CMS Approves $216 Million Year 1 Budget to Stabilize and Transform Rural Health Care in Missouri
View the Budget Narrative
Enacted by the Trump Administration, the Rural Health Transformation Program (RHTP) is a five-year program intended to drive major innovation and transformation in rural healthcare.
Funding cannot be used for supplanting existing funding from the State or private sector
(e.g., staff salaries), new construction, building expansion, payment for clinical services
currently covered under insurance, among others.
Missouri’s RHTP goal centers on the Transformation of Rural Community Health Care (ToRCH Care) – a statewide network of healthcare “hubs” designed to bring care closer to home, make clinical and non-clinical services more seamless, and ensure that no rural resident is left behind.
For Year 1 of the RHTP, CMS has awarded Missouri $216M, 9th highest in the country
Missouri has directed $202M (>90%) of this funding into MO’s rural healthcare ecosystem.
CMS-approved Year 1 funding allows Missouri to immediately activate ToRCH Care across five pillars designed to stabilize providers, launch regional networks, modernize digital infrastructure, and lay the groundwork for long-term sustainability.
Pillars of Missouri's Rural Health Transformation:
- Activating Regional Networks & Local Hubs
- $52,040,578.20
- Advancing Sustainability Through Payment Reform
- $8,791,933.32
- Laying the Digital Foundation for Long-Term Transformation
- $56,159,145.29
- Expanding and Retaining Rural Health Workforce
- $17,769,473.99
- Strengthening Rural Providers and Modernizing Service Delivery
- $57,225,308.79
The remaining $24,215,707.02 will be use for Program Enablement.
Pillar 1: Activating Regional Networks & Local Hubs
$52,040,578.20
- As the operational backbone of ToRCH Care, this funding integrates local providers into a unified system through staffing for local community hubs and supported by a regional coordinating network structure.
- Locally tailored access and care programs
- Partnerships with community-based organizations
These networks will integrate hospitals, FQHCs, behavioral health providers, EMS, pharmacies, and public health agencies into coordinated regional systems. By establishing shared referral pathways and governance structures in Year 1, Missouri will begin replacing fragmented services with an aligned, community-driven care model.
Hubs & RCNs Staffing ($4M)
Staff members across state to support state, regional and hub-level activities. Example staff to be hired/contracted include:
- State-level: RHTO State Director, Program Success Managers, Workforce Development Managers, Fiscal/Grants Managers/specialists
- Regional/RCN-level: Regional Directors, Analytics Managers, Technical Assistance Specialists, Clinical Leads, and Community Liaisons
- Local/Hub-level: Program Managers and Coordinators, Community Health Workers (CHWs)
Hubs Access ($15M)
Expand community-based care access through pharmacy services, community paramedicine, and specialty telehealth consultation lines to improve rural access to care.
Programs supported include:
- Pharmacy-based care: test-and-treat, chronic disease management, behavioral health screening, care coordination
- Community paramedicine (MIH-CP): non-emergency home visits, chronic disease monitoring, post-discharge follow-up
- Specialty consultation lines: real-time provider support for maternal mental health, child psychiatry, and behavioral health
Hub Menu ($9M)
Support hub-led programs addressing local needs.
Programs supported include:
- Perinatal home visiting: CHW/nurse visits, maternal screening, care coordination
- Nutrition programs: produce prescriptions, medically tailored meals, education
- School-based clinics: primary and behavioral health services for students
RCNs/Hubs programs ($24M)
Other funds to be allocated to RCNs/Hubs programs
Pillar 2: Advancing Sustainability Through Payment Reform
$8,791,933.32
Funding initiates the transition toward performance-based reimbursement models that prioritize patient health and lower total costs of care. These investments lay the technical groundwork for long-term financial sustainability, ensuring rural providers can transition from volume-based reimbursement to performance-based models over time.
Alternative Payment Models (APMs) design and pilots ($5M)
Design and launch incentive models to support providers transition to value- and performance- based arrangements.
Key initiatives include:
- Incentive structures tied to reductions in ED visits and inpatient admissions
- Performance pools distributing shared savings to Hubs and providers
- Ecosystem alignment around common measures and reporting (e.g., Medicaid MCOs and participating payers)
Technical assistance and enablement for APM adoption ($4M)
Provide technical assistance and analytics to support Hub and provider participation in value-based payment models.
Key initiatives include:
- Baseline analytics, performance reporting, and quality measurement tools
- Payer engagement, provider readiness, and implementation of APM reporting requirements
- Change management and implementation support
Pillar 3: Laying the Digital Foundation for Long-Term Transformation
$56,159,145.29
Missouri is investing $56 million to build a "digital backbone" that connects rural providers through secure, shared data systems. These foundational technology upgrades enable real-time care coordination and pave the way for expanded telehealth and remote patient monitoring - ensuring rural Missourians receive modern, high-tech care regardless of their zip code.
Tech Modernization and Interoperability ($46M)
Modernize and integrate rural provider systems to enable interoperability, digital care delivery, and coordinated data exchange.
