For the 81.7 million Americans living in rural areas, a $50 billion opportunity is on the horizon. 

Rural Americans, who make up nearly a quarter of the U.S. population, face limited access to care and higher health risks than their urban counterparts. Limited in-person access to doctors, workforce shortages and underfunded specialty care, among other barriers, have led to difficulties in rural care delivery. Now, a new federal initiative will offer states the funding and flexibility to improve upon rural care delivery, especially in the heartland. 

What is the Rural Health Transformation (RHT) Program?

In response to the changes made by the One Big Beautiful Bill Act (OBBBA), signed into law on July 4, 2025, Congress established the Rural Health Transformation (RHT) Program. Administered by the Centers for Medicare & Medicaid Services (CMS), this $50 billion, five-year grant program aims to uniquely support rural health care. 

While predictions show the OBBBA to increase the number of uninsured Americans and reduce federal Medicaid spending in rural areas over the next decade, the RHT Program, introduced late in the OBBBA negotiations, is intended to help counter these rural health impacts by stabilizing health outcomes and revamping care systems with financial support.

Five strategic goals guide the program and should serve as the framework for state applications:

1. Make Rural America Healthy Again: Improve access to rural care and outcomes, especially for chronic illnesses and behavioral health
2. Sustainable Access: Build strong local public-private partnerships and financially sound care models 
3. Workforce Development: Recruit, train and retain rural providers
4. Innovative Care: Use data and technology to expand care access and efficiency 
5. Technological Innovation: Support providers and patients with emerging technologies, digital tools and digital assistance 

Funding Breakdown:

All 50 states are eligible to receive grant funding and must apply via the Grants.gov portal by November 5, 2025. $50 billion will be allocated in two tranches: 

• $25 billion (referred to as “baseline” funding) will be equally distributed among all states that apply and are accepted, providing at least $100 million annually per accepted state ($500 million total per state over five years).
• The remaining $25 billion (referred to as “workload” funding) will be awarded through a CMS formula which takes into account factors including the ruralness of the state population, the potential long-term impact of the state’s proposal and any outlined policy commitments in the application. While all applicants are eligible for this portion of funding, there is no guarantee that all states will be awarded funding, as CMS is only required to award funding to 25% of applicants, suggesting states with greater determined need will potentially receive a greater portion of funding.

Why Heartland States Stand to Gain the Most 

The heartland is uniquely positioned to benefit from the RHT Program. With a higher share of rural residents than coastal areas, states from Minnesota to Alabama face acute health care challenges including provider shortages, hospital closures and longer travel times for care. These barriers can make it difficult for rural communities to achieve strong health outcomes and build sustainable health care systems.  

Recognizing these challenges, heartland leaders are already mobilizing around the RHT Program’s five goals. Heartland Forward’s Heartland Health Caucus, for instance, works to simplify the health care system, advance workforce and technology policies tailored to rural needs and reframe health as a driver of economic vitality. This work complements the RHT Program by laying the groundwork for innovation and policy solutions affecting rural realities. 

The RHT Program offers a historic chance to accelerate these ongoing efforts and strengthen rural health care across the heartland. Here’s how the heartland can seize on this moment: 

1. Invest in Technology that Works for Rural Communities

From telehealth and remote monitoring to simplified electronic patient records, user-friendly technology can make rural health care more efficient. The RHT Program gives states resources to train providers and patients on new software and implement streamlined digital systems. Improved connectivity and more efficient technology means faster care for residents, better data for doctors and smoother operations for health systems.

2. Build a Stronger Rural Health Care Workforce  

The provider shortage in rural America isn’t new, but it is worsening. The RHT Program can fund initiatives to train, retain and support health professionals, whether by expanding providers’ skills or introducing tools like AI software to reduce administrative burdens. 

Strengthening the workforce also requires supporting staff outside of work. Heartland states can invest in local medical education, offer incentives for professionals to stay in rural communities and address factors driving turnover. Loan forgiveness, housing assistance and competitive salaries can also help attract new talent.

