All 50 states across the U.S. submitted applications to the $50 billion Rural Health Transformation Program, according to the Centers for Medicare & Medicaid Services (CMS).
The application process opened on September 15 and ended Wednesday. Per CMS, the application needed to outline how states would expand access, enhance quality and improve outcomes for patients through “sustainable, state-driven innovation.”
Many of the plans outline how states would use the CMS funds to support health care workers through education and retention efforts, improve access by bolstering telehealth capabilities and provide better specialized care.
Some governors have also signed their own bills to support rural health care
Why It Matters
In September, CMS announced the Rural Health Transformation Program, which was authorized by the One Big Beautiful Bill and aims to improve health care access, quality and outcomes by transforming the health care delivery system in rural communities across America.
The program allocates $50 billion to approved states over five years, starting in 2026. Half of the funding will be distributed equally to all approved states and the other half will be allocated by CMS based on factors like rural population and the proportion of rural health facilities in the state.
CMS Administrator Dr. Mehmet Oz said in a statement Wednesday that seeing all 50 states come forward to reimagine the future of rural health is “an extraordinary moment.”
“This program moves us from a system that has too often failed rural America to one built on dignity, prevention and sustainability,” he said. “Every state with an approved application will receive funding so it can design what works best for its communities—and CMS will be there providing support every step of the way.”
What To Know
All 50 states submitted applications. Below is a summary of what some of these plans aim to accomplish and what state leaders are saying about the importance of obtaining these funds for rural communities.
Alabama
Alabama’s plan includes 11 initiatives that will make rural health care facilities more financially viable, increase access to critical health care services and improve quality of care and patient health outcomes.
This includes upscaling the workforce, enhancing communication and collaboration and adopting telehealth and other modern technologies.
“My team left no stone unturned as it gathered information to submit our plan,” Governor Kay Ivey said. “It is a thoughtful, strategic plan that must be coupled with state policy changes to maximize effectiveness. Once implemented, the initiatives and policy changes will make meaningful improvements to health care in rural Alabama. They will help fulfil President Trump’s goal to Make America Healthy Again, and I have no doubt they will help Alabamians become healthier.”
Arizona
Governor Katie Hobbs submitted her state’s application with a bipartisan letter for support. The plan would see a $57 million a year investment in the rural health care workforce to increase residencies, subsidize health education and fund retention initiatives to upskill and train health professionals working in Arizona. The plan also calls for a $45 million investment in improving access to health care, including telehealth, co-location services and mobile clinics and $27 million a year for health initiatives focused on behavioral health and substance use disorders, maternal-fetal health and chronic illness prevention and treatment.
Arkansas
Arkansas Governor Sarah Huckabee Sanders said improving the health and well-being of all Arkansans is a top priority for her administration and that the CMS funding will not only help increase access to care but will also reduce inefficiencies throughout the health care system, which she said ultimately benefits Arkansans in smaller communities across the state.
Florida
Florida’s Agency for Health Care Administration Secretary Shevaun Harris submitted the state’s application, which was built on three core principles: workforce development, advancing technological infrastructure and innovation, and increasing access to care.
Harris said Florida’s application reflects what her officer has heard directly from providers, stakeholders and rural communities about the challenges they face and the solutions they need.
“We are laser-focused on creating a lasting impact by strengthening our workforce, driving innovation, and expanding access to care,” she said. “This plan is designed to ensure that rural families across Florida can count on a health system that is sustainable, responsive, and built around their needs.”
The proposal included initiatives to improve nutrition and physical activity and reduce preventable emergency department visits.
Iowa
In Iowa’s plan, titled Healthy Hometowns, Governor Kim Reynolds said there is an emphasis on increasing access to cancer screening and treatment while supporting families and conducting more research.
“Since taking office, my administration has emphasized the importance of supporting and revitalizing rural Iowa through targeted investments and policy initiatives. Rural communities are the backbone of our state—home to nearly half of all Iowans and the foundation of our economy, culture, and identity,” Reynolds said. “Healthy Hometowns is a pivotal opportunity to build a high-quality, sustainable system of care that vastly improves health, well-being, and quality of life for rural Iowans.”
In five years, the state anticipated there would be a decrease in emergency department visits, more rural residents receiving care locally, an increase in provider-to-patient ratios and expanded telehealth access across rural communities.
Kansas
Governor Laura Kelly said Kansas’ plan has five main goals. These include improving health outcomes by implementing initiatives that focus on preventative care and address the root causes of diseases, enhancing efficiency and sustainability for health care providers, attracting and retaining high-skilled health workers, boosting growth and innovation while reducing costs and fostering the use of innovative technologies to increase access to care.
Maine
In September, Governor Janet Mills said Maine was applying for the fund.
“Like many people across our state, rural Maine is my home. It is where I was born and largely raised, and it is where my heart is. It is important to me that folks who live in rural Maine have economic opportunity and have a strong health care system to support their health and wellbeing,” she said. “But today health care in rural Maine — and across rural America more broadly — faces real and serious challenges, and I am deeply worried about it. Maine will fight for every possible dollar of funding through the Rural Health Transformation Program, beginning with a robust public process to engage Maine people on innovative ways we can improve health care in our rural areas and give our application the strongest possible opportunity to make an impact in Maine.”
