Part 3 of the guide
Direct answers to the real questions buyers, providers, vendors, and advisors ask, plus the common misconceptions that cost people time and money. For depth, follow the links to Part 1 (how the money flows) and Part 2 (how to get it).
The basics
A $50 billion federal program over five years, federal fiscal years 2026 through 2030, about $10 billion a year. It was created by Section 71401 of Public Law 119-21, enacted July 4, 2025, and is run by CMS. It funds states to transform rural health care.
$50 billion total, roughly $10 billion per year, five budget periods from fiscal 2026 through fiscal 2030. The first budget period is 10 months. Each later one is 12 months.
The Administrator of CMS, through the Office of Rural Health Transformation, which was established inside the Center for Medicaid and CHIP Services in December 2025. The program contact is MAHARural@cms.hhs.gov.
The application to become an approved state was a one-time event in 2025. The funding then flows annually for five years, with each year's workload half recalculated based on state performance.
Who gets the money
Only the 50 states. Not the District of Columbia, not territories, not local governments, hospitals, universities, nonprofits, tribes, or companies. Those organizations receive money only downstream, from their state.
Yes. All 50 states were approved, and awards were announced December 29, 2025. First-year awards ranged roughly $147 million to $281 million, averaging about $200 million. Those are year-one numbers.
Half of each year's money is split equally among approved states, about $100 million per state per year. The other half is awarded by a points formula based on rural population and facilities (scored once) and on the quality of the state's plan and its policy actions and metrics (recalculated yearly).
The equal half is fixed. The workload half can grow or shrink each year based on the state's performance against its committed metrics and policy actions. CMS announces each next year's allocation by October 31 of the prior year.
How an organization gets the money
You almost never get a direct grant. Your routes are: subcontract to a funded recipient (a hospital, FQHC, nonprofit, or collaborative that won a subaward), win a state procurement (an RFP through the state's purchasing system), or join a state technology or group-purchasing vehicle. A subaward goes to entities carrying out the program; a contract is procurement, which is where vendors belong.
Apply to your state's competitive subgrants and RFAs. Hospitals and clinics may also receive direct provider payments (within the 15% cap) and capital and infrastructure funds (within the 20% cap).
Win a state subaward, or serve as the intermediary a state routes regional funds through. You must follow federal procurement rules (2 CFR Part 200) when you spend the funds.
On each state's RHTP program page and procurement portal. The Rural Health Information Hub maintains the master list of all 50 states. State subgrants are generally not on Grants.gov; SAM.gov is for registration, not discovery.
Active SAM.gov registration and UEI, no debarment, insurance, often a physical presence in the state, financial systems that meet 2 CFR Part 200, Single Audit readiness if you spend $1 million or more in federal funds in a fiscal year, and state vendor registration for procurements.
Roughly third to fourth quarter 2026 for year one. States spent late 2025 and early 2026 finalizing budgets, then run listening sessions and release NOFOs and RFPs in spring and summer 2026, then award and contract. Many programs reimburse after spend rather than paying upfront.
What the money can be used for
Three or more of ten statutory categories: prevention and chronic disease, provider payments, consumer technology, technology training and technical assistance (including remote monitoring, robotics, and artificial intelligence), workforce with a five-year rural commitment, IT and cybersecurity, right-sizing delivery systems, opioid and other substance use and mental health access, value-based and innovative care models, and a catch-all for sustainable rural access. The CMS Notice of Funding Opportunity adds named categories beyond the statute, including behavioral health, community collaboration, and capital and infrastructure.
Yes. Administrative costs are capped at 10% (statutory). The NOFO caps provider payments for care at 15%, capital and infrastructure at 20%, and EMR replacement at 5% where a certified EMR was already in place.
It cannot finance the non-federal share of Medicaid or CHIP (the anti-supplantation rule). The NOFO prohibits new construction and building expansion (minor renovation and equipment are allowed), clinician salaries at facilities with non-compete agreements, replacing insurance-reimbursable clinical services, and abortions.
The two rules that decide most outcomes
RHTP money must fund something new, not replace or backfill existing spending, and it cannot finance a state's match for other federal programs. Requests framed as "pay for what we already do" tend to fail. Requests framed as new, measurable transformation tend to succeed. This is the most common reason a use of funds is rejected.
States must show how funded activities continue after the program ends. A credible path to becoming Medicaid-billable or payer-reimbursed, or part of a value-based contract, materially strengthens any request.
Common misconceptions
No. CMS funds only states. You work through your state, not through Grants.gov or CMS directly.
No. The award is the top of the funnel. After the 10% admin cap and the state's own structure, the money is split across many initiatives and distributed through subgrants, procurements, and provider payments. What is addressable to you is a specific sub-initiative, not the headline number.
For many organizations, especially vendors, the decisive work happens before the RFP, during listening sessions when programs are designed and by building the recipient or partner relationship. By the time the RFP posts, the framing is often set.
Not necessarily. A smaller-award state whose funded initiatives fit your capability, with a clear gate and less competition, can be a better target than a larger-award state where you do not fit.
No. The caps (10% administrative, 15% provider payments) deliberately push states toward transformation, technology, workforce, and collaboratives, which is what opens the door for vendors, partners, and new models.
Key facts to keep handy
Public Law 119-21, section 71401, codified at SSA 2105(h) / 42 U.S.C. 1397ee(h).
$50 billion total over fiscal years 2026 through 2030, about $10 billion per year.
50% equal among approved states, 50% by a performance-weighted formula.
The 50 states only.
Funding Opportunity Number CMS-RHT-26-001 and Assistance Listing 93.798.
Use it or lose it: spend by the end of the following fiscal year. Unobligated funds return to the U.S. Treasury by October 1, 2032.
The Rural Health Information Hub maintains the master list of all 50 state RHTP pages, plans, and FAQs at ruralhealthinfo.org/resources/lists/rhtp.
Sources
See the consolidated source lists in how RHTP money flows and how to get RHTP money. Primary anchors: the authorizing statute as published by CMS, the CMS NOFO CMS-RHT-26-001, the CMS RHT overview and FAQ, and the Rural Health Information Hub. All accessed 2026-05-27.
The guide answers what RHTP is. The Atlas tells you what it means in your state, for your organization, with the gates and the named people who control the money.