As you all know by now, CMS has launched one of the most ambitious rural-health initiatives in decades. The Rural Health Transformation (RHT) Program will distribute up to $50 billion through FY 2026-2030 to help states redesign how rural care is delivered—funding prevention, workforce pipelines, and digital access.

We’ve been digging into the details and getting as much insight to share as possible. On Friday of last week (10/10/25) we had a live Zoom call that included a slew of stakeholders from ag, food and healthcare. We have included the Zoom above. We plan to hold one more zoom this week.

In the meantime, we’ve created a shared drive where we will be updating information as it is received Google Drive. In addition to the program materials and state links and more, we have added a document DRAFT “State Language Framework - Crowd Source Document” that is designed to become a succinct set of language to be used to provide to your state officials or any other contacts helpful.

We welcome this group to “crowd source” this document but have some ground rules (some are redundant to details in the How To Engage section):

* MUST BE VENDOR AGNOSTIC

* Clearly articulate the scoring impact, specifying each measure and points

* Make it quantifiable (we are revising what we have created to do just that)

* MUST be sustainable without grant $$

* Please enhance and/or add new bullets/sections, don’t delete what is there

The specifics of what we suggest are found in the How To Engage Section below.

Who’s driving it

Health and Human Services (HHS) is leading the charge via Centers for Medicaid and Medicare (CMS), the HHS department responsible for program funding decisions and program oversight

* Alina Czekai, Director, Office of Rural Health Transformation

* Kate Sapra, Acting Deputy Director, focused on cross-state coordination

* Emily Chen, Senior Advisor, who urged evidence-based innovation, not pilot fatigue

* Christopher Clark, Grants Management Officer, who explained funding and compliance

Contact: [email protected]

“Rural transformation must move beyond keeping hospitals open. We’re building systems that keep people healthy where they live.” - Czekai

The timeline

Awards are expected by December 31, 2025.Funding begins January 2026, with five one-year budget periods running through FY 2030.Unspent funds can roll forward for one fiscal year before redistribution.

Key dates:

* Letter of Intent (optional) - Sept 30 2025

* Application deadline - Nov 5 2025 (11:59 p.m. ET)

* Awards announced - Dec 31 2025

* Budget Period 1 starts - Jan 2026

What states must deliver

Only states can apply directly, but CMS expects them to braid public and private resources. Each application must include:

* Needs Assessment – baseline data on rural access, chronic-disease burden, and facility status.

* Transformation Plan – clear goals and a sustainability model beyond federal dollars.

* Implementation Timeline – milestones through 2031.

* Stakeholder Engagement – Medicaid, tribal health, community providers.

* Evaluation Metrics – at least four measurable outcomes such as hospital readmissions, telehealth uptake, or A1C improvement.

“We’re not funding activities - we’re funding outcomes.” - Spara

Where Innovators Fit

Startups can’t apply directly, but CMS expects them to power execution through sub-awards and state partnerships. Five “use-of-funds” categories create multiple entry points:

Technology Innovation - broadband, telehealth, remote monitoring, cybersecurity, and data integration. Emily Chen stressed that CMS wants digital infrastructure that lasts beyond grant cycles.

Innovative Care Models - produce-prescription programs, lifestyle or behavioral-health integration, and “food as medicine” pilots. These align perfectly with Food is Health thinking.

Workforce Development - rural residencies, tele-EMS, community-health training, and loan-repayment tie-ins. Kate Sapra linked this to CMS’s new workforce data initiative.

Prevention and Consumer Health Tech - nutrition apps, wearables, and farm-to-clinic supply chains. Alina Czekai invited proposals that “connect agriculture and health.”

Data and Evaluation Systems - cross-state data hubs and AI-based outcome tracking. Christopher Clark reminded applicants that all systems must meet federal privacy and interoperability standards.

How to help your state prepare

Startups:

* Create a one-page brief showing how your technology improves access, quality, or cost. Map it to one of the five funding categories. Contact your State Office of Rural Health or Department of Health this summer to be added as a partner.

Universities and nonprofits:

* Offer to manage evaluation and metrics - every state must prove measurable impact.

Investors and corporates:

* Align co-investment or in-kind support with the 25 percent non-federal match requirement.

How to Engage: Turning Rural Innovation into State-Ready Language

The Rural Health Transformation (RHT) Program isn’t just another grant cycle. It’s a five-year framework where states must design working systems, not pilots.That means startups, community programs, and local innovators will shape the real implementation work - if they show up early enough.

Here’s how.

1. Understand what states are being asked to build

Each state must produce a comprehensive transformation plan, not a single project.They’ll need to demonstrate measurable improvements in access, quality, and cost—especially around chronic disease and hospital dependence.That means they’re looking for partners who can deliver ready-to-insert programs that fit inside their proposals.

