Community Care Hubs as Backbone Infrastructure for Rural Health

How states can unlock their value in the Rural Health Transformation Program

Introduction: A Model at an Inflection Point

Community Care Hubs (CCHs) have as a promising model for connecting health care providers, health plans, and community-based organizations (CBOs) to address social needs, thereby improving health outcomes and reducing healthcare costs. By centralizing functions such as contracting, referrals, payment and reporting, CCHs have enabled CBOs to participate in healthcare delivery at scale—demonstrating their value as connective infrastructure between sectors that have historically struggled to work together.

A new use case for hubs is now emerging. Through the five-year, $50 billion (RHTP), established by H.R. 1, states are proposing to deploy CCH-like entities not only to coordinate social services but to serve as backbone infrastructure for rural health system transformation.

This shift presents a significant opportunity—but also raises a critical question: what will it take for CCHs to succeed in this expanded role? Their impact will depend on how effectively states build on what has worked in Medicaid, tailor responsibilities to new goals, and address persistent challenges around sustainability, capacity, and role clarity.

The Opportunity: Solving Structural Challenges in Rural Health Systems

Rural health systems face structural barriers that make transformation difficult. Care delivery is fragmented across small local hospitals, federally qualified health centers, behavioral health providers, and CBOs—many of which lack the administrative capacity to manage contracting, data reporting and cross-sector coordination. Even when funding is available, the infrastructure to implement large-scale change is often missing.

States’ RHTP applications and requests for proposals reflect both recognition of these constraints and a response: some are using hub models to centralize capabilities and coordinate transformation efforts. For example:

• North Carolina selected five —lead organizations for regional, locally governed networks that coordinate medical, behavioral health and social support services and implementation of RHTP initiatives across multi-sector networks.
• Missouri is Local Community Hubs, aiming to of 30 hubs linked through seven Regional Coordinating Networks to manage referrals, coordinate care and allocate funding; only organizations participating in a Hub are eligible for RHTP funds.
• Rhode Island plans to pair to integrate care delivery and local engagement. 

Some states are designing these types of hubs around specific priorities—like and initially focused on addressing diabetes and obesity. Others, including and , are proposing more traditional CCH models focused on coordinating care and social services across providers, health plans and CBOs.

In the RHTP context, where states and rural stakeholders suddenly have meaningful resources for planning and implementation, CCHs offer a compelling mechanism to organize fragmented systems, centralize operational functions, and enable participation in transformation efforts that would otherwise be out of reach for many rural providers and organizations.

The Value Proposition: What CCHs Can Bring to Rural Transformation

The emerging role of CCHs in RHTP builds on capabilities developed through Medicaid investments, such as in and . While the context is evolving, several elements of the CCH value proposition remain highly relevant.

• Community-rooted coordination and trust. CCHs bring deep local knowledge, established relationships, and the ability to engage stakeholders in culturally appropriate ways—an asset in rural communities where trust and alignment are critical.
• Backbone infrastructure for fragmented systems. CCHs centralize administrative and operational functions, such as contracting, referral management, data collection and reporting, and quality oversight. By pooling these functions, hubs reduce duplication and enable smaller organizations to participate in coordinated care models without needing to build their own infrastructure. Hubs can also support shared services or group purchasing, expanding access to infrastructure that could otherwise be out of reach.
• Cross-sector partnerships. CCHs are designed to bring together organizations with different missions, cultures, funding streams, and operating models. In the RHTP context, the mix of partners are likely to be quite broad—including schools, public health agencies and regional collaboratives—making their role to coordinate and translate more complex and more essential.
• Implementation and execution support. Beyond convening stakeholders, hubs support training, workflow design, data collection, and program execution; these functions are crucial for translating transformation strategies into an operational reality.

Taken together, these capabilities position CCHs to serve as operational engines for rural transformation, not just as coordinators across healthcare and social services.

The Challenges: What Must Be Managed for Hubs to Succeed

Experience with CCHs in Medicaid highlights several challenges that will need to be addressed as the model expands into rural transformation efforts.

• Sustainability beyond time-limited funding. Long-term financing remains an unresolved issue for CCHs. Like prior Medicaid investments (often derived through time-limited Section 1115 Medicaid demonstrations), RHTP funding is finite. Without clear pathways to ongoing financing, there is a risk that newly established hub infrastructure may be difficult to sustain.
• Capacity and capability gaps. Effective hubs must strike a difficult balance: they must be credibly embedded in their communities and possess the operational sophistication required to manage contracts, data systems, and performance reporting. Identifying (or building) organizations that can meet both criteria represents a significant challenge.
• Role clarity and scope management. Without clearly defined responsibilities, hubs risk becoming overextended or duplicative, serving simultaneously as conveners, administrators and implementers without a focused mandate or sufficient resources for the wide range of responsibilities.
• Evolving capabilities and expectations. The shift from coordinating social services to supporting system-wide transformation requires new competencies. Hubs may need to engage with different partners and have a greater emphasis on system coordination, infrastructure development and implementation support. This shift raises the bar for what CCHs must deliver and elevates operational capabilities.

Designing Hubs for Impact: Key Considerations for States

As states move to incorporate hub models into rural transformation efforts, several key considerations can help guide design and implementation:

• What are the highest priority problems the hub is solving?
• Which functions should be centralized versus local?
• Who is best positioned to serve as the hub entity?
• How will the hub be sustainably financed?
• How will success be measured?  

Answering these questions upfront can help states intentionally design hub models for long-term impact. If done well, CCHs become enduring infrastructure for service delivery, coordination and resilience in rural health systems—not just another short-lived initiative.