Rural Health Transformation Program

The Rural Health Transformation Program offers an opportunity for Washington state to help rural communities take important steps forward in accessible, safe, and sustainable health care.

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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 & Human Services (HHS) administers the program.

So far, CMS awarded Washington state about $181 million for year 1 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.

Latest news

The Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) approved Washington state’s revised budget for the Rural Health Transformation (RHT) Program. CMS has allocated Washington a year 1 budget of $181 million.

During the original application, CMS suggested that states budget for $200 million yearly. For the new budget, the Health Care Authority (HCA), in partnership with the Department of Health (DOH) and Department of Social and Health Services (DSHS) — in support of the Governor’s Office — have adjusted the original application without eliminating any activity. See the revised budget.

With our revised RHT budget approved, our next step is to review a cooperative agreement with CMS.

More about the program

The RHT Program provides $10 billion annually for fiscal years (FYs) 2026–2030, and states have two years to spend each year’s funding. Every approved state will receive the same amount, with additional funds distributed by CMS based on a state’s rural population, rural health facilities, and other factors.

CMS awarded Washington $181 million for year 1 of the program. Once the program begins, states will have yearly budget reconciliation with CMS to update program plans based on allocated funds.

Washington’s plan

Washington’s plan for the RHT Program is detailed in these key parts of our original program application:

  • Project narrative: The original full description of our proposed RHT Program plan and the most important part of the application.
  • Project summary: The original one-page summary of our proposed RHT Program plan.
  • Governor’s endorsement: A letter from Governor Ferguson expressing his support for our proposed RHT Program plan.

These materials were reformatted from the submitted version so they’re easier to read. All wording matches the original documents.

After CMS approved our application, we revised our original budget to match the $181 million budget that CMS allocated to Washington for year 1. See the revised budget.

Washington’s RHT plan includes six initiatives to help build a healthier, more resilient, and financially sustainable rural health system. While the project narrative details each initiative, here’s a summary:

Initiatives
  • Ignite innovation in Washington’s rural hospitals: This initiative improves how rural hospitals operate. Investing in long-term solutions will give rural Washingtonians better access to high-quality specialty and emergency medical care.
  • Prevent disease and manage care in community settings: This initiative focuses on bringing health care into rural communities, beyond the walls of the doctor’s office. These community-based solutions will help rural residents access the right level of care at the right time.
  • Invest in the health of Native families: This initiative reserves a portion of RHT Program funds for sovereign Tribal Governments to make critical investments to improve the health and wellbeing of Native families.
  • Adopt technology and data solutions to enable health improvements: This initiative invests in technology that increases efficiency, access, and quality in Washington’s rural health care system. These improvements will help rural Washingtons get specialty care and monitor chronic conditions.
  • Develop Washington’s rural workforce to support rural communities: This initiative grows, trains, and maintains the health care workforce in rural Washington. With a larger and increasingly skilled workforce, rural Washington can better support individuals with long-term care needs.
  • Expand and sustain Washington’s rural behavioral health system: This initiative improves standards for behavioral health care and gets people into care faster. Mobile crisis support will decrease strain on rural hospitals and school-based behavioral health care services will better support rural youth.

Input from people in Washington

We asked for public input to help shape our state’s strategy for implementing the RHT Program. We reached out through this webpage, email, and social media. We also had in-depth discussions with various groups interested in the RHT Program.

The community reached back with over 300 written responses. We’ll continue to partner with the public as the RHT Program moves forward.

Who we heard from

We received input from a wide range of groups:

  • Rural hospitals and districts
  • Nonprofit organizations
  • Non-hospital provider groups
  • Health care education programs
  • State and national associations
  • State agencies
  • Interested individuals
  • Colleges and universities
  • School districts
  • Tribes
  • Emergency medical services and firefighters
  • Public health departments
What we heard

Everyone’s input helped us clarify rural health needs. Many shared their lived experiences. We found common themes throughout:

  • Technology
  • Hospital operations and infrastructure
  • Workforce
  • Service expansion and retention
  • Data and EHR infrastructure
  • Behavioral health
  • Payment reform
  • Education
  • Opioid use disorder treatment
  • Telehealth
  • School-based care
  • Special health care needs
  • Wellness
  • Youth-focused services
  • Special health care needs
  • Oral health
  • Maternity and perinatal care

Resources

Materials
News and announcements

Disclaimer: This program is supported by CMS/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.

Contact

Email: HCA Rural Health Transformation Program