All 50 states have submitted applications for the $50 billion Rural Health Transformation (RHT) Program, underscoring nationwide interest in strengthening rural health systems. The Centers for Medicare and Medicaid Services (CMS) will now review applications to ensure compliance with the Notice of Funding Opportunity (NOFO) requirements. What do Community Health Centers (CHCs) need to know to position themselves to get access to funding from the program?
Awards are expected to be announced by December 31, 2025, with funding distributed over a five-year period beginning in Fiscal Year 2026. Once approved, each state will receive dedicated support from CMS’s Office of Rural Health Transformation to design, launch, and evaluate its projects.
CHCs Identified as Key Stakeholders in the RHT Program
When the NOFO was first released, CHCs were identified as key stakeholders in the RHT Program design and implementation. NACHC worked closely with Congress and CMS during H.R. 1 negotiations to ensure that both CHCs and PCAs were formally recognized as essential partners and providers within the program.
This blog highlights how states plan to use RHT Program funds and identifies opportunities for CHCs and PCAs to engage with state officials, access CHC-focused funding, and influence program implementation. As of November 13, 35 states have released information on their applications—either full documents or public summaries.
NACHC’s preliminary analysis shows strong recognition of CHCs and inclusion of meaningful funding opportunities. The examples below illustrate how CHC and PCA advocacy have already influenced state strategies and reveal key RHT funding trends driving rural health innovation for CHCs. View NACHC’s state-by-state review of applications.
RHT Program Funding Trends Shaping Rural Health Innovation for CHCs
Strengthening the Rural Health Workforce
CHCs serve as the backbone of rural health care—41% of CHCs are located in rural areas, and in many communities they are the only health care access point for dozens or hundreds of miles. Rural CHCs face significant workforce shortages, compounded by lower rural salaries and a projected 35,000-provider shortfall by 2030. Investments in the rural health center workforce are vital. States have dedicated investments through their RHT application into the healthcare workforce development.
The New Health Community Health Center in northeastern Washington State was highlighted by its state as a model program they plan to continue to invest in. NEW Health CHC launched New Health University in partnership with local high schools, universities, and the school board. The program offers on-the-job training for low-income and rural students, including a Medical Assistant Apprenticeship, a Pre-Apprenticeship program, and a Dental Assistant Training Program, along with dedicated monthly educational time for all employees.
In California, the state plans to develop a “Statewide Workforce Mapping and Planning Tool” to identify regional, county, and sub-county workforce needs and expand non-physician roles, including CHWs, nurses, doulas, and midwives. Funding will support pipeline programs, expansion of clinical placement sites, supervision, retention, and relocation incentives. In West Virginia, they plan to launch a “Mountain State Care Force” initiative that will focus on offering “return-to-home” incentives, as well as launching apprenticeships and entry-level healthcare jobs through the Learn & Earn model and at community colleges. Massachusetts, Ohio, Vermont, and Washington State have proposed financial assistance to support healthcare workforce housing opportunities for clinical and support staff. Funding would help establish housing support programs to facilitate workforce transitions and retain providers in the long term. Recently, 20% of rural health care workers reported that a lack of affordable housing is a significant barrier to retention. This finding underscores how housing challenges directly affect workforce stability in rural communities.
Technology and Infrastructure
CHCs continue to face significant interoperability challenges, with 61% reporting difficulties in aligning their health information systems, along with ongoing concerns about privacy. These gaps highlight the need for a more robust, compatible health IT infrastructure and stronger data protection. Interest in advanced technologies is high, with many CHCs seeing AI, machine learning, and predictive analytics as opportunities to improve operations, but cost remains a key barrier. Currently, 64% of CHCs are not yet using generative AI tools but plan to, and 77% are not using machine learning or predictive models, though many intend to adopt them. RHT funds provide a one-time opportunity for CHCs to build or modernize health IT systems to support this transition.
Throughout all the RHT applications, states included a focus on modernizing technology and infrastructure, including in Montana, which plans to fund critical facility repairs and modernization across rural facilities, including CHCs. Texas proposed the “Rural Texas Patients in the Driver’s Seat” program to expand Remote Patient Monitoring (RPM) by investing in technology that will establish consumer-facing health portals that engage patients and facilitate HIE between patients, providers, and payers. Massachusetts intends to launch the “Stronger and Healthier Communities through Integration of Emerging Health Tech” (SHINE HT) Program to provide financial resources, T/TA, and implementation support to CHCs serving rural populations and for the implementation and adoption of new technology solutions within their existing EHR systems.
Value-Based Payments
Value-based payments (VBP) link reimbursement to quality, outcomes, and cost rather than service volume. Many states are integrating VBP and other innovative payment models into Medicaid to help CHCs improve care quality, strengthen outcomes, control costs, and modernize delivery. Through RHT funding, states are accelerating this shift. These efforts aim to shift incentives toward better patient outcomes, positioning rural health systems for long-term sustainability and success under primary care transformation programs.
