In 2023, Heartland Forward launched the Heartland Health Caucus at the Heartland Summit to improve health outcomes across the heartland, advance smart health policy and foster cross-state collaboration. Formed in response to Heartland Forward’s 2022 report, Health Care Access in the Heartland, the Heartland Health Caucus is a non-partisan group of health policy leaders, lawmakers and executive branch officials from eight heartland states: Arkansas, Indiana, Kansas, Kentucky, Louisiana, Missouri, Oklahoma and Tennessee. The caucus, which meets biannually in-person and virtually each month, serves as a forum for action to improve health outcomes in heartland communities through effective health policy implementation.

Guided by the policy recommendations in the Health Care Access in the Heartland report and The Economic Case for Investing in Maternal Health report—to increase affordability and reduce complexity of health systems, address workforce shortages by increasing access to telehealth and bolster the health care workforce—caucus members exchange ideas to address pressing health issues and accelerate new and consistent policy approaches across member states.

At its inception, caucus members identified three critical areas of focus to improve health outcomes across member states: maternal health, mental health and strengthening thehealth care workforce. In alignment with these priority areas, the caucus works to advance health policy, taking ideas from concept to implementation, as demonstrated by the caucus’ successful advocacy for the passage of two state laws creating pathways for Community Health Workers (CHWs)—trusted and local frontline health care professionals.

CHWs play a key role in navigating the health care system, managing physical and behavioral needs and addressing social determinants of health, such as housing, food and education—all factors impacting an individual’s overall well-being. CHWs work across health disciplines, supporting maternal health, mental health and expanding the health care workforce. In 2022, Kentucky passed HB 525, establishing CHW certification and Medicaid reimbursement and thereby allowing more Kentucky residents to access health care through CHW services. Kentucky’s legislation served as a model for other heartland states, including recent legislation in Arkansas (HB1258, The Community Health Worker Act) and Oklahoma (SB 424, The Oklahoma Community Health Workers Act).

Through shared learning—exemplified by model legislation and the passage of new policies—the Heartland Health Caucus positions itself as a meaningful resource for advancing effective rural health policy and a framework to address regional health disparities nationwide. 

Timely Collaboration: The Heartland Health Caucus and the Rural Health Transformation Program 

The caucus convened in November of 2025, in New Orleans, Louisiana, for its biannual in-person meeting with a focus on preparing to implement one of the largest rural health investments in decades—the Rural Health Transformation Program (RHTP), a federal program administered by the Centers for Medicare & Medicaid Services (CMS) that will invest $50 billion in rural health care over the next five years. A unique characteristic of the RHTP is its flexibility, allowing for innovative, community-based solutions that can advance the caucus’ priorities of maternal health, mental health and the health care workforce. 

Recognizing both the opportunity and complexity of a statewide program, the caucus offered a platform for members to discuss implementation of their RHTP applications, submitted to CMS in early November. This collaborative session helped states spot shared priorities and strategies and discuss approaches to putting proposed policies into practice. Common themes included new bold ideas for the heartland:

• Improving Access to Care: Expanding rural primary care, strengthening regional health networks with expanded scope of practice for providers and supportive staff, like CHWs, pharmacists and nurses, modernizing rural facilities and investing in preventive care to reduce emergency department overuse.
• Building Workforce Pipelines: Increasing clinical training programs, expanding opportunities for medical students to experience practicing in rural areas through rural rotations and creating recruitment initiatives, including financial incentives to practice in rural areas. 
• Leveraging Technology and Data Integration: Using telehealth, harnessing artificial intelligence and streamlining health systems for patients and providers to improve care coordination.
• Chronic Disease Prevention: Improving access to healthy foods and exercise programs and addressing preventable conditions before they become more costly on the system and more detrimental to the long-term health of the patient. 
• Sustainable Financing and Delivery Models: Adopting value-based payment structures—models that reward hospitals for quality of care and keeping people healthy rather than volume of services provided—and investing in care coordination.

The deadline to submit RHTP applications to CMS was November 5, 2025 and awards will be decided by December 31, 2025. CMS will allocate $10 billion of funding each year, for five years, beginning in 2026 and ending in 2030. Half of the funding will be “baseline” funding that is equally distributed among approved states and the other half of the funding will be allocated based on a CMS formula that accounts for a variety of factors included in each state’s RHTP application, like existing health care infrastructure and ruralness of the state population. Learn more about the status and content of each Heartland Health Caucus state’s RHTP application:

• Arkansas Department of Finance and Administration
• Indiana Family and Social Services Administration  
• Kansas Department of Health and Environment 
• Louisiana Department of Health
• Missouri Department of Social Services
• Oklahoma Department of Health
• Tennessee Department of Health
• Kentucky (application not yet public)

What’s Next for the Heartland Health Caucus 

The Heartland Health Caucus will continue to serve as a forum for coordinated health strategy and strengthened policy collaboration across the member states. As planning for 2026 begins, the caucus is well positioned to move quickly from health policy ideation to implementation by working collaboratively across a region facing similar health needs-building practical, consistent solutions to transform the rural health landscape across the heartland.

Additional Heartland Forward Health Care Resources 

• Community Health Workers Provide Vital Services to the Heartland  
• The Economic Case for Investing in Maternal Health
• Maternal Health Awareness: Improving Access to Telehealth
• Maternal Health Awareness: Care, Cost and Transparency
• Maternal Health Awareness: Community Health Workers, Doulas and Midwives