The Centers for Medicare & Medicaid Services (CMS) recently announced the Rural Health Transformation Program (RHTP), a substantial $50 billion investment to reimagine and strengthen rural America’s healthcare delivery system.
The RHTP Notice of Funding Opportunity outlines that a total of $50 billion will be distributed from FY 2026–2030 ($10 billion annually), with 50% serving as baseline funding divided equally among approved states and 50% distributed based on workload factors such as rural population, facility needs and application quality.
This investment comes at a critical moment, as rural providers brace for the consequences of major federal spending reductions as part of H.R.1, the “One Big Beautiful Bill Act.” According to the Kaiser Family Foundation (KFF), the major reductions in federal healthcare spending are to offset part of the costs of extending expiring tax cuts.
Also, the Congressional Budget Office’s (CBO) latest cost estimate shows that the reconciliation package would reduce federal Medicaid spending over a decade by an estimated $911 billion (after accounting for interactions that produce overlapping reductions across different provisions of the law) and increase the number of uninsured people by 10 million.
More details about KFF’s summary of CBO’s estimates of Federal Medicaid spending reductions across States can be found here. Read the full CBO report here.
The RHTP serves as a transformative opportunity and as a stabilizing response to protect access to care in rural communities that stand to be most affected by these cuts. NRHA welcomes this bold federal effort and commends CMS for recognizing that meaningful rural transformation requires intentional, upfront investment.
But the RHTP, while an important step forward, must be paired with durable reforms that ensure rural Americans have reliable access to care for years to come. NRHA strongly advocates that a substantial portion of the RHTP funds be directed to rural hospitals, clinics, community-based organizations, and other local partners who are the trusted institutions that provide essential care and economic stability for rural residents.
Why States Should Embed Rural Age-Friendly Care Programs in RHTP Implementation
NRHA, through the National Rural Age-Friendly Initiative (NRAFI) supported by The John. A Hartford Foundation, encourages states to integrate rural age-friendly care initiatives and older-adult health priorities into their RHTP implementation. As the U.S. population rapidly ages, with more than 20% of Americans ages 65 and older now living in rural areas, there is an urgent need for effective policies and programs to address the challenges of aging, particularly in rural areas.
Rural communities experience distinct healthcare challenges, especially among older adults, such as a higher burden of chronic and complex health conditions, scarce long-term care services, economic hardship, social isolation, inadequate transportation, and food insecurity.
States should strengthen rural hospitals’ ability to deliver geriatric and tele-geriatrics services and expand emergency services.
The absence of robust in-home support, visiting health teams, and hospice services further limits care access for rural older adults. While rural age-friendly care initiatives offer effective strategies to address these gaps, they remain underdeveloped in many rural areas. Integrating the needs of rural older adults into states’ RHTP implementation is essential for achieving fair and sustainable health outcomes for rural elders.
Most importantly, each of the five strategic goals of the RHTP inherently reflects the needs and priorities of rural older adults. Efforts from advancing prevention and chronic disease management to strengthening access, workforce development, promoting innovative care models, and expanding digital health capacity align closely with what it means to deliver age-friendly care initiatives in rural communities across the country.
RHTP Strategic Goals
- Make Rural America Healthy Again: Advance prevention, chronic-disease management, behavioral health and prenatal care.
- Sustainable Access: Strengthen the efficiency, coordination and sustainability of rural providers to become long-term access points for care by working together or having a high-quality regional system to share or coordinate operations, technology, primary and specialty care and emergency services.
- Workforce Development: Recruit, train, and retain a high-skilled rural health workforce, including clinicians, pharmacists and community health workers, to support patients in navigating the healthcare system.
- Innovative Care: Promote flexible, value-based care models that improve outcomes and reduce costs. Develop and implement payment mechanisms incentivizing providers or Accountable Care Organizations (ACOs) to reduce healthcare costs, improve care quality, and shift care to lower cost settings.
- Tech Innovation: Expand digital health tools, data-sharing capacity, telehealth and cybersecurity in rural facilities to promote efficient care delivery.
How States Can Integrate Age-Friendly Care Initiatives in Their RHTP Implementation
1. Make Rural America Healthy Again
- Expand prevention programs for conditions like diabetes, cardiovascular disease, dementia and fall prevention, which are prevalent in older adults in rural areas.
- Deliver preventive and wellness programs/services directly to places where rural older adults live and connect, such as churches, care homes for elders, respite centers and local clinics, etc.
- Support behavioral health and social-connection initiatives to reduce social isolation, loneliness and depression among older adults living in rural areas. Some social connection programs can include, but are not limited to, congregate meals programs, respite care, older adults companion programs, volunteer visitor initiatives, adult day services, intergenerational activities, community wellness classes, faith-based outreach and telephone reassurance or friendly-caller programs.
2. Sustainable Access
- Strengthen rural hospitals’ ability to deliver geriatric and tele-geriatrics services and expand emergency services.
- Foster partnerships with rural aging service organizations to implement successful and sustainable age-friendly initiatives in rural areas.
- Expand home-based care, food and transportation access for rural older adults.
3. Workforce Development
- Integrate geriatric and dementia-care training into rural clinician pipelines.
- Recruit, train, develop, and retain rural community health workers (CHW) and pharmacists to assist older adults with the 4Ms Framework of age-friendly care (what matters to them, their mobility, mentation and medication management).
- Ensure sustainable funding models for rural CHWs by developing state policies around services reimbursement.
- Incentivize clinicians with geriatric expertise to serve in rural areas.
4. Innovative Care
- Implement rural age-friendly elements that reward fall prevention, chronic-care management, and home-based interventions into value-based care models.
- Embed the 4Ms Framework of age-friendly care in new aging care models implemented in rural communities.
- Advance the Age-Friendly Ecosystem model through partnerships with rural healthcare systems, public health, homes and CBOs, educational systems, workplaces, and communities, cities, counties and states to promote rural age-friendly care initiatives.
5. Tech Innovation
- Invest in broadband access and digital literacy for rural older adults.
- Expand remote-monitoring and telehealth solutions that support rural aging in place.
- Ensure data-sharing systems integrate rural hospitals, clinics and long-term-care providers.
- Support the development and funding of rural-relevant, technology-driven home-enhancement products that promote safety and help prevent falls.
- Promote intergenerational programs that pair young adults with older adults living in rural areas to provide hands-on technology assistance and foster social connection.
As states finalize their applications, NRHA calls upon leaders to prioritize rural providers and integrate rural age-friendly frameworks that ensure rural transformation benefits older adults.
To learn more about NRHA’s NRAFI, visit the National Rural Age-Friendly Initiative Resource Hub. For more information about the NRAFI, contact Laura Hudson at Lhudson@ruralhealth.us or Rebecca (Becky) Yeboah at ryeboah@ruralhealth.us
More information on the RHTP is available on the NRHA RHTP page. For specific policy updates related to the RHTP, please reach out to Carrie Cochran-McClain at ccochran@ruralhealth.us or Marguerite Peterseim at mpeterseim@ruralhealth.us.
Carrie Cochran-McClain, DrPH, is Chief Policy Officer, Rebecca Yeboah, MDP, is Program Services Coordinator and Marguerite Peterseim is Government Affairs and Policy Coordinator, all with the National Rural Health Association.
Photo credit: Shutterstock/bastera rusdi
