The first year of the Rural Health Transformation Program (RHTP) moved quickly by statutory necessity. States had to interpret a new funding mechanism, finalize implementation plans, establish governance structures, and begin moving resources into rural communities. Providers often had only a few weeks to assess opportunities, identify potential projects, assemble partners, and submit applications.
This compressed timeline encouraged many organizations to react to available funding before they had fully tested whether a project fit their strategic priorities, addressed a documented community need, or was sustainable after the grant ended. The result was an understandable focus on application readiness rather than long-term transformation.
Going into the second year of the program, providers in states issuing new funding opportunities, procurements, or implementation solicitations under their CMS-approved RHTP initiatives may have more time to assess fit and prepare than they did during the first cycle. States have completed initial reporting requirements, and CMS is expected to communicate subsequent funding allocations to states in October 2026.
However, that time is valuable only if organizations use it well. The advantage will belong to organizations that use it to identify which investments can meaningfully reshape access, care delivery, workforce capacity, and financial sustainability in their communities.
Providers should also consider the question that most states will ask when reviewing opportunities, “Does the expected benefit justify the investment relative to alternative uses of the funding?” Projects that advance the state’s rural transformation strategy and the objectives articulated in its approved RHTP plan may be more likely to receive funding.
How Should Providers Approach RHTP Opportunities in Year Two?
The RHTP is intended to support rural care transformation through care redesign, workforce development, technology enablement, infrastructure, and community partnerships. In general, the funds are not meant to support one-time programs or temporarily offset financial pressure, but to create a more sustainable rural healthcare ecosystem that improves access and outcomes while lowering costs over time.
Accordingly, as providers consider how to access RHTP funds, they should start with the community and the strategy, not the grant. They should ask not “What can we apply for?” but “What does our community need, and what must our delivery system become to sustainably meet that need?” Leaders can drill down on this question by asking:
- Which services are most important to preserving access, and which are most at risk?
- Where are patients experiencing avoidable barriers, delays, fragmentation, or travel burdens?
- Which workforce constraints most threaten the organization’s mission and operating model?
- What initiatives can help reduce dependence on scarce workforce resources or improve workforce productivity?
- What care models, partnerships, technology, or infrastructure could materially improve access and outcomes?
- Which investments would remain strategically important even without grant funding?
- What must be true for the initiative to remain viable once the RHTP funding runs out?
Leaders should also consider the broader community ecosystem that Medicaid has historically supported. State Medicaid funding reductions may extend to affect transportation, behavioral health, home and community-based services, care coordination, developmental disability programs, and other supports that help vulnerable populations remain healthy and independent.
Rural providers should evaluate which community services are most critical to maintaining access and avoiding higher-cost utilization and identify opportunities to preserve or redesign these functions before funding disruptions occur.
How Can Providers Use Documented Community Need to Define RHTP Opportunities?
Many providers already have access to the data they need to identify high-value opportunities. Community Health Needs Assessments, county health improvement plans, population health assessments, utilization data, and other community health improvement planning efforts can reveal care gaps, access barriers, workforce shortages, transportation challenges, behavioral health needs, maternal health concerns, and chronic disease burdens that align with RHTP priorities.
Grounding a proposal in documented need strengthens the initiative in three ways. First, it establishes why the project matters to the population served. Second, it demonstrates that the initiative is community driven rather than constructed solely in response to a grant. Third, existing assessments may provide baseline measures that can support target setting, performance monitoring, and future reporting.
Providers should use community need to help guide prioritization rather than to attempt to address every identified challenge. Most rural communities face more needs than any single organization or grant cycle can absorb. Providers should focus on opportunities where they can achieve meaningful impact and where they have—or can develop—the required capabilities, resources, and relationships to execute them. Strategic discipline means not just selecting the right initiative but also declining projects that are important but poorly matched to the organization’s role or capabilities.
How Can RHTP Funding Support Provider & Community Partnerships?
Rural healthcare challenges can rarely be solved within the boundaries of one organization. Workforce shortages, behavioral health access, transportation, social drivers of health, and care transitions cross institutional lines. As providers seek to leverage RHTP funding to improve outcomes, they should consider initiatives that involve coordinated action across the healthcare and community ecosystem.
Potential partners may include FQHCs, Rural Health Clinics, behavioral health providers, county health departments, emergency medical services, independent physician practices, aging and disability organizations, community-based organizations, food banks, postsecondary institutions, and workforce development organizations.
