The Rural Health Transformation Program (RHT Program) is a $50 billion federal initiative under Public Law 119-21 that awards funds to states. Integral Healthcare Solutions (IHS) drafts the program design, governance, quality, data-sharing and compliance documents for rural providers and clinically integrated networks working with their state's plan. This page is for rural hospital, clinic and network leaders and boards building a hub-and-spoke model or a rural clinically integrated network, and IHS drafts for your clinicians and board to review and approve while your organization adopts and runs the program.
Last reviewed: October 2026.
What is the Rural Health Transformation Program?
The RHT Program is a $50 billion initiative established under Public Law 119-21, and CMS announced awards to all 50 states on December 29, 2025 (CMS press release, page opened October 4, 2026). The Medicaid.gov program page names the authority as Section 71401 of Public Law 119-21 (Medicaid.gov Rural Health Transformation Program page, page opened October 4, 2026).
The CMS release says "$50 billion in funds will be allocated to approved states over five years, with $10 billion available each year from 2026 through 2030." It also says "In 2026, states will receive first-year awards from CMS averaging $200 million within a range of $147 million to $281 million." It describes half the funding as distributed equally among all approved states, with the other half distributed by other factors in the CMS Notice of Funding Opportunity, which IHS has not read (CMS press release).
On eligibility, the Medicaid.gov page says "only the 50 U.S. states are eligible to receive an RHT Program award" (Medicaid.gov). A rural provider or network is therefore not eligible to receive an award from CMS under that eligibility statement.
The same page says states must use the funds for three or more of the approved uses. Three of the ten listed are "Providing payments to health care providers for the provision of health care items or services, as specified by the Administrator," "Providing technical assistance, software, and hardware for significant information technology advances designed to improve efficiency, enhance cybersecurity capability development, and improve patient health outcomes," and "Developing projects that support innovative models of care that include value-based care arrangements and alternative payment models, as appropriate." One of the program's strategic goals is sustainable access, in which rural facilities work together or with regional systems to "share or coordinate operations, technology, primary and specialty care, and emergency services" (Medicaid.gov).
Who needs a network program build, and what triggers it?
Rural hospitals, clinics and provider groups that expect to take part in their state's plan, or that are forming a network of their own, are the buyers. The CMS release says "many states are planning efforts that will" advance several goals. Under the goal it titles "Driving Structural Efficiency & Empowering the Community Providers," it says the effort "includes establishing specialized hub-and-spoke models, rural regional centers of excellence, comprehensive data-sharing platforms, and rural clinically integrated networks" (CMS press release). IHS has not read any state's Rural Health Transformation Plan.
Typical triggers, in IHS's reading as of October 2026:
- Your state's plan names a hub-and-spoke model, a regional center of excellence or a network that your organization will join or lead.
- Your organization and its neighbors want to share clinical programs, quality reporting or data, and need written governance to do it.
- A state agency or partner asks for policies, a quality program or a data-sharing framework from the network.
How do rural providers get RHT Program funds?
That depends on the state. IHS's reading, October 2026: each state sets its own rules for passing funds to providers, and IHS has not read any state's plan, subaward rules or application dates. The Medicaid.gov page lists provider payments among the approved uses, as specified by the Administrator, but it does not say any given state will pay any given provider. IHS makes no prediction about which providers will receive funds, and your state agency is the place to confirm how your state handles it.
How IHS helps
IHS offers process expertise. IHS drafts the program, policies and clinical content for your clinicians to review and approve, and your organization adopts and runs it.
- Read the state plan that you supply and list the initiatives that touch your organization.
- Gap assessment of your current governance, quality, data-sharing and compliance documents against what a network program needs.
- Document and evidence mapping from each initiative in the state plan that you identify to the policy, charter or record that supports it.
- Drafting the network program design, governance documents, quality program, data-sharing policies and compliance program.
- Mock review of the draft document set against the state plan's stated initiatives.
- Readiness support while your clinicians and board revise and adopt the documents.
What you supply: your state's plan and any state documents on how funds reach providers, your participant list, your current policies, and your counsel's decision on legal structure.
The limit: IHS does not write grant applications, does not represent your organization to your state or CMS, does not decide your legal structure, and does not promise funding. Your organization submits anything to your state.
What to have ready
This is IHS's planning list, built from the two government pages named above and not from any state's requirements.
- Your state's Rural Health Transformation Plan and the name of the state agency that administers it.
- Any state document that describes how funds reach providers, since each state sets its own rules.
- The approved uses of funds on the Medicaid.gov page (Medicaid.gov), marked with the three or more your state chose.
- A list of the facilities and services in your hub-and-spoke model or network, and the role each one plays.
- Existing governance documents, such as bylaws, board and committee charters and conflict of interest policies.
