your organization’s data, outcomes, and community insight can directly inform how the state crafts its strategy.
“My advice to anyone trying to figure out what they can do, I would focus hard on those pieces within your direct control and operations and leveraging your expertise and those of others to advocate for the patients you serve,” said Wallace.
The upside of early engagement is significant. Providers that help shape their state’s plan can position themselves to secure funding for sustainable models — like integrated behavioral health, telehealth expansion, mobile services, or value-based care infrastructure. These are long-term investments that can stabilize rural systems well beyond the life of the grant.
Advocacy tactics
| Tactic | What it involves | Tips / Best practices |
| Contact legislators | Reach out to state senators and state representatives | • Know who your legislators are
• Be succinct: “Here’s what rural health needs, here’s what funding can achieve, here’s how your action helps your constituents” • Offer to serve as resource • Follow up and keep the relationship going |
| Local engagement | If allowable, contribute or engage with political channels to build access and goodwill | • Be mindful of legal and ethical constraints
• Even modest contributions can open access • Participate in candidate forums or invite candidates to visit rural clinics |
| Work with state associations | Leverage your state health associations to serve as intermediary, convener, or amplifier | • Ensure your voice is represented in the association’s RHT planning task force
• Ask the association to prepare issue briefs or testimony in support • Coordinate a “state rural health summit” or policy forum • Use the association’s existing relationships with state government |
| Grassroots and patient voices | Engage patients and community leaders | • Host “town hall” or listening sessions
• Encourage letters-to-editor, op-eds, social media campaigns • Train patients or local advocates to meet legislators |
| Engage with local media | Use local press to amplify need and urgency | • Pitch stories about the challenges of rural health
• Use visuals (maps, infographics) • Publish op-eds or guest columns • Align announcements with key windows (legislative sessions, NOFO release) |
| Weigh in on funding plans and rulemaking | When states issue drafts of their transformation plans, solicit public comment and provide feedback | • Monitor state health agency/legislative websites for drafts
• Submit formal written feedback with data, cost estimates, and alternative language • Offer to present at stakeholder hearings • Propose specific metrics or guardrails to protect rural equity |
| Engage with stakeholders | Build alliances with local health departments, community organizations, social service providers, universities, payers | • A broader coalition gives weight
• Align with upstream partners (transportation, broadband, housing) to make cross-sector arguments • Engage payers or Medicaid office early — alignment with payer strategies helps viability |
| Track and respond in real-time | Assign staff or engage consultants to monitor state budget, committee hearings, policy dockets | • Use legislative tracking tools
• Issue “alerts” to partners when key votes are coming • Be nimble — respond within windows of opportunity • Document your interactions and outcomes to support accountability |
Community Health and Rural Health Training and Solutions
Community health providers face unique needs and challenges — serving a diverse and under-served patient population, high-cost, complex patient population, and an ever-changing funding landscape. Challenges in recruiting and retaining staff along with the healthcare professional shortage across the country create additional challenges in providing high quality, whole person care. Learn how Relias solutions for community health and rural health clinics can help.
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