CMS made it clear:

“Show us ideas that a governor can stand behind and a hospital CEO can implement.”

The RHT categories are deliberately broad - digital health, prevention, workforce, and innovation—because CMS expects cross-sector participation.If you have a working model (say, a produce-prescription program, wearable-driven nutrition app, or tele-behavioral network), treat it as a component the state can adopt and scale.

2. Write “plug-and-play” proposal language

Don’t send a deck; send words states can drop directly into their grant narrative.Officials are under pressure to hit submission deadlines and will naturally use clear, pre-written content that aligns with CMS scoring criteria.

Structure your draft contribution like this (in case you want to create your own in addition to what we are creating):

Section Title: Use of Funds – Innovative Care Model: Produce Prescription ExpansionProblem: High rates of diet-related chronic disease in rural counties; limited access to affordable produce.Solution: Partner with FreshRx or a comparable provider to implement a produce-prescription model reaching 500 patients in Federally Qualified Health Centers.Expected Outcomes: 10% reduction in A1C; 15% improvement in food security scores; measurable reduction in per-member per-month costs within 18 months.Metrics: Number of patients served, change in HbA1c, hospitalization rates, program retention.Sustainability: Program funded through Medicaid Section 1115 waiver in Year 3.

That language fits the CMS template and makes it easy for a state health department to say “Yes - insert this.”

3. Find the right people in each state

Every state has a State Office of Rural Health (SORH) and often a Rural Health Advisory Council reporting to the governor.These offices will coordinate the RHT response with Medicaid, public-health, and workforce agencies.

Start here:

* Visit nosorh.org/states - click your state for director contact info.

* Search “Office of Rural Health Transformation” or “Rural Health Policy Council” on the state health-department site.

* Reach out to the Governor’s Health Policy Director or State Medicaid Innovation Office (often leads these cross-agency efforts).

* Ask: Who is leading your state’s CMS RHT application process, and how can we share draft program language for consideration?

Several states - Oklahoma, Missouri, North Carolina, and Maine - already have dedicated transformation offices that will anchor their proposals.Others will build task forces this summer; being early means you can help shape the scope.

4. Anchor your pitch in metrics and sustainability

The biggest mistakes CMS sees are vague claims and no plan for what happens after federal funding ends.Each idea needs both a numerator (how many people it reaches) and a denominator (the total population affected).If you can’t quantify it, it won’t make it into a state plan.

Propose clear measurement methods:

* Link to existing CMS quality metrics (readmissions, blood pressure control, depression screening, telehealth access).

* Identify data sources (claims data, EHR extracts, or program dashboards).

* Outline the path to sustainability - Medicaid waivers, value-based care contracts, employer partnerships, or insurer pilots.

5. Focus on what states need help with most

From the webinar Q&A, CMS officials said states are especially seeking help in five areas:

* Data integration and reporting - systems that track outcomes across multiple health networks.

* Nutrition and lifestyle programs - initiatives that tie food access to measurable health improvement.

* Workforce retention - solutions that keep clinicians in rural communities via remote learning, tele-supervision, and loan-forgiveness alignment.

* Behavioral health access - models combining tele-mental health, addiction treatment, and local peer support.

* Sustainability and payment innovation - economic models that convert grants into lasting revenue streams.

6. Think systems, not silos

Alina Czekai summed up the program’s philosophy:

“The goal isn’t a better clinic - it’s a better community ecosystem.”

Startups that connect the dots between food, tech, workforce, and health outcomes will stand out.If your solution helps states measure, scale, or sustain that ecosystem, you belong in their plan.

Quick checklist for startups

* Identify your state’s RHT lead (start with the SORH).

* Map your product or program to one of the CMS “use of funds” categories.

* Draft one-page RHT-ready narrative text for state insertion.

* Define 2–4 measurable outcomes tied to CMS metrics.

* Describe how the model sustains itself post-grant.

The bottom line

* Don’t wait to be asked to provide language, help write it proactively.

* Every RHT proposal will need proof-ready programs that deliver measurable results.

* If you can hand a state a clean paragraph that fits their submission template, you’re not a vendor; you’re part of the plan.

Why it matters

Alina Czekai closed with a challenge:

“If rural America is to thrive, it needs a health system designed around prevention, data, and dignity - not scarcity.”

This is that moment.

This is a first pass at providing States with the resources to connect food, health, and technology into a coherent rural strategy if they so choose. They’ll need implementers who can show them the path and then help them execute. Right now they don’t know what they don’t know and it’s imperative we do all we can to get the message out that we can take actions that will lead to the end of the Chronic Disease Epidemic!

Resources

* 📄 CMS Webinar Replay: (link to video)

* 🏛 Program Details: (link to website)

* 📬 Email: [email protected]

* 📅 Funding Notice: Grants.gov ID CMS-RHT-26-001

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