Montana
Montana Governor Greg Gianforte said the Rural Health Transformation Program is “a historic investment in Montana’s future.”
He and Department of Public Health and Human Services (DPHHS) Director Charlie Brereton said the state’s plan is designed to address workforce development, sustainable access, innovative care models that expand value-based payment models and better leverage EMS and pharmacy services, community health prevention and technology innovation to modernize the electronic health record system.
“We are appreciative of the hundreds of Montanans and organizations who engaged in this process over the past several weeks,” Brereton said. “Their participation was essential in shaping a quality application rooted in sustainability and the needs of our communities, and we are extremely proud to submit it today.”
Tennessee
“Tennessee has a historic opportunity to invest in and strengthen health care for rural communities for generations to come,” Governor Bill Lee said. “We know what works, because supporting at-risk and underserved Tennesseans has been a priority of my administration since day one. I’m grateful to the Trump Administration for their partnership to ensure better care, closer to home, for every Tennessean.”
The state’s plan will invest in digital tools, increase early detection and prevention and support rural families through generational health investments.
Washington
Governor Bob Ferguson said that in order to sustain the way of life in rural Washington, the state must support a strong rural health care system. He said his bipartisan plan will help modernize and strengthen resources in the majority of Washington’s counties.
The state’s plan aims to increase clinicians, emphasize prevention and chronic disease and outline strategies to manage long-term financial security and identify specific causes that can lead to rural hospital closure, conversion or service reduction.
West Virginia
West Virginia Governor Patrick Morrisey said the plan will “make health care more affordable, more accessible and more effective while helping more West Virginians return to work and strengthening our economy.”
The plan aims to build a infrastructure to bring virtual and in-person care to people on demand, fund vehicle and driver grants to expand local and regional transition capacity, launch incentives to ensure qualified health care workers can learn and work in the state and expand maternal, infant, youth and elderly care support.
“This is about creating a healthier, stronger West Virginia,” Morrisey said. “We’re building permanent infrastructure that rewards results, not volume, and ensures every West Virginian has the opportunity to live a longer, healthier life.
Wyoming
The top priorities for Wyoming’s plan are improving the financial viability of small, rural hospitals, expanding affordable health insurance options, recruiting and retaining primary care physicians and nurses and strengthening obstetrics/gynecological, labor and delivery and other services to keep mothers and babies safe.
“Wyoming is taking full advantage of the Rural Health Transformation Program championed under President Trump,” Governor Mark Gordon said. “Our application reflects a clear vision for Wyoming’s health care future. Just as we have done with other transitory federal programs, we recognize this money is not forever and it is taxpayer money. So the investments we make must stand the test of time and not further burden our grandchildren. Rural states like Wyoming need the tools to build solutions that work here at home. These funds will help us transform care for Wyoming families and keep critical services local, where they belong.”
What Happens Next
CMS will review each proposal and notify awardees by December 31, 2025. The funding will then be distributed in the form of a cooperative agreement over the next five years. Monitoring and support from CMS will begin next year.
According to CMS, the review process will ensure completeness and compliance with the Notice of Funding Opportunity requirements. The baseline funding, which is half of the total available program funds, will then be distributed equally among states that meet those requirements.
Then, applications that meet the baseline criteria will undergo an additional “data-driven merit review” for the remaining 50 percent of the funds that will assess each state’s proposed initiatives and alignment with program goals to ensure a fair, transparent and consistent merit review process across all states, according to CMS.
“This is not just a funding opportunity—it’s a turning point for rural health,” CMS Administrator Oz said. “Together, we’re delivering the largest rural health investment in American history—and building a foundation for healthier communities for generations to come.”
What People Are Saying
Health and Human Services Secretary Robert F. Kennedy, Jr. said in a statement: “When every state steps up to strengthen rural health, it shows the true character of our nation. Rural families have been left behind—driving hours for care or going without it entirely. This program restores fairness and brings quality health care back to every American community.”
Arizona Governor Katie Hobbs said in a statement: “Arizonans are struggling with health care that is unaffordable and inaccessible. And rural Arizonans face challenges like potential service reductions and hospital closures, a lack of health care professionals, long wait times, insufficient access to specialty care, and outdated technology that is holding our communities back. As health care in rural Arizona continues to be under threat, I’m going to fight to deliver this critical funding for our state and protect Arizonans at risk of losing accessible and affordable health care.”
“With significant input from rural health care clinics, hospitals, clinicians, Medicaid health plans, Tribal partners, universities, and elected officials from across the political spectrum, I’m confident that this plan will be able to deliver truly lasting change for rural Arizona communities and protect Arizonans from threats to their health care.”
Kansas Governor Laura Kelly said in a statement: “Our Kansas Rural Health Transformation Plan will fundamentally change the delivery of health care in rural communities across the state. I’m confident that Kansas’ plan, crafted by leading experts, will lay the groundwork to build a more collaborative, more efficient health care system that provides the right care, at the right time, in the right place.”
