Making RHTP Investments That Last: How States and Stakeholders Can Achieve Long-Term Impact

Introduction

The Rural Health Transformation Program (RHTP), authorized by H.R. 1, is a five-year, $50 billion investment in rural health care distributed across all 50 states. For a rural health care delivery system contending with workforce shortages, shrinking revenues and rising costs, the roughly $1 billion each state stands to receive represents a meaningful opportunity to address longstanding structural challenges.

States are still in the early stages of designing, implementing and making funding decisions for their RHTP plans. This makes it exactly the right moment to think carefully about where these dollars should go. States have until October 30, 2026 to obligate their first-year awards, creating real urgency to move quickly. But speed cannot come at the cost of vision. RHTP is a time-limited program. The goal should not be just to put the money to work but to ensure its impact is sustained well beyond the life of the program.

So how should states—and the health systems, rural providers and vendors bringing them proposals—make the most of these investments? Three compelling opportunities stand out for their potential to create lasting impact.

Addressing Rural Workforce Shortages and Access Gaps Through Telehealth

For rural communities struggling to recruit and retain providers, RHTP offers a chance to fund technology that extends the reach of available clinical resources while also connecting rural patients and providers to specialists that may otherwise be entirely out of reach. Statewide or regional telehealth networks, built on a hub-and-spoke model, are one of the most promising ways to do this, enabling a single specialist to support multiple rural hospitals through real-time consultation or virtual oversight without requiring a physical presence in every community.

The Medical University of South Carolina (MUSC) Center for Telehealth demonstrates what this can look like at scale, with hospital-based services spanning telestroke, palliative care, neurology, tele-ICU and others. The hub-and-spoke model improves clinical outcomes by giving patients access to specialists they would not otherwise have, reducing avoidable transfers and keeping patients closer to home. It also makes financial sense for both sides: hub institutions generate revenue through reimbursable telehealth encounters, while spoke locations gain access to supporting infrastructure that would otherwise be unaffordable, helping smaller facilities continue to see patients and keep revenue local. It is also exactly the kind of model with established rural impact that South Carolina intends to scale with RHTP funds.

Minnesota is also moving in this direction, prioritizing the development of a statewide Rural Telehealth Services Center as part of its RHTP plan. The Center would oversee development of regional telehealth hubs, build shared infrastructure and EHR integrations, and support the rural workforce with training on virtual care delivery and continuing education. The plan makes clear that future telehealth services delivered through the hubs will be sustained through established payment mechanisms rather than grant funding.

Unlocking Reimbursable Services for Rural Providers

Remote patient monitoring (RPM), chronic care management (CCM) and transitional care management (TCM) are services that hold promise for rural communities, where distance from in-person care can make it difficult for care teams to stay closely connected to patients. RPM allows providers to track patients' vital signs and health data from home, flagging warning signs early and enabling proactive intervention before problems escalate. For rural patients who may be hours from the nearest specialist or emergency department, that early detection can be the difference between a managed event and a crisis. CCM supports ongoing coordination for patients managing chronic conditions like diabetes or heart disease between visits, while TCM helps ensure patients recently discharged from the hospital get the follow-up care they need to avoid readmission. These services also represent meaningful and sustainable revenue opportunities for rural providers. But standing up these programs require significant upfront investment in technology, workflow redesign and care team capacity that many rural facilities simply cannot afford. For providers that see the clinical and financial potential of these services but lack the capital to get started, RHTP offers a way in.

Nebraska is putting this into practice. Through RHTP, the state is funding hospital-to-home RPM programs that enable rural hospitals and FQHCs to remotely monitor patients with chronic conditions and those recently discharged from the hospital. A companion initiative supports chronic disease management education and navigation, helping patients better understand their conditions, connect to resources and take a more active role in their own health. Both initiatives share a goal of reducing avoidable emergency department admissions and unnecessary health care spending. Together, they reflect a broader strategy of using RHTP dollars to catalyze infrastructure development for programs that can be self-sustaining after award funding runs out.

Rewarding Rural Providers for Managing Patient Health More Effectively

Value-based care (VBC) models reward providers who manage their patients' health effectively and keep costs in check. Successfully participating in these models and demonstrating impacts on health outcomes and total cost of care requires data infrastructure, care management capacity and population health tools that most rural providers cannot easily afford to build or buy. Some rural providers are already delivering the kind of high-quality, coordinated care these models are designed to incentivize, but without the enabling infrastructure, they cannot participate and do not stand to benefit financially. RHTP can fund that infrastructure and open the door to payment models that reward the care that rural providers are already working hard to deliver.

Kansas has set one of the most ambitious VBC targets in the country, with a goal of having 100% of rural Medicare and Medicaid beneficiaries in accountable care relationships by 2031. The state's Care Collaborative, operated by the University of Kansas Health System, will run an ACO for rural providers not yet participating in the Medicare Shared Savings Program or ACO REACH. Providers who commit to participating will become eligible for state-funded incentive payments through Kansas's RHTP plan to build and maintain necessary infrastructure and performance reporting capabilities.

Georgia's RHTP initiative, the GREAT Health Program, is using RHTP dollars to prepare rural hospitals for the state’s participation in the CMS AHEAD model, a total cost of care initiative that aligns incentives across Medicare, Medicaid and commercial payers. By funding financial and technology readiness assessments, EMR enhancements and VBC infrastructure now, Georgia is positioning rural hospitals to succeed in AHEAD and capture the long-term performance benefits.

Looking Ahead

Many of the opportunities that could most meaningfully strengthen rural providers' clinical and financial position have simply been out of reach due to the startup costs and complexity of participation. Given the real pressure on states to obligate first-year funds quickly, some of this more foundational infrastructure work may be better suited to years two through five of the program, but the design work and partnership development for these more ambitious investments should begin now.

RHTP will not solve every challenge facing rural health care, but it represents a genuine chance to close some of those gaps in ways that endure. States and their partners that approach this moment with a long horizon view and invest boldly in removing the structural barriers that have long prevented rural providers from building solutions to their most pressing challenges are the ones that will drive lasting change for rural communities.