Part 2 of the guide
How to get RHTP money.
The money reaches different organizations by different routes. The first job is to know yours. Naming your route correctly is the difference between months of chasing a grant that does not exist for you, and going straight to the channel that does.
The first principle
Find your money path.
You do not apply to CMS. CMS funds only states. Public Law 119-21, Section 71401 (codified at SSA 2105(h)) View source Accessed 2026-05-27 You receive RHTP value through one of a small number of downstream routes, and which route fits you depends on what kind of organization you are. The list, before the cards below:
- Win a competitive state subaward or subgrant. The state posts a NOFO or RFA; you apply. For providers, nonprofits, collaboratives.
- Win a state procurement. The state issues an RFP for goods or services; you bid. For vendors, consultancies, service providers.
- Subcontract to a funded recipient. A hospital, FQHC, nonprofit, or collaborative wins a subaward and pays you out of it as a procured vendor. For vendors and service providers.
- Join a state technology or group-purchasing vehicle. Some states stand up a vetted vendor channel or a technology catalyst fund. For technology vendors.
- Receive direct provider payments. The state pays providers for care, within the 15% cap. For eligible rural providers.
- Receive funds through an intermediary. A regional collaborative or, in some states, a managed-care entity re-distributes. Varies by state.
Your route, by organization type
Six organizations, six different doors.
Each card names the route that actually works for that organization type, and explains the route below it. The technology-vendor card is highlighted because that audience makes the most expensive mistakes about how RHTP works.
-
The case people get wrong
Health-technology vendors
Subcontract to a funded recipient, win a state procurement, or compete into a state technology vehicle.
A vendor generally cannot receive a direct state subgrant. The realistic routes are partnering with a hospital, FQHC, nonprofit, or collaborative that won a subaward (and getting paid out of their award as a procured contractor), bidding into the state's central procurement for technology and services, or competing into a vetted vendor channel or technology catalyst fund if the state stands one up. This is the case people get wrong most often.
-
Rural hospitals and Critical Access Hospitals
Competitive state subgrants, plus capped direct provider payments and capital and infrastructure dollars.
Apply to the state's RHTP NOFOs and RFAs as a subrecipient. Hospitals are usually named as anchor recipients in state plans. Also eligible for direct provider payments (within the 15% patient-care cap) and capital and infrastructure spending (within the 20% cap).
-
FQHCs and Rural Health Clinics
Competitive state subgrants, frequently in chronic-disease, access, and behavioral-health programs.
Same route as hospitals: apply to the state's RHTP subgrants and RFAs. Federally Qualified Health Centers and Rural Health Clinics are explicit subrecipient candidates and are commonly named in state plans for chronic disease, access, and behavioral health work.
-
Nonprofits and collaboratives
Win a state subaward, or serve as the intermediary a state routes regional funds through.
Eligible subaward recipients, and often the intermediary a state routes money through to re-distribute regionally. When a nonprofit spends RHTP funds, it must follow federal procurement standards (2 CFR Part 200).
-
Consultancies and advisors
Win a state technical-assistance procurement or subcontract to a funded recipient.
Same two vendor routes apply: bid into a state's technical-assistance, facilitation, or evaluation procurement, or subcontract to a funded recipient. Consultancies are properly contractors, not subgrantees.
-
MCOs and Medicaid plans
Often an intermediary the state routes funds through, especially where Medicaid runs the program.
Several states run RHTP from inside the Medicaid agency, which makes managed-care organizations natural partners without by itself giving them funds. The intermediary role varies by state and is not universal.
A short, hard truth
The vendor reality.
A vendor selling commercial products and services almost never gets a direct grant from a state's RHTP program. The federal distinction that governs this is the same one that governs every federal funding stream: a subaward goes to an entity carrying out the program's purpose, and a contract is procurement of goods or services. 2 CFR Part 200, Uniform Administrative Requirements View source Accessed 2026-05-27 Vendors selling commercial products and services are properly contractors, not subgrantees. Some states do name a vendor as a subrecipient if they structure it that way, but that is the exception.
01
Subcontract to a funded subrecipient.
Partner with or sell to a hospital, FQHC, nonprofit, or collaborative that won a state subaward, and get paid out of their award as a procured vendor. This is the most common vendor path.
02
Win a state procurement.
States issue RFPs for technology and services through their central procurement systems and you bid. This requires state vendor registration in each state where you plan to compete.
03
Compete into a state technology vehicle.
Some states stand up a vetted vendor channel or a technology catalyst fund, often as performance-based contracts. These are less common but high-leverage where they exist.
Contractors carry a lighter compliance load than subrecipients: deliver per the contract and document invoices, versus the full 2 CFR 200 and Single Audit obligations that come with subrecipient status.
Prerequisites
What has to be in place before you can apply or bid.
These categories are durable. Specific thresholds (insurance minimums, in-state-presence rules, indirect-cost expectations) move by state, so verify the state-specific ones at the state's RHTP page or vendor portal before relying on them. Get these done early; they take time and gate everything.
-
Federal registration
Active UEI (Unique Entity Identifier) and active SAM.gov registration, renewed annually. Not suspended, debarred, or excluded from federal funds.
-
Insurance
Certificate of insurance (state minimums vary; some states require $2M general liability).