Key capabilities include:
- EHR modernization and upgrades
- Interoperability and Cloud hosting
- Remote patient monitoring integration for chronic and maternal care
- Ambient AI tools to reduce documentation burden
- Telehealth expansion to improve access
- Social care referral network enabling closed-loop coordination
Governance/Readiness ($10M)
- Data/AI governance board and policies
- Digital readiness assessment
- APM analytical tools
Pillar 4: Expanding and Retaining Rural Health Workforce
$17,769,473.99
Year 1 funding invests Missouri’s rural healthcare workforce pipeline and improving retention across critical roles. Investments include:
- Expanding EMS training, certification programs, and regional coordination to stabilize emergency care and patient support in rural communities
- Supporting early pipeline programs, including rural high school and community college healthcare pathways
- Supporting retention efforts through childcare, housing, transportation, and preceptor incentives that reduce barriers to rural practice
- Expanding maternal health workforce programs, including doula training, home visiting staff, and development of Missouri’s first Certified Nurse Midwife (CNM) training pathway
- Expanding rural clinical training through medical clerkships and hospital partnerships to improve long-term physician retention
These investments address workforce shortages by building a sustainable pipeline, enabling providers to practice at the top of their license, and improving retention in high-need rural communities.
Workforce Expansion ($12.5M)
Expand rural workforce training and clinical education programs, including:
- Maternal workforce expansion (CNM, doulas, perinatal home visitors)
- Rural medical student clerkships and clinical placements
- Early healthcare career pathways through rural CTE and community colleges
- Rural preceptor incentives to increase training capacity
- EMS workforce training and regional network strengthening
Retention ($5.5M)
Flexible funding to RCNs/Hubs to support community-driven workforce retention strategies that improve recruitment, retention, and long-term sustainability of the rural healthcare workforce
Pillar 5: Strengthening Rural Providers and Modernizing Service Delivery
$57,225,308.79
Year 1 funding advances Missouri’s Provider Transformation efforts by stabilizing rural hospitals and modernizing care delivery through targeted investments in infrastructure, technology, and service lines.
Investments include $42 Million across two areas:
- Critical infrastructure repair, safety compliance, and essential equipment replacement to preserve core services in financially vulnerable facilities
- Service line modernization and strategic growth, including expansion of maternal health, behavioral health, and outpatient capabilities (subject to program caps)
Year 1 efforts also advance technology-enabled care by deploying remote patient monitoring (RPM) and ambient AI tools designed to reduce administrative burden and enable proactive, technology-enabled care. Providers are further supported in transitioning to value-based care through participation in alternative payment models and performance-based incentives.
Strategic Renovations / Tech Modernization and Interoperability ($46M)
Modernize and integrate rural provider systems to enable interoperability, digital care delivery, and coordinated data exchange.
- Horizon 1 ($30M)
- Preserve essential healthcare services in financially vulnerable rural facilities. Investments may support:
- Infrastructure repairs and safety upgrades
- Stabilization of hospital and clinic services
- Prevention of service disruptions
- Preserve essential healthcare services in financially vulnerable rural facilities. Investments may support:
- Horizon 2 ($12M)
- Support provider smart growth / service line modification
Technical Assistance for Modernization ($8M)
- Fund Alternative Payment Model (APM) payer/ provider operational and change mgmt.
Remote patient monitoring ($3M)
- Fund Remote patient Monitoring (RPM) licensing and integration
Ambient AI ($4M)
- Support automation of clinical documentation and workflows
RHTP Enablement
$24,215,707.02
Provide strategic and operational support to coordinate and execute the Rural Health Transformation Program statewide.
Key initiatives include:
- Program governance and management: Support centralized leadership, planning, and oversight of RHTP initiatives
- Cross-initiative coordination: Align providers, Hubs, RCNs, workforce programs, digital infrastructure, and payment reforms
- Implementation support: Manage sequencing of initiatives, vendor engagement, and procurement processes
- Performance management: Track program outcomes, monitor KPIs, and support data-driven decision making
- Stakeholder engagement: Coordinate collaboration across state agencies, healthcare providers, community partners, and payers
- Program analytics and reporting: Provide dashboards, reporting, and insights to guide statewide implementation
MO Rural Health Transformation Program Near-Term Steps
With CMS approval secured, DSS and the Rural Health Transformation Office (RHTO) are moving from planning to execution. Year 1 will focus on establishing the systems, partnerships, and infrastructure needed to activate ToRCH Care statewide. Key actions include:
- Launching statewide town halls and webinars to communicate the program’s vision, structure, and expected impact
- Issuing competitive procurement opportunities to support core infrastructure, including digital backbone, interoperability, and workforce development
- Establishing standardized governance, onboarding, and performance processes to ensure consistency and accountability across all regions
- Analyzing the Digital Readiness Survey to assess electronic health record (EHR) maturity, interoperability capacity, and cybersecurity readiness to guide technology investments and modernization efforts
- Onboarding the first community Hub cohort, including leadership structure, staffing, and referral workflow integration
A Long-Term Commitment to Rural Missouri
The Rural Health Transformation Program brings together hospitals, clinics, community-based organizations, and local leaders to develop sustainable solutions tailored to the unique needs of Missouri’s rural communities.
Developed through a collaborative process recognizing Missouri’s innovation, community engagement, and measurable impact, the state’s transformative plan was crafted in coordination with the Governor’s Office, DSS, the Department of Health and Senior Services, the Department of Mental Health, and many healthcare partners and stakeholders.
The Rural Health Transformation Program information provided by the Missouri Department of Social Services is supported by the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $216,276,817.66, with 100 percent funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, CMS/HHS, or the U.S. Government.