The extra planning time going into year two of the RHTP gives providers an opportunity to determine not only whom to involve, but how the partnership will operate. Organizations should clarify the lead applicant, each participant’s responsibilities, governance and decision rights, data-sharing expectations, performance accountability, and the flow of funds. In some cases, a hospital may be the appropriate lead. In others, the hospital may create more value as a supporting partner while another organization directs implementation.
Successful collaborations also typically align incentives across participants. Planning efforts should identify how each partner will benefit from the initiative and whether the operating model will remain attractive after grant funding ends.
These collaborative initiatives may be especially important in states that use regional networks or intermediary entities to distribute funding. Early partnership development allows organizations to vet collaborators, resolve competing expectations, and design a coherent community delivery model before an application deadline forces premature commitments.
How Can Leaders Pressure-Test RHTP Opportunities Before Applying?
Once an organization has identified potential RHTP initiatives, leaders should use the additional lead time in year two to evaluate each one rigorously. The goal is not to make projects appear grant-ready, but to determine whether they are strategically sound, operationally executable, financially sustainable, and capable of producing measurable community-level change.
- Strategic alignment: An initiative should advance existing priorities related to access, outcomes, workforce stability, sustainability, or community health. A useful test is whether the organization would still view the initiative as strategically important if grant funding were unavailable. If the project has little value without the award, sustaining it after the award may be difficult.
- Operational fit: Leaders should assess how the initiative integrates with existing service lines, workflows, care models, and accountability structures. They should identify an executive sponsor and operational owner, validate staffing capacity, and understand how the work will be supported after launch. Projects that add complexity without resulting in improved workflows are unlikely to transform delivery.
- Financial sustainability: Analysis should extend beyond the grant budget to the total cost of ownership. Implementation, reporting, compliance, performance monitoring, technology maintenance, and program management all create costs that may continue after grant funding ends. A viable project needs a realistic post-award operating model, including the payment, cost savings, shared infrastructure, or partner contributions that will sustain it.
- Execution capability: Organizations should assess whether they have succeeded with comparable initiatives, whether project management resources are available, whether partners have the capacity and commitment to perform their roles, and whether the team can meet required timelines. This evaluation should surface gaps early enough to change the design, add capabilities, or decide not to proceed.
- Data, technology, and measurement readiness: CMS and states are demanding that RHTP initiatives result in measurable, demonstrable transformation. Before selecting a project, leaders should confirm methods for measuring targeted outcomes, establishing baseline performance, reliably collecting data, and reporting to satisfy program requirements. They should also determine whether technology infrastructure, cybersecurity, interoperability, and data governance can support the initiative over time.
How Can Providers Plan for Compliance With RHTP Requirements?
Winning funding is only the beginning. Compliance under federal grant programs requires disciplined governance, policies and procedures, documentation, performance monitoring, and financial controls. In addition, compliance requirements under the RHTP can vary depending on whether the receiving entity is considered a subrecipient or a contractor. For organizations in either of these roles, treating the requirements as an afterthought can create exposure to potential compliance issues, audit findings, and ultimately, repayment risk.
For financially stressed rural providers, recoupment of funds already spent could work against the program’s sustainability goals. Incorporating compliance into the operating model is critical to help avoid this outcome. Before applying, organizations should define and codify policies and processes for procurement and contracting controls, documentation standards, reporting responsibilities, subrecipient oversight, performance review, and escalation pathways.
This integrated approach also helps improve execution. When organizations build governance, measurement, finance, and compliance into the design, leaders gain earlier visibility into problems and can make adjustments before the initiative falls short of its intended community impact.
How Forvis Mazars Can Help With RHTP Strategy
Navigating a federal program like RHTP can be challenging because project selection, application strategy, implementation, compliance, and sustainability are interdependent. Forvis Mazars can support organizations across the grant life cycle, from identifying opportunities aligned with strategy, community need, and organizational capabilities, to preparing competitive applications and establishing the governance, compliance, and reporting systems needed after an award.
Whether your organization needs targeted assistance or end-to-end support, the objective should remain the same: use the additional year-two planning window to pursue investments that will create durable improvements in rural care delivery and strengthen the long-term sustainability of rural health providers while improving access and outcomes. If you have questions about the RHTP or would like assistance, please reach out to our professionals today.