Rural Health Transformation Program

Governor Greg Gianforte and Department of Public Health and Human Services (DPHHS) Director Charlie Brereton announced on Wednesday, Nov. 5 that Montana has officially submitted its application for the federal Rural Health Transformation Program (RHTP), a critical initiative that could secure over $1 billion in federal funding to stabilize and modernize rural health care systems across the state over the next five years.

The RHTP, established by the U.S. Centers for Medicare and Medicaid Services (CMS), is authorized to provide up to $50 billion nationally to participating states through 2030. This funding is specifically earmarked for stabilizing, transforming, and restructuring rural hospitals and other essential health care providers.

Montana submitted its Rural Health Transformation Plan (“Plan”) in advance of the Nov. 5, 2025, deadline. States were given approximately six weeks to develop their plans.

During the Plan development process, DPHHS closely scrutinized proposals for sustainability and prioritized transformative initiatives that don’t require ongoing RHTP funding to remain in effect. With award decisions expected in late December, DPHHS will now shift to implementation planning, including establishing and hiring for an internal RHTP unit responsible for administering the program over a five-year period.

DPHHS incorporated vital rural health metrics, including those pertaining to glycemic status, hypertension, obesity, and suicide rates, into its long-term commitment to evaluating and monitoring Plan outcomes.

The Plan was developed using public input collected over several weeks, including a Request for Information (RFI), a statewide webinar with nearly 650 participants, a formal tribal consultation, direct engagement with over 20 external stakeholder groups, all eight tribal nations and Urban Indian Organizations, and close collaboration with several other state agencies.

This page will be updated as more information becomes available.

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.

States must apply for funding from the Centers for Medicare and Medicaid Services (CMS). It is expected that the Department of Public Health and Human Services (DPHHS) will be allocated funds to award to eligible entities in accordance with Montana’s approved rural health transformation plan.

DPHHS issued a Request for Information (RFI) for public input to help shape Montana’s RHTP application and overall strategy, and has been reviewing submissions received

Background

H.R. 1 created a $50 billion fund for states with an approved rural health transformation plan, with $10 billion available per year from FFY2026 through FFY2030. 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.

To receive funding from the RHTP, states must submit a rural health transformation plan to CMS by November 5, 2025. The plan must describe how the state would use program funds to:

  • Improve access to hospitals, other health care providers, and health care items and services furnished to rural residents of the state;
  • Improve health care outcomes for rural residents;
  • Prioritize the use of new and emerging technologies that emphasize prevention and chronic disease management;
  • Initiate, foster, and strengthen local and regional strategic partnerships between rural hospitals and other health care providers to promote measurable quality improvement, increase financial stability, maximize economies of scale, and share best practices in care delivery;
  • Enhance economic opportunity for, and the supply of, health care clinicians through improved recruitment and training strategies;
  • Prioritize data- and technology-driven solutions that help rural hospitals and other rural health care providers furnish high-quality care as close to patients’ homes as possible;
  • Outline strategies to manage the long-term financial solvency and operating models of rural hospitals in the state; and
  • Identify specific factors driving the increasing rate of closures, conversions, or service reductions among stand-alone rural hospitals.

Funds must be used for three or more of the allowable activities, including:

  • Promoting evidence-based, measurable interventions to improve prevention and chronic disease management;
  • Providing payments to health care providers for furnishing health care items or services, as specified by the Administrator;
  • Promoting consumer-facing, technology-driven solutions for the prevention and management of chronic conditions;
  • Providing training and technical assistance to support the development and adoption of technology-enabled care delivery models—such as remote monitoring, robotics, artificial intelligence, and other advanced technologies;
  • Recruiting and retaining clinical workforce talent in rural areas, with a minimum five-year service commitment to rural communities;
  • Providing technical assistance, software, and hardware to support significant information technology advancements that enhance efficiency, cybersecurity, and patient health outcomes;
  • Assisting rural communities in right-sizing their health care delivery systems by identifying appropriate service lines—including preventative, ambulatory, pre-hospital, emergency, acute inpatient, outpatient, and post-acute care services;
  • Supporting access to opioid use disorder treatment services, other substance use disorder treatments, and mental health services;
  • Developing projects that support innovative models of care, including value-based care arrangements and alternative payment models, as appropriate; and
  • Supporting additional uses that promote sustainable access to high-quality rural health care services, as determined by the Administrator.

 

CMS will award funds by December 31, 2025.

Montana has submitted its Letter of Intent to CMS to apply for the RHTP.