- Existing quality program documents and measures.
- Current data-sharing agreements and your cybersecurity and information technology documentation.
- Existing compliance program materials and your compliance officer's name.
- Your counsel's decision on the network's legal structure.
- The name of the person at your organization who will submit materials to your state.
Printable version of this checklist (PDF)
Bring what you have to the free introductory call.
How it compares
Which one fits depends on your state, your facilities and your counsel's advice.
| Route | What to know |
|---|---|
| Work through your state agency's process | IHS's reading, October 2026: the state chooses among the approved uses of funds, so its plan is where any request to providers would appear. |
| Build a network program independently | A network can write its own governance, quality and data-sharing documents whether or not a state pays providers. Whether that serves your state's plan is for you and your state agency to decide. |
| Hub-and-spoke model or clinically integrated network | The CMS release names both as examples without defining the difference (CMS press release). IHS's reading, October 2026: hub-and-spoke is about how services are organized around a hub, and a clinically integrated network is about how providers govern quality and data together. See our page on URAC clinically integrated network accreditation for that separate program. |
| Single-facility paths | Rural emergency hospital conversion and rural health clinic certification are different programs. See rural emergency hospital conversion and rural health clinic certification readiness. If a member of your network is a federally qualified health center, see FQHC site visit readiness. |
What it costs
The two government pages we opened describe awards to states and show no applicant fee for providers. The funding amounts above are state awards, not payments to providers. Verify current requirements with your state agency and CMS. IHS scopes each engagement after a free introductory call.
What this is not
- This is not grant writing. IHS does not write applications, and it does not promise or predict funding for any provider.
- IHS does not contact, represent or speak for your organization to your state, CMS or any contractor. IHS drafts, and your organization submits.
- IHS is a consulting firm, not a law firm. This page is not legal advice, and IHS gives no opinion on whether a rule applies to your organization. That question belongs to your counsel.
Frequently asked questions
What is the Rural Health Transformation Program and who gets the money?
It is a $50 billion federal initiative established under Public Law 119-21, and CMS announced on December 29, 2025 that all 50 states will receive awards. The money goes to states, not directly to rural hospitals, clinics or networks. IHS drafts program documents for rural providers and networks that work with their state's plan.
How much does each state receive and for how long?
The CMS release says first-year awards in 2026 average $200 million, within a range of $147 million to $281 million. It says $50 billion is allocated to approved states over five years, with $10 billion available each year from 2026 through 2030. These are state awards, not payments to any provider.
Can a rural hospital or clinic apply to CMS?
The Medicaid.gov program page, opened October 4, 2026, says only the 50 U.S. states are eligible to receive an award. A rural hospital, clinic or network is therefore not eligible to receive an award from CMS. IHS's reading, October 2026: whether and how a state involves providers is set in that state's own process.
How do providers get funds?
IHS's reading, October 2026: each state sets its own rules for passing funds to providers. The Medicaid.gov page lists payments to health care providers among the approved uses of funds, as specified by the Administrator. IHS has not read any state's plan or subaward rules, so this page does not say which states pay providers or networks.
What are hub-and-spoke models and clinically integrated networks in this context?
The CMS release says many states are planning efforts that include specialized hub-and-spoke models and rural clinically integrated networks, among other items. The release does not define either term. IHS's reading, October 2026: hub-and-spoke describes how services are organized around a hub, and a clinically integrated network describes how participating providers govern quality and data together.
What do states have to spend the funds on?
The Medicaid.gov page says states must use the funds for three or more of the approved uses, and it lists ten. Examples on the page include payments to health care providers, technical assistance, software and hardware for information technology advances, and projects that support innovative models of care. IHS has not read any state's plan, so which uses a state chose is a question for that state.
What does a rural network need to have ready before it works with its state?
IHS's planning list starts with your state's Rural Health Transformation Plan, any state document on how funds reach providers, your participant list, and your current governance, quality, data-sharing and compliance documents. The checklist above gives the full list. Bring what you have to the introductory call.
How does a network govern quality and data sharing?
IHS drafts the documents for your clinicians and board to review and approve. These include committee charters, quality measures and reporting routines, and data-sharing policies. The CMS release names comprehensive data-sharing platforms as one example of what some states are planning, and IHS has not read your state's plan.
How is this different from converting to a Rural Emergency Hospital or becoming a Rural Health Clinic?
Those are single-facility programs with their own requirements. A network build is about how several providers organize clinical care, quality and data together under a state's plan. IHS has separate pages on rural emergency hospital conversion and rural health clinic certification readiness.
What compliance program does a clinically integrated network need?
This page does not say what the law requires of a particular network, and that question belongs to your counsel. IHS drafts a compliance program for the network, sized to what the network does, for your board and counsel to review and approve. Your organization adopts it and runs it.