-
Compliance systems
Financial management and documentation that meet 2 CFR Part 200 / Part 300 and HHS grants policy.
-
Single Audit readiness
Required if you expend $1 million or more in federal funds in a fiscal year (2 CFR 200 Subpart F).
-
State vendor registration
Each state runs its own procurement system; vendors register state by state. Often required even to bid.
-
Indirect-cost posture
Know whether you use the 2 CFR 200 de minimis rate or a negotiated indirect-cost rate. The program-wide 10% administrative cap will constrain how much overhead a state can recognize.
Reference: 2 CFR Part 200 governs federal grants compliance. 2 CFR Part 200, Uniform Administrative Requirements View source Accessed 2026-05-27 Federal entity registration is at SAM.gov. SAM.gov entity registration View source Accessed 2026-05-27
Timeline
When the money actually moves.
A consistent pattern across states, with year-one dates that will continue to move as states publish their schedules. The use-it-or-lose-it clock from Part 1 is what forces this pace.
- Late 2025 to early 2026 Award and budget finalization with CMS (year-one process, specific to year one).
- Early 2026 onward Governance and staffing stand up: councils, program leadership, named gates.
- Spring to summer 2026 Stakeholder and listening sessions, then state NOFOs, RFAs, and RFPs (year-one rhythm).
- Q3 2026 onward Awards and contracting; first money begins moving to subrecipients.
- Late October 2026 Year-one funds obligated by the close of the first budget period.
- Many programs Reimbursement-based: the subrecipient spends first, documents, and is reimbursed after approval, so cash arrives after the work, not before.
Where opportunities are posted
It is the state pages and portals, not Grants.gov.
Grants.gov hosted only the federal NOFO to states. State subgrants are generally not on Grants.gov. SAM.gov is for entity registration, not opportunity discovery. The real places to track are the state pages.
-
Your target state's RHTP program page.
The primary source. Every state has one. The agency that runs the program (Department of Health, or in several states the Medicaid agency) maintains it.
-
State subgrant and NOFO pages.
Where open opportunities are posted. Application is often through a state form or portal.
-
State central procurement portals.
Where the RFPs vendors bid on are posted. Each state has its own system.
-
Rural Health Information Hub master list.
Maintains the master list of all 50 state RHTP pages, plans, and FAQs. Rural Health Information Hub, state RHTP master list View source Accessed 2026-05-27
Practical tracking: pick your target states, register early in both SAM.gov and each state's vendor system, monitor each state's RHTP page and procurement portal, and watch the RHIhub list for cross-state coverage.
How to frame a request
Anti-supplantation, and sustainability.
Two framings decide most outcomes.
Beat the anti-supplantation trap
Funds cannot backfill what you already do, and they cannot finance the non-federal share of Medicaid or CHIP. The losing pitch is "pay us for our existing service." The winning pitch reframes the same capability as new, measurable, transformation: a workforce-sustainability model, an access expansion, a value-based arrangement, with baseline data and targets. The technology is the enabling mechanism, not the ask.
Answer "what pays for this after 2030"
States must submit a Sustainability Plan and CMS weights sustainable access heavily. A credible path to becoming Medicaid-billable, payer-reimbursed, or part of a value-based contract turns a one-time spend into a fundable, sustainable initiative.
The strongest position also shows fit to the state's actual funded initiatives (not generic capability), names the gate that controls the relevant money, and arrives before the RFA closes, often by engaging during the listening-session window when programs are still being designed.
The capture sequence
Five steps, in order.
- 01
Identify your money path and your target states.
Use the cards above to name your route. Pick a small number of states where your stack actually fits.
- 02
Map your fit.
For each target state, identify the funded initiatives and sub-initiatives that match what you do, and the gate (which state agency or recipient) that controls that money.
- 03
Get eligible, in parallel.
SAM.gov and UEI, state vendor registration, insurance, compliance systems. These take time; start now.
- 04
Engage early.
Attend listening sessions, build the recipient or partner relationship, and prepare the anti-supplantation-safe, sustainability-backed framing. By the time the RFA posts, the framing is often already set.
- 05
Apply or bid on time, and track the next windows.
The workload-funding recalculation and the use-it-or-lose-it clock mean opportunities keep opening across the five years. The first window is not the last window.
Sources
Where every fact on this page comes from.
All sources below accessed 2026-05-27. State-specific dates, portals, and dollar figures move; verify at the state source before relying on them.
- Authorizing statute. Public Law 119-21, Section 71401, codified at SSA 2105(h). CMS-published chapter text. cms.gov, chapter 4 (PDF)
- Program overview and FAQ. CMS RHT program page. cms.gov, RHT overview
- Master state list. Rural Health Information Hub, all 50 state RHTP pages, plans, and FAQs. ruralhealthinfo.org, RHTP state list
- Federal grants compliance. 2 CFR Part 200, Uniform Administrative Requirements (subaward vs contract distinction, single audit threshold). ecfr.gov, 2 CFR 200
- Federal entity registration. SAM.gov for UEI, active registration, and the federal exclusions list. sam.gov
Now see if your stack fits.
The guide tells you the route. The Atlas tells you what it means in your state, for your organization, with the gates and the named people who control the money.