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Rural Health Transformation Program (RHTP)
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Rural Health Transformation: A Guide for Stakeholders
About the Program

A New Era for Rural Health in Missouri: 
Understanding the Rural Health Transformation Program

The Rural Health Transformation Program (RHTP) is a landmark $50 billion federal investment designed to reshape healthcare in rural communities across America.1 

Established by Public Law 119-21, this five-year program is not a short-term grant but a significant opportunity to build a stronger, more sustainable healthcare system for the future.1 

In Missouri, the Department of Social Services (DSS), through its MO HealthNet Division, is leading the state's application effort in close collaboration with the Department of Health and Senior Services (DHSS) and the Department of Mental Health (DMH).3

What is the intention of the program?

For years, rural communities have faced unique healthcare challenges, including hospital closures, shortages of doctors and nurses, and overall poor health outcomes compared to urban areas.1 The RHTP was created to address these long-standing issues head-on. 

The program represents a fundamental shift in federal policy. Instead of providing temporary funds to patch financial holes, it aims to support states in making systemic, long-term changes. 

The goal is to move from a healthcare system that is struggling to survive in rural areas to one that is innovative, financially stable, and built for lasting success.1

Strategic Goals

The Five Strategic Goals

The Centers for Medicare & Medicaid Services (CMS) has outlined five core goals that guide the RHTP. These goals provide a clear roadmap for the types of projects Missouri will pursue to transform its rural healthcare landscape.

Improve Rural Health: 

The goal is about stopping people from getting sick before it happens, as well as ensuring appropriate access to early identification and upstream interventions. It helps with projects that keep us healthy, looking at the main reasons for diseases like diabetes and heart problems, and make it easier to get important services like mental health and care for
pregnant women.1

Sustainable Access: 

The goal is to keep rural hospitals and clinics open by encouraging them to work together. This means they will share resources, improve how they operate, and become
financially stable. This way, they can continue to be trusted places for healthcare in their communities.1

Workforce Development: 

The goal is to help fix the shortage of healthcare workers in rural Missouri. It supports programs that bring in, train, and keep skilled workers, such as doctors, nurses, community health workers, and technicians.1

Innovative Care: 

The goal is to create a Community Health Hub, which brings hospitals, clinics, and other community leaders together to meet the health needs of their specific community.
This will allow hospitals and clinics to get paid to help patients stay healthy in addition to helping treat them when they get sick.1

Tech Innovation: 

The goal is to use new technology to make healthcare better in rural areas. This means using things like video calls for doctor visits, keeping track of patients from far away, and safely sharing information. This will make healthcare easier and faster for people and doctors in rural areas.1

RHTP Application timeline (the text of the page describes each point on the timeline
The Road to Transformation

A Timeline for Missouri

The RHTP has a structured timeline with several key dates that have guided Missouri's application process. Understanding this timeline helps stakeholders see how the state has moved from planning to action.

DateEventSignificance for Missouri
August 26, 2025Missouri DSS Opens Public Comment PeriodThis marked the official start of stakeholder engagement, allowing providers, advocates, and the public to provide crucial input to shape the state's application and priorities.4
September 30, 2025Missouri DSS Closes Public Comment PeriodThis was the deadline for initial public and stakeholder feedback, which forms the foundation of Missouri's Rural Health Transformation Plan.4
September 30, 2025Optional Letter of Intent Due to CMSMissouri submitted this non-binding letter to inform CMS of its intent to apply for the program, helping the federal government plan for the review process.1
November 5, 2025Final Application Due to CMSThis is the hard deadline for Missouri to submit its comprehensive plan, detailing how it will use RHTP funds to achieve the program's five strategic goals.1
December 31, 2025CMS Announces State AwardsBy this date, Missouri will learn if its application has been approved and receive its initial funding determination for the first year of the program.1
Early January 2026First-Year Funds DistributedOnce approved, Missouri will receive its first allocation of funds, allowing the state to begin implementing the transformative projects outlined in its plan.1
Toolbox of Strategies

A Toolbox for Change: How Missouri Can Use RHTP Funds

The RHTP provides states with a broad and flexible "toolbox" of approved activities. To be approved, Missouri's plan must include investments in at least three of the eleven categories below.1 These categories directly align with the program's five strategic goals.
 

