On Sept. 15, the Centers for Medicare and Medicaid Services (CMS) announced the launch of a new 5-year, state-based grant program beginning in fiscal year 2026 to improve the quality of healthcare and health outcomes for Americans living in rural communities.
The $50 billion in available funding through the Rural Health Transformation Grant Program will be awarded to selected states. Successful state program applications will focus on addressing the program’s strategic goals of making rural America healthy through prevention, innovation, sustainable access to care, use of technology, and rural-focused workforce development. With an application deadline of Nov. 5, the window of opportunity is very short to develop strong, evidence-based, feasible, high-impact proposals.
Opportunity to Expand Access to Nutrition Counseling and Impact Chronic Disease
As states draft their applications to address these strategic imperatives and reduce the health disparities experienced by rural Americans, the Academy of Nutrition and Dietetics and the Malnutrition Quality Improvement Initiative strongly encourage states to recognize and expand the roles of registered dietitian nutritionists (RDNs) in rural healthcare teams to reach the growing older population.
Chronic diseases such as diabetes, cardiovascular disease, obesity and hypertension disproportionately affect rural populations, and more than half of the U.S. older adult population is living with two or more chronic diseases. Evidence-based clinical nutrition interventions—delivered by RDNs—are proven to help prevent and manage these conditions effectively. For example, medical nutrition therapy (MNT) has been shown to reduce HbA1c levels in patients with diabetes, lower blood pressure in hypertensive individuals, and support weight loss and lipid management. These interventions not only improve quality of life but can also reduce hospitalizations and healthcare costs.
The burden of chronic disease is particularly concerning in rural communities due to the shifting demographic landscape, with its significantly older population. According to the U.S. Census Bureau, nearly 20% of rural residents are ages 65 or older compared to 16% in urban areas. This trend is projected to accelerate over the next decade, which, combined with the higher rates of chronic disease in older adults, is increasing demand for effective chronic disease prevention and management strategies.
Medical Nutrition Therapy Benefits Patients and Can Help Improve Outcomes
RDNs are uniquely qualified members of the healthcare team who translate scientific evidence into practical dietary guidance tailored to individual patient needs. They deliver MNT, which is evidence-based care and can include nutrition assessment/reassessment, nutrition diagnosis, nutrition intervention and nutrition monitoring/evaluation. MNT typically results in the prevention, delay, or management of diseases and/or conditions.
‘Incorporating expanded RDN roles into state applications for the Rural Health Transformation Grant Program will enable innovative models that can leverage RDNs’ full scope of practice.’
RDNs’ expertise extends beyond acute care; they play critical roles in primary care settings, long-term care facilities, community health programs and telehealth services—especially vital for geographically isolated rural communities. Integrating RDNs into multidisciplinary teams enhances care coordination, supports patient self-management education, and drives measurable improvements in clinical outcomes.
Rural Health Transformation Grants Could Help Take Away Cost Barriers
Unfortunately, current reimbursement mechanisms present significant barriers to comprehensive nutrition care access for most patients. Medicare coverage for MNT is limited primarily to diabetes and renal disease; Medicaid benefits for MNT vary widely by state; and private insurance often excludes or restricts RDN services via narrow service delivery restrictions and diagnostic categories. As a result, many rural residents cannot access or afford evidence-based MNT that could help prevent costly complications.
Incorporating expanded RDN roles into state applications for the Rural Health Transformation Grant Program will enable innovative models that can leverage RDNs’ full scope of practice—such as embedding RDNs in primary care clinics, deploying them via telehealth and incorporating RDN delivered MNT in food as medicine programs—to address both prevention and management across a spectrum of chronic diseases prevalent among older rural populations. By doing so, states can advance rural health access, improve health outcomes, reduce avoidable healthcare expenditures and build more resilient rural health systems and populations.
Add RDNs to the Program!
For these reasons, we strongly urge states to prioritize expanded integration of RDNs as part of their strategies under the new Rural Health Transformation Grant Program. We encourage directors of community programs that focus on older adults to reach out to their states’ health teams and share ideas for innovative deployment of nutrition services through the Rural Health Transformation Grant Program. If current rural health programs involving RDNs are already operating in the state that could advance the aims of the new Rural Health Transformation Grant Program, reach out to them, too, and make sure they are aware of this opportunity. Taking such steps can benefit rural communities and the older adults who live there.
For more information on the new Rural Health Transformation program, click here.
Shelby Harrington, RN, is a managing director for Avalere Health in Washington, DC. Charla Burill, JD, RD, is a senior director for state legislative and government affairs with the Academy of Nutrition and Dietetics in Washington, DC.
Photo credit: Shutterstock/buritora
