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 Montana’s rural health care providers in delivering sustainable, high-quality affordable care.

This investment 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.

Over 600 Montanans Participated in 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 was held on Thursday, Jan. 22 at Montana State University (MSU) in Bozeman. Over 600 participants joined the meeting both in person and virtually.

The meeting also included an extensive presentation about the RHTP by DPHHS staff.
This session focused on project goals and gathering public feedback.

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).

If direct funding opportunities for communities and providers become available, they will be announced at ruralhealth.mt.gov.

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 aims to provide all residents with affordable, high-quality care regardless of geography. The State’s RHTP plan tackles rural health disparities through five core initiatives: workforce development, sustainable access, innovative care models, community health and prevention, and technology innovation.

Eligibility varies by initiative, but typical applicants include tribal nations, government agencies, health care providers, educational institutions, nonprofits, and other partners capable of implementing rural health projects.

The State is currently designing its RHTP fund distribution plans, which must comply with state procurement rules. Most initiatives will involve competitive bidding via bids.mt.gov, while others may use government-to-government contracts with another state agency (for example, the Department of Labor and Industry) or grant applications. If direct funding opportunities for communities and providers become available, they will be announced at ruralhealth.mt.gov.

Each funding opportunity will specify review criteria and selection processes aligned with Centers for Medicare & Medicaid Services (CMS) requirements, such as rural impact, feasibility, sustainability, and budget effectiveness.

CMS uses Health Resources and Services Administration (HRSA) standards, classifying 51 of Montana’s 56 counties as non-metropolitan. Specific census tracts within the five metropolitan counties (Cascade, Gallatin, Lewis and Clark, Missoula, and Yellowstone) may also qualify. While initiatives must focus on rural health, they can include non-rural areas if they significantly benefit rural populations.

Yes, provided the work demonstrably benefits rural communities. Initiatives must focus on rural health but can include non-rural regions if the rural impact is clear.

Yes. The Department of Public Health and Human Services (DPHHS) initiatives submitted on Nov. 5, 2025 are final and funded as awarded. Per CMS rules, initiatives cannot be added or removed, though the state may adjust funding, goals, and timelines within them.

Part of the second initiative, the CoE is a time-bound program providing data-backed, tailored recommendations to improve rural health facility sustainability and care delivery. Facilities can opt in to receive financial incentives for implementing these transformation plans. For details, see Montana’s RHTP Project Narrative.

The Rural Health CoE Governing Board is expected to serve as the oversight and decision-making body for the Rural Health CoE. In that role, the CoE Governing Board may provide facility-specific optional recommendations to participating hospitals, informed by data, best practices, and rural health expertise.

The RHTP Stakeholder Advisory Committee (SAC) will serve in an advisory role, offering input and perspectives from a broad range of stakeholders. However, it will not have decision-making authority or issue recommendations to individual facilities.

The Department will finish appointing members to the Rural Health CoE Governing Board over the next few months, subject to the timing of Centers for Medicare & Medicaid Services’ (CMS) budget approval. The Department aims to balance rural health experience with subject-matter expertise to ensure a qualified, representative board.

The RHTP receives annual funding over five budget periods. Funds must be used by the end of the following period or they will be redistributed to other states. While Montana may distribute funds via subawards or subcontracts to execute initiatives, specific decisions have not yet been made. All efforts prioritize sustainability and impact beyond the five-year grant term.

CMS prohibits using RHTP funds for construction, major building projects, cosmetic upgrades, independent research, or restricted telecommunications equipment. Additionally, funds cannot supplant existing funding streams. For a complete list of restrictions, see pages 18–22 of the NOFO and the CMS FAQ.

RHTP incorporates stakeholder input through three main channels:

  • Stakeholder Advisory Committee (SAC): Convened by the Montana Office of Rural Health, the SAC represents 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.
  • CoE Board: A time-bound group ensuring impacted stakeholders participate in CoE decision-making.
  • Ongoing Engagement:
    • Website: Central hub for updates, timelines, and procurement.
    • Email Inbox: Dedicated channel for direct feedback and questions at HHSRuralHealthTransformation@mt.gov.
    • Interested Parties Emails: Sign up to receive timely updates from DPHHS via email at ruralhealth.mt.gov.

Stakeholder Advisory Meetings