3. Bring Health Care Closer to Home

Many rural residents travel long distances for basic care. The RHT Program encourages states to build local digital infrastructure, expand staffing models through development of vast community-based services and rely on supports like Community Health Workers (CHWs) and pharmacists to test, treat and work at the top of their licenses. Through a hub-and-spoke model local centers could handle routine care via telehealth while regional hospitals focus on complex cases. This approach keeps residents connected to local providers who understand their needs while limiting the travel time some patients undergo.

Interested in learning more about the role of CHWs in rural health care delivery? Read more from Pulse here: The Rise of the Community Health Worker in the Heartland. 

4. Prevent More Rural Hospital Closures

Rural hospitals are both care centers and economic anchors. Yet, over the past two decades 80+ rural hospitals have closed and 60+ more have been converted to non-acute hospitals. The RHT Program supports regulatory flexibility, inter-hospital collaboration and innovative financial models to keep hospitals open. States can use funding to support light renovations and infrastructure improvements in existing rural facilities; RHT funding, however, cannot be used on any new construction. Heartland states can use funds to pilot coordinated care networks, reduce overhead and strengthen preventive, community-based care. For communities on the brink of being in a health care desert, this support could mean the difference between shutdown and survival. 

5. Prioritize Long-Term Stability

To maximize the impact of RHT funding, heartland states must focus on sustainable transformation. This means aligning local policies with federal initiatives, embracing new technology and piloting innovative care models. Achieving lasting change requires bold, system-wide solutions, not incremental fixes. By leveraging technology, balancing costs and simplifying the patient experience, states can build resilient systems ready for future health challenges.

Heartland leaders understand what isn’t working in rural health care. By tapping into local expertise, forging strong public-private partnerships and addressing priorities like chronic disease prevention, they can turn RHT-funded initiatives into a national model for rural health success.

To further explore how heartland states can deliver high quality health care to rural populations, read the Health Care Access In The Heartland research report.

Bold Ideas for Heartland States to Fund Under the RHT Program 

To maximize the RHT Program, heartland states should look beyond traditional ways to approach health care challenges and lean into creative, locally rooted solutions. The following ideas highlight how partnerships and community-based initiatives can align with the RHT Program’s goals while driving measurable impact across the region.

• Public-Private Partnerships: Heartland states can leverage partnerships with local companies to promote healthier lifestyles, reduce demand for routine care and generate data to guide future policies. Examples could include:
  • Collaborate with regional technology firms to encourage active living through wearable devices and fitness tracking. 
  • Establish a pilot with local healthcare innovators to provide comprehensive, at-home health care for eligible households. 
  • Partner with a nutrition-focused business to deliver dietitian-approved meal plans and guidance to families.
  • Work with active lifestyle companies to promote community biking initiatives, increasing access to physical activity and combating chronic disease.
    
    These partnerships align with the RHT Program’s focus on innovation and prevention, all while staying rooted in local, heartland economies and driven by heartland expertise and innovation. 
• Community-Based Chronic Disease Prevention: Heartland states can invest in prevention programs that reduce chronic disease rates and lower long-term health care costs. Proven strategies include health education workshops, universal school nutrition programs, mental health screenings and accessible opportunities for physical activity.
  
  A $10 per person annual investment in community-based programs could save $16 billion nationally within five years—a return of $5.60 for every $1 spent. By combining prevention efforts with strategic partners, like local schools, libraries and community centers, the heartland can amplify the impact of the RHT funding, improve health outcomes and model sustainable rural health solutions for the nation. 

Final Thoughts 

The November 5 deadline is fast approaching. Heartland states have an opportunity not just to reshape rural health care but to lead the nation in showing how it can be done effectively. With clear goals, a timely funding opportunity slated to move quickly and a population in need, now is the time for the heartland to get to work on transforming rural health care.