VA Virginia

Virginia received a $189,544,888 award for FY26, the first year of the federal $50 billion Rural Health Transformation Program enacted under P.L. 119-21 §71401 (signed July 4, 2025). CMS announced the award on December 29, 2025. The full five-year plan, named VA Rural Vitality, totals approximately $1 billion through FY30.

The Department of Medical Assistance Services (DMAS) is the lead applicant and primary administrator. DMAS is supported by the Office of the Secretary of Health and Human Resources (OSHHR) and the Virginia Department of Health (VDH). Money flows through eight channels: DMAS direct competitive RFPs (53.6% of the five-year plan) plus seven named distribution organizations including VHCF, VHREF, VIPC, VFCCE, Virginia Works, VDOE, and VDH OEMS.

Virginia's plan organizes around four named initiatives: CareIQ ($282.6M five-year, technology and innovation), Homegrown Health Heroes ($132M, workforce development), Connected Care, Closer to Home ($412M, the largest, access and care delivery), and Live Well, Together ($124.2M, chronic prevention and dual-eligible integration). Each initiative breaks down into named sub-initiatives administered by specific gate organizations.

Mobile and Hybrid Care, at $264 million over five years, is the single largest sub-initiative in the Virginia plan. It is administered through DMAS direct competitive RFPs and funds mobile clinics, telehealth kiosks, hub-and-spoke models, and clinic-in-a-box deployments aimed at the listening-session theme that rural Virginians drive too far for care.

There are three primary paths: register on eVA Virginia (the state's mandatory vendor portal at eva.virginia.gov), monitor DMAS Procurement and Grants.gov for active RFPs, and submit unsolicited proposals to RuralTransformation@governor.virginia.gov. Workforce sub-initiatives carry a five-year rural-service commitment requirement; telehealth alone does not satisfy it.

Anti-supplantation is the federal rule that RHTP funds cannot replace existing operating costs. CMS scoring rejects framings that read as service-line revenue replacement and rewards framings that read as technology adoption, capacity building, workforce development, demonstration pilot, or infrastructure investment. The distinction is judged by the language used in the application narrative, not just by the underlying activity.

Nine of Virginia's 31 rural inpatient hospitals are at risk of closing, with six at immediate risk. Connected Care, Closer to Home is the initiative most directly designed to address rural-hospital financial pressure by shifting care-model economics away from inpatient volume toward mobile, hybrid, and home-based care.

Day-to-day program decisions sit with DMAS Director Cheryl Roberts, JD (NAMD President-Elect), under the Office of the Secretary of Health and Human Resources led by Marvin Figueroa. The Virginia Department of Health, led by Commissioner Dr. B. Cameron Webb, MD, JD, oversees community paramedicine and EMS-related sub-initiatives. Each gate organization (VIPC, VHCF, VHREF, VFCCE, Virginia Works, VDOE) runs its own program officers for the sub-initiatives it administers.

CMS announced Virginia's FY26 award on December 29, 2025. Core team hiring and listening sessions run through Q1 2026. The first DMAS competitive RFPs are expected to release during 2026, with multi-year award funding running through FY30 (program sunset October 1, 2030). CMS recalculates each state's annual workload-pool share based on year-1 performance, so early execution shapes years 2 through 5.

RHTP is a separate $50 billion FY26 to FY30 federal program for rural health system restructuring. GUIDE is a CMS dementia care model. AHEAD is a CMS state-level total-cost-of-care model. Section 1115 waivers are Medicaid demonstration authorities. They run on different statutes and timelines, but a single Virginia proposal can frequently sit at the intersection: an RHTP-funded mobile clinic can serve dementia patients (GUIDE-eligible) under Virginia's 1115 waiver authority, with sustainability flowing through MCO ILOS arrangements.