Rural Health Transformation (RHT)

Overview 

The One Big Beautiful Bill Act (Section 71401) creates a new Rural Health Transformation (RHT) grants program administered by the Centers for Medicare and Medicaid Services (CMS), allocating $50 billion nationwide from federal fiscal years 2026 through 2030 — $10 billion annually. Funds will flow through states, which must submit a Rural Health Transformation Plan to CMS by Dec. 31, 2025, to access and manage these resources.

To learn more about the RHT program, visit the CMS website here.

Iowa's Application

• Project Narrative
• Cover Letter
• Project Summary
• Healthy Hometowns One-Pager

Healthy Hometowns: Iowa’s Proposal

Healthy Hometowns is the state’s submission to the Rural Health Transformation Program, a federal funding initiative managed by the Centers for Medicare and Medicaid Services (CMS). The bold and comprehensive proposal is aimed at building a high-quality, sustainable system of care that improves the health, well-being, and quality of life in rural communities across the state. If fully awarded, Iowa could receive $200 million per project year period (a total of $1 billion over the 5-year grant).

Hometown Connections

An initiative that builds formal partnerships to restructure healthcare delivery options for rural communities. This includes an expansion of Iowa Governor Kim Reynold’s Centers of Excellence Program and a rare opportunity to develop enhanced Health Hubs, or hub-and-spoke networks of care, with investments in telehealth, specialized medical equipment, provider recruitment and retention, efficient space utilization, and limited funds to support care for uninsured Iowans.

Health Hubs may include school-based service provision. This initiative also includes Best and Brightest, a sub-initiative to recruit and retain an excellent rural healthcare workforce.

Combat Cancer-Prevent and Treat

An initiative to comprehensively tackle cancer throughout the state via increasing access to cancer screening, forming cancer-specific Health Hubs, upgrading equipment for cancer screening and treatment, delivering supportive care for families impacted by cancer, and supporting studies and analyses by academic partners.

Iowa will address lung cancer prevention through radon testing and mitigation, breast cancer by paying for mammograms and follow-up breast MRIs, colorectal cancer through FIT tests and follow-up colonoscopies, skin cancer through telehealth and new equipment, and prostate cancer through routine screening methods.

Communities of Care

An initiative that supports co-location of different rural provider types for convenient patient access and improved coordination, hires community health workers as system navigators, and invests heavily in chronic disease prevention and management techniques.

Health Information Exchange

An initiative that allows records to be accessible across the state as patients travel throughout new Health Hubs and seek care in new ways.

EMS Community Care Mobile

An initiative that invests in new telehealth technology for high-risk transport of mothers and their new babies to higher levels of care throughout the state and a mobile integrated healthcare program that brings prenatal, postpartum, post-surgery discharge, chronic disease management, and other types of care to rural residents in their homes or to easily accessible sites in their communities.