Prevention and Chronic Disease: 

Funding programs that use evidence-based methods to prevent and manage chronic conditions.
Example: Expanding the use of providers such as Pharmacists, Community Paramedics and Community Health Workers to address chronic diseases at their root cause. 
 

Provider Payments: 

Making payments to healthcare providers for services, particularly as part of new, innovative payment models. 
Example: A new payment model for providers to help prevent diseases at their root cause in addition to treating those conditions. 
 

Consumer Tech Solutions: 

Promoting technology that patients can use themselves to manage their health. 
Example: Using the latest technology tools, including Artificial Intelligence, to help predict and manage chronic diseases.
 

Training and Technical Assistance: 

Helping rural hospitals adopt advanced technologies like remote monitoring, robotics, or artificial intelligence. 
Example: Provide training to healthcare workers and others on the latest technology such as Artificial Intelligence to make their more efficient.
 

Workforce: 

Recruiting and retaining healthcare professionals in rural areas, with a requirement that they serve in the community for at least five years. 
Example: Connecting rural high school students who are interested in health care careers with internships and other healthcare related opportunities. 
 

IT Advances: 

Providing funds for significant upgrades to information technology, including software, hardware, and cybersecurity. 
Example: Connecting rural healthcare facilities with specialists using telemedicine for complex and urgent medical and behavioral health care.
 

Appropriate Care Availability: 

Assisting rural communities in determining the right mix of healthcare services they need to be sustainable. 
Example: Using a combination of technology such as telemedicine and additional workforce members such as community paramedics and pharmacists to connect patients with the right care at the right time at the right place.
 

Behavioral Health: 

Supporting access to mental health and substance use disorder treatment. 
Example: Funding the two-year college education for front-line behavioral health workers.
 

Innovative Care: 

Developing new models of care, including value-based payment arrangements. 
Example: Establishing local community-based health Hubs across the state in which hospitals, doctors, rural clinics, behavioral health providers and community-based organizations like food pantries and school-based clinics work together to improve the health of their community.
 

Fostering Collaboration: 

Creating strategic partnerships between rural facilities and other providers to improve quality, financial stability, and access to care. 
Example: Establishing regional networks run by a collaboration of hospitals, clinics, and behavioral health professionals to coordinate the care most needed in their region.
 

About Funding
How Much Funding is Available?

How RHTP Funding Works: The Two Streams of Support for Missouri

The RHTP will distribute a total of $50 billion nationwide over five federal fiscal years (2026-2030), with $10 billion made available each year.1

1. Baseline Funding (50% of Total)

Half of the program's total funds ($25 billion over five years) are designated as Baseline Funding.1 This money is divided equally among all states that have an approved application. This provides a stable, predictable funding stream that Missouri can count on each year to form the foundation of its transformation plan. If all 50 states are approved, this would amount to approximately $100 million per state annually.10

2. Workload Funding (50% of Total)

The other half of the program's funds ($25 billion over five years) is designated as Workload Funding.1 This funding is distributed competitively based on a formula that evaluates two things: a state's level of rural need and the quality of its transformation plan.1 This creates an opportunity for Missouri to earn significant additional funding by clearly demonstrating its rural health challenges and presenting a thoughtful, strategic, and high-impact plan for the future.

How Much Will Missouri Receive?

If Missouri's application is approved, the state will receive a portion of these funds through a two-part model designed to provide both a stable foundation and an incentive for high performance. Estimates suggest Missouri could receive between $200 million and $250 million annually through this program.3

1. Baseline Funding

Baseline Funding is distributed over 5 years.1 This ensures a stable annual funding stream, allowing Missouri to support its transformation plan. 

2. Workload Funding

Missouri can secure significant additional funding by effectively showcasing its rural health challenges and presenting a strategic, impactful future plan.

Funding Timeline

Funding Timeline

Funding is awarded in five annual budget periods. A key feature of the program is its flexibility; for each budget period, Missouri will have until the end of the following federal fiscal year (September 30) to spend the awarded funds.1 For example, funds awarded for the first budget period in early 2026 can be spent until September 30, 2027. This will require careful planning for complex, multi-year projects.

For each budget period, recipients will have until the end of the following fiscal year (September 30) to spend awarded funding.

