Rural Health Transformation Program

The Rural Health Transformation Program offers an opportunity for Washington state to support health care transformation and meet the unique needs of rural communities.

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On July 4, 2025, the H.R.1 budget reconciliation bill was signed into law. Part of this legislation included a federal $50 billion Rural Health Transformation Program (RHTP) to improve rural health care across the country.

RHTP will be administered by the Centers for Medicare & Medicaid Services (CMS). Visit CMS’s RHTP webpage for more details.

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

Washington state’s RHTP application

Washington state applied for RHTP funding on time and with all necessary materials. CMS will respond to our application by December 31. Read these key parts of the application to learn more about Washington’s plan for RHTP:

  • Governor’s Endorsement: A letter from Governor Ferguson expressing his support for our proposed RHTP plan
  • Project Summary: A one-page summary of our proposed RHTP plan
  • Project Narrative: A full description of our proposed RHTP plan and the most important part of the application

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

For the application, CMS required states to submit a $200 million budget per year. CMS will determine each state’s actual funding amount. Once the program begins, states will have yearly budget reconciliation with CMS to update program plans based on allocated funds.

While we’ve submitted the application, our work isn’t done. We’ll keep you updated on this webpage with new information during the coming months.

More about the program

RHTP 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.

Required components and eligible activities

To receive funding, states must submit a Rural Health Transformation Plan that addresses specific, required components. States must also commit to using RHTP funds for three or more activities.

To see all the requirements, visit Grants.gov's RHTP webpage and download the full announcement in the Related Documents section.

Required components
  • Improve access to hospitals, other health care providers, and health care items and services provided to rural residents.
  • Improve health care outcomes of rural residents.
  • Prioritize the use of new and emerging technologies that emphasize prevention and chronic disease management.
  • Initiate, foster, and strengthen local and regional strategic partnerships between rural hospitals and other health care providers to promote measurable quality improvement, increase financial stability, maximize economies of scale, and share best practices in care delivery.
  • Enhance economic opportunity for, and the supply of, health care clinicians through enhanced recruitment and training.
  • Prioritize data- and technology-driven solutions that help rural hospitals and other rural health care providers provide high-quality health care services as close to a person’s home as is possible.
  • Outline strategies to manage long-term financial solvency and operating models of rural hospitals in the state.
  • Identify specific causes that drive the increased rate of stand-alone rural hospitals becoming at risk of closure, conversion, or service reduction.
Eligible activities
  • Promoting evidence-based, measurable interventions to improve prevention and chronic disease management.
  • Promoting consumer-facing, technology-driven solutions for the prevention and management of chronic diseases.
  • Providing payments to health care providers for the provision of health care items or services.
  • Providing training and technical assistance to develop and adopt technology enabled solutions that improve care delivery in rural hospitals, including remote monitoring, robotics, artificial intelligence, and other advanced technologies.
  • Recruiting and retaining clinical workforce talent to rural areas, with commitments to serve rural communities for a minimum of five years.
  • Providing technical assistance, software, and hardware for significant information technology advances that are designed to improve efficiency, enhance cybersecurity capability development, and improve patient health outcomes.
  • Assisting rural communities to right size their health care delivery systems by identifying needed preventive, ambulatory, pre-hospital, emergency, acute inpatient care, outpatient care, and post-acute care service lines.
  • Supporting access to opioid use disorder treatment services, other substance use disorder treatment services, and mental health services.
  • Developing projects that support innovative models of care that include value-based care arrangements and alternative payment models.
  • Designing additional activities to promote sustainable access to high-quality rural health care services, as determined by the CMS Administrator.
  • Designing/implementing other programs that support sustainable access to high-quality rural health care services.

Input from people in Washington

We asked for public input to help shape our state’s strategy for implementing RHTP. We reached out through this webpage, email, and social media.

The community reached back with 285 written responses. We also had in-depth discussions with various groups interested in RHTP.

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

Contact

Email: HCA Paying for Value