Delaware plans to invest RHT funds in a “FQHC Value-Based Care Readiness” initiative. These efforts will support rural providers and CHCs through technology upgrades, expanded care teams, care management infrastructure, and strategic planning. The goal is to help providers build the operational, financial, and data-reporting capacity required to successfully transition to VBC arrangements. Georgia and Connecticut plan to use RHT funding to prepare providers—including rural hospitals, primary care practices, and CHCs—for participation in value-based and alternative payment models, including CMS’s Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model. Their strategies include expanding technical assistance, strengthening financial modeling capabilities, supporting data interoperability, and creating more predictable and aligned payment structures across Medicaid and other payer types.
Behavioral and Maternal Health
Maternity outcomes at health centers are at or above the national average, despite serving lower-income and higher-risk patients. Over 70% of pregnant CHC patients access prenatal care in the first trimester, with CHCs delivering a lower percentage of low-weight infants compared to the national average (8% vs 10%). CHC behavioral health integration with primary care allows patients to access both types of healthcare in a one-stop shop, which can help prevent costly emergency room visits. Investments in behavioral and maternal health services at CHCs can help preserve limited resources to meet the demands of necessary care and produce better health outcomes.
Nearly two-thirds of RHT state applications include initiatives to expand behavioral and maternal health services. These include Florida, where they are allocating start-up funds to expand services through satellite clinics and mobile health units. New Hampshire plans to strengthen sustainable long-term access to care by expanding and strengthening the state’s network of Certified Community Behavioral Health Clinics (CCBHCs) to improve integration of behavioral health, substance use disorder (SUD) services, primary care, and continuous crisis response. Alabama plans to establish an “Obstetric Digital Regionalization Initiative” which will provide funding for healthcare facilities, including, but not limited to, CHCs, to connect them with regional referral hubs. These funds will help acquire and install telerobotic ultrasound devices at regional hubs and, through these hubs, at smaller rural hubs throughout the state, allowing for the optimization of maternal and fetal health services delivery.
Innovation and Non-Clinical Factors of Health
In addition to providing comprehensive primary care, health centers routinely screen for non-clinical factors that influence patients’ overall well-being—such as food insecurity, housing instability, and transportation barriers—and connect them to community resources or on-site support services. Many CHCs partner with local organizations, schools, housing agencies, and public health departments to coordinate care, offer case management, and integrate services that reduce barriers to health.
States aim to implement creative strategies to address broader non-clinical factors of health, including Utah, which plans to implement the “Preventive Action and Transformation for Health (PATH)” program to strengthen rural food infrastructure, support local producers, and improve community walkability, safety, and recreation to encourage regular physical activity and active transportation. Minnesota plans to stand up a community-based preventative care and chronic management system which will provide tools to rural residents to make healthy lifestyle choices and improve their health outcomes by supporting access to nutritious foods, promoting physical activity, providing education in accessible formats by community-based frontline health workers and Tribal Community Health Representatives, and leveraging technology that makes it easier for people to track their decisions and progress.
Making an Impact: How CHCs and PCAs Can Engage Their State Leaders
As CMS reviews and finalizes RHT awards, CHCs and PCAs still have meaningful opportunities to influence how their states implement these programs. Strategic engagement now can ensure that investments are directed toward initiatives that meet community needs and strengthen rural health systems. Here’s how to get involved effectively:
Review Your State’s Application: Start by carefully examining your state’s submitted RHT application. Understanding the proposed strategies, funding mechanisms, and policy priorities is critical. Review NACHC’s preliminary application summaries here. Identify programs where your CHC or PCA expertise can directly influence outcomes.
Advocate for Funding: RHT applications outline how states plan to distribute resources—through grant programs, competitive applications, or legislative appropriations. Determine which projects or funding streams CHCs are eligible for and begin proactive engagement by connecting with state agencies and legislators to ensure CHCs have a voice in deciding about funding allocation. If your state establishes an application process, now is the time to begin developing the outline(s) of your submission(s). Start by pulling together data and other information that can be incorporated into the application(s), which highlights how your CHC will achieve program outcomes. You want to use this information to create a story of why your CHC is best suited to receive the money.
Influence Policy: CMS will score state applications partly based on proposed state policy initiatives. These scores help determine the amount of funding that a state will receive. These policy initiatives include:
- Expanding scope-of-practice laws
- Participating in interstate compacts
- Establishing Nutrition Continuing Medical Education programs
- Other workforce, reimbursement, or care delivery policies
Based on your state’s application, there is an opportunity for CHCs and PCAs to participate in policy discussions. Your input ensures legislation and program design reflect real-world clinical and operational perspectives.
Explore Partnership: The RHT program’s broad scope opens doors for partnerships with vendors in telehealth, analytics, workforce housing, and care coordination technology. Health centers can leverage these partnerships to strengthen local infrastructure, enhance sustainability, and expand care delivery capacity.
Take Action Now: By following these steps, CHCs and PCAs can position themselves as key stakeholders in shaping the success of the RHT program—ensuring investments meet community needs and advance rural health transformation. As states move from planning to implementation, sustained engagement from CHCs and PCAs will be essential to ensuring that these funds drive meaningful, community-led changes. By collaborating with state leaders, advocating for the inclusion of CHCs, and exploring new partnerships, the health center movement can help shape a stronger, more equitable future for rural healthcare.
REVIEW NACHC’S PRELIMINARY APPLICATION SUMMARIES HERE