Tribal rural health transformation

Washington Rural Health Transformation logo (CMS)

The Rural Health Transformation Program offers an opportunity for sovereign Tribal governments to make critical investments to improve the health and wellbeing of Native families.

The Rural Health Transformation (RHT) Program is part of the H.R.1 budget reconciliation bill. The RHT Program offers $50 billion funding nationwide to improve rural health care. The Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) administers the program.

So far, CMS awarded Washington state about $181 million for year one of the program. These funds will support the hospitals, clinics, and providers that rural families rely on every day.

The Health Care Authority (HCA), Department of Health (DOH), and Department of Social and Health Services (DSHS)—in support of Governor Ferguson’s Office—partnered to develop and run Washington state’s RHT plan.

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Input from Tribes

We asked Tribes to help shape our state’s strategy for implementing the RHT Program. We reached out through the Rural Health Transformation webpage, email, and social media. We also had in-depth discussions with Tribes during two listening sessions, one roundtable discussion, and two formal Tribal consultations. That input helped shape Washington’s RHT Program. We will continue to partner with Tribes as the RHT Program moves forward.

RHT Program funding for Tribes

The state of Washington reserved a portion of the RHT Program funds for sovereign Tribal Governments to make critical investments to improve the health and wellbeing of Native families. Based on formal Tribal Consultation, the state has set aside 10 percent of all RHT Program funds for Tribes to conduct activities in support of Initiative 3: Invest in the health of Native families. Tribes do not need to apply to receive these funds.

For information about other RHT funding opportunities that may be available to Tribes, visit bids and contracts.

For other RHT news, please visit the Washington Rural Health Transformation webpage.

Rural Health Transformation for Tribes

Initiative 3 provides funds for Tribes to make critical investments to improve the health and wellbeing of Native families. Funds can be used to expand workforce programs to support Native families, establish care coordination agreements with hospitals and specialty providers, and/or support investments in technology infrastructure and electronic information exchange systems. Tribes are encouraged to think broadly when considering activities and solutions related to this initiative.

Initiative 3: Invest in the health of Native families
Activity	Potential projects
3.1: Invest in Native workforce	Recruit, hire, and support staff through programs such as the Tribal Community Health Provider Programs Native doula workforce development initiatives Fund mobile outreach teams for chronic disease management and prevention Hire a treatment navigator to help coordinate care for Tribal members Provide additional training to existing staff
3.2: Establish care coordination agreements	Tribe hires a lawyer/consultant/staff to formalize care coordination agreement and work with local hospitals Tribe hires staff to attend Rural Health Transformation meetings and participate in alternative payment model development Tribe hires staff to oversee the care coordination process and ensure information exchange meets the requirements of SHO Letter 16-002 and HCA is alerted to claims delivered under care coordination agreements Participate in statewide network of Tribal care coordinators
3.3: Investments to support health information exchange	Tribal electronic health records (EHR) modernization projects Purchase a third-party application to support electronic information exchange Update software/hardware as needed for information exchange Secure data-sharing platforms between Tribes and hospitals Remote care and telehealth technology deployment Mobile technology solutions for community health workers Hire someone to work collaboratively with regional partners, such as hospitals, on care coordination technology and information exchange

Frequently asked questions (FAQ)

How can Tribes apply for Rural Health Transformation (RHT) Program funds?

How Tribes apply for RHT funds varies. Funds to support Initiative 3. Invest in the health of Native families, will be distributed to Tribes through contracts under existing Sovereign Nation Agreements. Based on formal Tribal Consultation before the application was submitted, the state of Washington agreed to set aside 10 percent of all RHT funds for Tribes to conduct activities in support of Initiative 3. In addition to the 10 percent set aside, Tribes will receive limited additional funds to support the administration of the Initiative 3 contracts. Tribes do not need to apply to receive those funds.

Tribes may also be eligible to apply for funding from the other RHT initiatives. Tribes that would like to apply for funding for the other RHT initiatives should monitor the Rural Health Transformation how to participate webpage and sign up for the RHT mailing list. HCA is likely to hold several requests for proposals (RFPs) in 2026.

Urban Indian programs that treat rural patients may be eligible for RHT funding and are also encouraged to monitor the RHT website for more information and subscribe to the RHT mailing list.

How will RHT Program funds be distributed to Tribes?

The Health Care Authority (HCA) was directed by Tribes via formal Tribal Consultation to divide the Tribal RHT set aside equally among all 29 federally-recognized Tribes in Washington.

What activities are eligible for funding under Initiative 3 of the RHT Program?

What prohibitions exist with regards to spending RHT funds?

Per guidance from CMS, RHT funds may not be used for any of the following:

Pre-award costs
Federal or local fund matching
Services, equipment, or support that is the legal responsibility of another party
Goods or services not allocable to the project
Supplanting state, local, Tribal, or private funding
Construction or building expansion
Independent research and development
Covered telecommunications and video surveillance equipment
Meals, unless in limited circumstances
Lobbying
Duplicated payments
Clinician salaries or wage supports for non-compete limitations
Social Security Act 2105(c) paragraphs 1, 7, and 9

What is the timeline for spending year one RHT funds?

Year one RHT funds will need to be spent no later than September 30, 2027.

What if my Tribe can't spend all the RHT funds received?

RHT funding cannot roll over, and underspent budgets will be reallocated to other states in subsequent periods. HCA’s Office of Tribal Affairs will work closely with Tribes to monitor progress and billing. If by June 1, 2027, it becomes clear that your Tribe can’t spend all the RHT funds before the end of the year one performance period (09/30/2027), then funds will be redistributed to other Tribes for the current period.

Who at the Health Care Authority serves as the RHT Program point of contact for Tribes?

Please contact Ryan Hill, HCA Tribal Program Specialist, for any questions or concerns regarding Rural Health Transformation.

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Disclaimer: This program is supported by CMS of the U.S. Department of Health and Human Services (HHS) as a financial assistance award totaling $181,257,515.06 with 100 percent funded by CMS/HHS. The contents are those of the author and do not necessarily represent the official views of, nor an endorsement by, CMS/HHS or the U.S. Government.