Rural Health Transformation Program

Governor Greg Gianforte and Department of Public Health and Human Services (DPHHS) Director Charlie Brereton announced in December 2025 a historic $233 million investment from the Trump administration to stabilize and modernize rural health care delivery throughout Montana. Awarded by the Centers for Medicare & Medicaid Services' (CMS) Rural Health Transformation Program (RHTP), these funds will support improving Montana’s rural health care providers in delivering sustainable, high-quality affordable care.

This award reflects the first-year award of a five-year federal grant program, with Montana currently set to receive up to $1.2 billion over the life of the program.

The announcement follows the successful approval of Montana’s application to CMS, which was submitted by DPHHS in November 2025. The state received the fourth-highest funding award among all 50 states, signaling the quality and strength of Montana’s application.

First RHTP Stakeholder Advisory Committee meeting

The RHTP Stakeholder Advisory Committee was established to provide guidance to DPHHS to support effective implementation of the RHTP initiatives. The committee’s first meeting is Thursday, Jan. 22, from 10 am to 4 pm at Montana State University (MSU) in Bozeman.

This session will focus on project goals and gathering public feedback. However, no funding decisions will be made. While open to the public, some portions of the meeting will be closed.

Registration for the meeting is required. For registration, meeting details, agenda, directions, and parking information, visit the ORH website.

Funding information

CMS requires states to submit revised budgets aligned with announced awards by January 30. DPHHS is currently adjusting its budget to prioritize high-impact programs with the capacity to absorb additional funding.

Once the budget is finalized, most funds will be awarded through competitive bidding at bids.mt.gov. Other methods include grant applications or inter-agency contracts (e.g., with the Department of Labor & Industry).

All funding opportunities will be announced at ruralhealth.mt.gov as they become available.

Next Steps

DPHHS will collaborate with rural providers, hospitals, community organizations, and other health care stakeholders to deliver five core initiatives tailored to Montana's rural health care challenges.

The five core initiatives are:

  1. Workforce Development
  2. Sustainable Access
  3. Innovative Care Models
  4. Community Health and Prevention
  5. Technology Innovation

For questions about this project, please email HHSRuralHealthTransformation@mt.gov.

  • Area Health Education Centers (AHEC) 
  • Behavioral Health Alliance of Montana (BHAM) 
  • Big Sky Care Connect 
  • Blackfeet Tribal Nation 
  • Blue Cross/Blue Shield Montana 
  • Chippewa Cree Tribal Nation 
  • Confederated Salish and Kootenai Tribal Nation 
  • Confluence Public Health 
  • Crow Tribal Nation 
  • Department of Labor and Industry (DLI) 
  • Department of Public Health and Human Services (DPHHS) – Human Services Division 
  • DPHHS – Public Health and Safety Division 
  • EMS Advisory Committee 
  • Fort Belknap Tribal Nation 
  • Fort Peck Tribal Nation 
  • Little Shell Chippewa Tribal Nation 
  • Montana Academy of Family Physicians 
  • Montana Academy of Pediatrics 
  • Montana Dental Assn 
  • Montana EMS Association 
  • Montana Health Network  
  • Montana Healthcare Foundation 
  • Montana Hospital Association (MHA) 
  • Montana Medicaid 
  • Montana Medical Association (MMA) 
  • Montana Pharmacy Assn 
  • Montana Primary Care Association (MPCA) 
  • Montana State University Extension 
  • Montana Trauma Advisory Committee   
  • Mountain Health Coop 
  • Mountain Pacific Quality Health 
  • Northern Cheyenne Tribal Nation 
  • Office of Public Instruction (OPI) 
  • Office of the Commissioner of Higher Education (OCHE) 
  • PacificSource 
  • Public Health Institute 
  • Rocky Mountain Tribal Leaders Council 
  • School Administrators of Montana 
  • Urban Indian Consortium 

Established by President Trump’s Working Families Tax Cuts legislation, the RHTP provides up to $50 billion nationally through 2030 to help states stabilize, transform, and restructure rural health systems and support essential health care providers with sustainability.

H.R. 1, enacted on July 4, 2025, established a federal $50 billion Rural Health Transformation Program (RHTP) to stabilize and strengthen rural health care delivery systems, including hospitals and other providers.

To receive funding from the RHTP, states had to submit a rural health transformation plan to CMS. In November 2025, Montana applied for  funding from the Centers for Medicare and Medicaid Services (CMS), and on Dec. 29, 2025, DPHHS was awarded a historic $233 million in funds to stabilize and modernize rural health care delivery throughout Montana. DPHHS will now allocate funds to eligible entities in accordance with Montana’s approved rural health transformation plan.

Prior to submitting the plan, DPHHS conducted several weeks of public outreach to Montana’s hospitals, over 20 rural health stakeholders, all eight tribal nations and Urban Indian Organizations, and other state agencies. DPHHS also integrated feedback from a 900-registrant webinar and over 300 formal responses to an agency-led Request for Information. The plan reflects this input.