  • Recap: Budget Period will start on December 31, 2025. The Federal Fiscal Year begins October 1, but the subsequent Budget Period funding for RHTP will be distributed in November of each fiscal year. 
Funding timeline. For each budget period, recipients will have until the end of the following fiscal year (September 30) to spend awarded funding. Recap: Budget Period 1 will start on December 31, 2025, and Subsequent Budget Periods will start on October 31 of each fiscal year.
Key Limitations

Prohibited Uses

RHTP funds cannot be used for the following:

  • New Construction: Building entirely new facilities is not allowed. However, funds can be used for renovations, alterations, or equipment upgrades in existing buildings.1
     
  • Supplanting Funds: The money is intended for new or expanded activities. It cannot be used to replace or substitute existing state, local, or private funding for a project that is already underway or budgeted.1
     
  • Duplicating Billable Services: Funds cannot be used to pay for clinical services that are already reimbursable through programs like Medicaid, Medicare, or private insurance. The goal is to transform care delivery, not just pay for more of the same services.1
     
  • Lobbying: Federal funds cannot be used for activities designed to influence the passage of legislation or other government actions.1
     

Program-Specific Funding Caps

CMS has also set limits on how much of a state's annual award can be spent on certain categories. These caps ensure a balanced investment across different aspects of healthcare transformation.

Spending Category

Maximum Allowed

Administrative Costs (State-level program management, oversight)10% of the state's total annual award1
Capital Expenditures (Renovations, equipment upgrades)20% of the state's total annual award1
Provider Payments (For direct healthcare services not otherwise billable)15% of the state's total annual award1
Replacing an Existing Certified EHR System5% of the state's total annual award1
"Rural Tech Catalyst Fund" Initiatives (Funding for health tech startups)The lesser of 10% of the annual award or $20 million1
Calculating Missouri's Award

The Federal Scoring Formula

The amount of competitive "Workload Funding" Missouri receives each year is determined by a formula that combines two distinct scores. Understanding this formula is key to maximizing the state's award.

Score 1: The Rural Facility and Population Score (The "Need" Score)

This score is a snapshot of Missouri's existing rural healthcare needs and challenges. It is calculated by CMS only once at the beginning of the program and will not change over the five years1. It is based on several data-driven factors, including:

  • The total number of people living in rural areas of the state.1
  • The number and proportion of rural health facilities, such as Critical Access Hospitals and Rural Health Clinics.1
  • The level of uncompensated care provided by hospitals in the state.1
  • The percentage of the state's total population that lives in rural areas.1
  • The state's total land area and the presence of very remote "frontier" areas.1
  • The percentage of hospitals that receive Medicaid Disproportionate Share Hospital (DSH) payments.1

Score 2: The Technical Score (The "Plan and Performance" Score)

This score measures the quality, strategic vision, and ultimately the performance of Missouri's transformation plan. This score is recalculated by CMS every year based on the state's progress.1 This annual rescoring is the program's core accountability engine. It turns the RHTP from a simple grant into a dynamic, performance-based partnership. 

A typical grant provides funding based on an initial application, with reporting focused mainly on compliance. The RHTP, however, ties future funding directly to present performance. If Missouri successfully implements its planned initiatives and meets its policy commitments, its Technical Score—and its Workload Funding—can increase in subsequent years. Conversely, a failure to make progress or follow through on commitments can lead to a lower score and reduced funding. This structure creates a powerful incentive for the state and its partners to not only write a strong plan but to execute it effectively, requiring robust project management and transparent reporting from day one.

MO Approach to Rural Health Transformation
Vision & Core Objectives

Vision

Rural Missourians have access to the high-quality care they need, through or from a well-aligned delivery system that is built to last.

