Rural Health Transformation

CMS awards the funds to states, and each state decides how money is distributed within its program. Depending on the state, subrecipients and contractors may include rural hospitals, clinics, health systems, technology companies, vendors, universities, and community partners. Eligibility rules vary by state, so the first step is to review your state's RHTP plan.

The program provides $50 billion in federal funding to approved states over five years, at $10 billion per year for FY2026 through FY2030. Half of each year's funding is base funding divided equally among states. CMS allocates the other half using state-specific factors.

States post opportunities on their RHTP webpages as requests for applications, requests for proposals, or grant solicitations. These pages often include timelines, FAQs, and webinar recordings. Our state resource center links to each state's program page.

Funded activities must support CMS's strategic goals: prevention and chronic disease management, sustainable access, workforce development, innovative care and payment models, and technology. Allowable uses vary by state initiative, and some states add limits. Nevada, for example, excludes new construction in one of its funds.

Review your state's project narrative, map your capabilities to its initiatives, and identify potential partners. Confirm that your financial management, controls, and reporting processes can stand up to applicant review. Organizations that wait for the solicitation often have little time left to build a competitive proposal.

Recipients and subrecipients are generally subject to federal grant rules under the Uniform Guidance (2 CFR 200), plus the terms of their state subrecipient agreements. Common requirements cover allowable costs, procurement, documentation, financial and performance reporting, and audits.

Nonprofits, states, local governments, and tribes that spend $1 million or more in federal awards in a fiscal year generally must have a Single Audit. RHTP funds count toward that threshold, so a new award can trigger a first-time audit. For-profit vendors are generally not subject to Single Audit, but their agreements may include other audit requirements.

When grant funds pay salaries, federal rules require records showing that the charges reflect actual work on the award (2 CFR 200.430). Weak documentation is a common cause of disallowed costs and audit findings.

Our advisors help you align your initiatives with your state's priorities and build the governance, internal controls, and reporting structure that funders expect. That groundwork strengthens your proposal and prepares you to manage the award once it's granted.

Yes. We help clients monitor grant obligations, collect evidence of results, produce executive reporting, and prepare for audits. We also help position organizations for future funding rounds.