H.R. 1 created a $50 billion fund for states with an approved rural health transformation plan, with $10 billion available per year from FFY 2026 through FFY 2030. Half of the funding will be split evenly between states with an approved transformation plan, and the other half will be distributed to states at CMS’ discretion based on each state’s rural population, rural health facilities, and other CMS-defined characteristics.

Rural Health Transformation Program Webinar PowerPoint Slides - October 2 2025

Frequently Asked Questions

  • COE - Rural Health Center of Excellence
  • CMS - Centers for Medicare & Medicaid Services
  • DPHHS - Department of Public Health and Human Services
  • HRSA - Health Resources and Services Administration
  • NOFO - Notice of Funding Opportunity
  • RHTP - Rural Health Transformation Program
  • SAC - Stakeholder Advisory Committee

Montana’s vision is to ensure that every resident has affordable access to high-quality, high value care regardless of geography. The State’s RHTP plan directly addresses the root causes of rural health disparities through five integrated initiatives that strengthen the workforce, secure financial solvency, modernize care delivery, embed prevention and community health at the center of care, and expand technology use.

Eligibility will be defined for each funding opportunity and may vary by initiative. Expected eligible entities may include tribal nations and tribal organizations, local and state government organizations, health care providers, educational institutions, nonprofits, and other partners with the capacity to implement rural health initiatives.

The State is still early in the process of determining how it will disperse RHTP funding. The State received funding to implement the specific initiatives in Montana’s application. We are currently developing plans for distributing funds related to each individual initiative or sub-initiative. Those fund distribution plans will need to follow state procurement rules.

For most of the initiatives, this will mean a competitive procurement managed through the bids.mt.gov website. In other instances, it might be a government-to-government contract with another state agency (for example, the Department of Labor & Industry) or a grant application process. Communities and providers may be able to apply directly for funding for certain initiatives. We will announce this if funding opportunities of this kind become available at ruralhealth.mt.gov and via the newsletter.

Each funding or procurement opportunity will specify the applicable review criteria and selection process, consistent with Centers for Medicare & Medicaid Services (CMS) requirements (e.g., rural impact, feasibility, sustainability, and budget effectiveness).

CMS defines “rural” according to the Health Resources and Services Administration (HRSA), which defines 51 of Montana’s 56 counties as non-metropolitan. Certain census tracts within the five remaining counties (Cascade, Gallatin, Lewis and Clark, Missoula, and Yellowstone) may be considered rural, as well. Initiatives must focus on rural health but need not exclude non-rural regions. Initiatives in non-rural areas that significantly impact rural health are also allowed.

Yes, if their work demonstrably benefits rural communities. Implementation must focus on rural health but do not need to exclude non-rural regions when impact on rural communities is clear.

Yes. The initiatives submitted by Department of Public Health and Human Services (DPHHS) on Nov. 5 are final, and the award announced by CMS directly funds these initiatives. Per CMS and the NOFO, states may not add or remove initiatives after submission. However, the state may adjust funding allocations, goals, and timelines within each approved initiative.

The CoE is a time-bound program within the second initiative (link to initiatives), that will develop and oversee the implementation of data-backed recommendations to support the financial sustainability and care delivery transformation of rural health facilities. These recommendations will be tailored to the individual needs of participating facilities. The CoE will offer an opt-in program for rural health systems, providing financial incentives to support the implementation of transformation plans developed in partnership with the CoE. For more information, please reference Montana’s RHTP Project Narrative.

The RHTP is broken into five award budget periods, with funds transferred to the State once each year. Awarded funds must then be used by the conclusion of the following budget period. Otherwise, they will be redistributed to other states. Funding can be distributed as subawards or subcontracts to other organizations and entities to execute initiatives with strong State oversight. The State has not yet made decisions about specific subawards or subcontracts. There is a strong emphasis within the RHTP on sustainable initiatives and their lasting impact, which extends beyond the five-year funding period.

CMS outlines that funding cannot be used to cover many specific costs, including construction or major building projects, supplanting existing funding streams, cosmetic upgrades, independent research costs, and telecommunications equipment flagged under federal law. There are many other restrictions that CMS details on pages 18 through 22 in the NOFO, which can be referenced for a comprehensive view. Additional restrictions are described in the PDF on the Centers for Medicare & Medicaid Services website.  

RHTP is designed to incorporate ongoing stakeholder input through multiple complementary channels:

  • Stakeholder Advisory Committee (SAC): A standing advisory body representing rural, tribal, provider, and partner perspectives; provides structured input on RHTP implementation, priorities, and emerging issues; meets bi-annually, with materials and summaries shared publicly when appropriate. The SAC does not have any decision-making authority. The SAC will be convened by the Montana Office of Rural Health.
  • CoE Board: A time-bound board that will ensure impacted stakeholders have representation and take part in the decision-making of the CoE.
  • Ongoing Engagement:
    • RHTP Website: This will be the central source for program updates, timelines, and key documents (including procurement information).
    • RHTP Email Inbox: This inbox will a dedicated channel for questions, feedback, and stakeholder input.
    • RHTP Newsletter: The newsletter will include periodic updates on progress, milestones, and upcoming engagement opportunities.