Core Objectives

DSS is organizing and prioritizing initiatives in the application according to three overarching objectives:

Access to Care: 

Ensure rural Missourians can access primary and behavioral health providers close to home, community-based maternity options, with connections to specialists and complex care enabled by telehealth and provider interoperability
 

Health Outcomes:

Strengthen healthcare quality through integrated care coordination, aligned incentives, and evidence-based practices – so rural Missourians consistently experience seamless, high-value care 
 

Sustainability:

Strengthen the long-term sustainability of rural providers through targeted investments in infrastructure, adoption of innovative technologies, and payment models that reflect the realities of rural care delivery

Initiatives

Missouri’s Initiatives

  • Rural Health Network and Hubs
     
  • Tech and Data Interoperability
     
  • Rural Health Workforce Pathways
     
  • Provider Transformation & Sustainability
     
Rural Health Network and Hubs

Rural Health Network and Hubs

Create community hubs supported by regional networks as the backbone that connects every rural resident to seamless high-quality care through:

  • Access expansion through and beyond traditional providers (e.g., pharmacy, Emergency Medical Services (EMS), Mobile Integrated Healthcare–Community Paramedicine (MIH-CP), Local Public Health Agencies (LPHA))
  • Care coordination integrating physical, behavioral and social health services
  • Technical assistance and programs tailored to local needs
Rural Health Workforce Pathways

Rural Health Workforce Pathways

Create an integrated rural health workforce pipeline that connects education, training, and employment to grow and retain Missouri’s healthcare talent locally, including efforts on:

  • New entry points into health careers through high school, college, and training programs
  • Expanding maternal and behavioral health training opportunities
  • Clinical placement and retention supports across rural communities
Tech and Data Interoperability

Tech and Data Interoperability

Create a statewide backbone for data interoperability that connects hubs, providers, and local partners to coordinate care, including:

  • Hub data integration
  • Community Information Exchange (CIE) for closed-loop referrals and shared care plans
  • Data standards and compliance
  • Public health connectivity
Provider Transformation & Sustainability

Provider Transformation & Sustainability

Ensure the long-term financial, operational, and sustainable future of Missouri’s rural healthcare system through:

  • Strategic infrastructure access modifications
  • Alternative payment innovations
  • Operational innovation and tech-enablement
Rural Health Network Flowchart
Works Cited

Works Cited

  1. Notice of Funding Opportunity Webinar, accessed October 15, 2025, https://www.cms.gov/files/document/rht-program-applicants-webinar-presentation.pdf
     
  2. Rural Health Transformation Program Summary, accessed October 13, 2025, https://www.ruralhealth.us/nationalruralhealth/media/documents/advocacy/2025/rural-health-transformation-program-summary.pdf
     
  3. CMS Releases State Guidance On Rural Health Transformation Program, accessed October 13, 2025, https://www.mohospitals.org/newsroom/cms-releases-state-guidance-on-rural-health-transformation-program/
     
  4. Missouri Department of Social Services Invites Public Comment on Rural Health Transformation Program - GovDelivery, accessed October 13, 2025, https://content.govdelivery.com/accounts/MODSS/bulletins/3ef7bd9
     
  5. Invitation to Comment: Rural Health Transformation Program - myDSS - MO.gov, accessed October 13, 2025, https://mydss.mo.gov/mhd/hot-tips/invitation-comment-rural-health-transformation-program
     
  6. Missouri Lawmakers Champion Rural Health, Unlocking Access to Quality Care for Rural Communities - Ways and Means Committee, accessed October 13, 2025, https://waysandmeans.house.gov/2025/09/23/missouri-lawmakers-champion-rural-health-unlocking-access-to-quality-care-for-rural-communities/
     
  7. DSS Seeks Input On Rural Health Transformation Program - Missouri Hospital Association, accessed October 13, 2025, https://www.mohospitals.org/newsroom/dss-seeks-input-on-rural-health-transformation-program/
     
  8. Billions on the Table: Missouri Invites Public to Shape Rural Health Future - Missourinet, accessed October 13, 2025, https://www.missourinet.com/2025/09/02/billions-on-the-table-missouri-invites-public-to-shape-rural-health-future/
     
  9. Missouri Department of Social Services seeking public help in planning for rural health innovatio... - YouTube, accessed October 13, 2025, https://www.youtube.com/watch?v=7B1VNbJueKc
     
  10. The $50 Billion Rural Health Transformation Program: What Providers Can Do Before Nov. 5, 2025, accessed October 13, 2025, https://www.lara.health/blog/the-50-billion-rural-health-transformation-program-what-providers-can-do-before-nov-5-2025
     
  11. Rural Health Transformation Program - Senate Finance Committee, accessed October 13, 2025, https://www.finance.senate.gov/download/rural-health-transformation-program_fact-sheet