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Rural Health Transformation Program (RHTP)

Understanding the Rural Health Transformation Program

The Rural Health Transformation Program (RHTP) is a landmark $50 billion federal investment designed to reshape healthcare in rural communities across America.1 

For questions about RHTP, email DSS.RHTP@dss.mo.gov. 

To recieve updates about the program, subscribe to the RHTP Stakeholder emails.

Opportunities

ToRCH Care Hub Boundaries and Hub Anchor Application

DSS has released official county groupings for the local community “Hubs” that will form the backbone of Missouri’s Rural Health Transformation Program (RHTP). 

A foundational element of Missouri’s program is a statewide network of healthcare “Hubs” designed to bring care closer to home, make clinical and non-clinical services more seamless, and ensure that no rural resident is left behind. Individual Hubs act as an organizing structure across ~3-5 counties made up of a variety of partners, including local hospitals, clinics, pharmacies, EMS, community-based organizations, and more. Within a Hub, partners collaborate to understand and track local needs, coordinate care through connected referral systems, and implement programs targeted to improve community-specific needs. 

The newly released Hub boundary map reflects detailed analysis, stakeholder feedback, and the recent public comment period to ensure that each Hub represents a practical care ecosystem. 

Please see the official Hub County groupings map below: 

click image to enlarge the map

On May 15, a request for application (RFA) inviting rural healthcare organizations to apply to serve as Hub “Anchors” within these boundaries was released. Hub Anchor organizations will serve as the neutral coordinator of their respective Hubs, hosting Hub staff supporting governance through a Leadership Board, and ensuring coordination workflows function effectively. 

To learn more, please access the press release.

Request for Application (RFA): Rural Health Transformation Program Hub Anchors

DSS recently closed its RFA, which invited rural healthcare organizations to apply to serve as ToRCH Care Hub Anchors under Missouri’s Rural Health Transformation Program (RHTP).

A foundational element of the program is a statewide network of healthcare “Hubs” that organize partners across approximately 3–5 counties to bring care closer to home, improve coordination of clinical and non‑clinical services, and ensure that no rural resident is left behind. As the Hub Anchor, the selected organization will serve as the neutral coordinator of this system, host Hub staff (including a Program Coordinator and Community Health Workers), support governance through a Leadership Board, and ensure that coordination workflows operate effectively.

Thank you to all organizations and partners who submitted applications. Your leadership and commitment to rural communities will help shape the future of Missouri’s rural healthcare system.

Rural Health News

(DSS) has published the ToRCH Care Hub Onboarding & Operations Procedures Manual to support organizations participating in Missouri’s Rural Health Transformation Program (RHTP).

The Hub Manual serves as the primary operational guide for ToRCH Care Hubs. It outlines the end-to-end process for Hub onboarding, governance and leadership structures, operating and support models, roles and responsibilities, localized programs, standard operating procedures, and data and assessment tools. It also includes key templates, tools, and sample materials to support Hub planning and ongoing operations.

The Manual is designed to support Hub Anchors and members, Regional Care Networks (RCNs), and other partners and stakeholders involved in establishing and operating ToRCH Care.

DSS encourages all interested hub participants to read and review the Manual alongside other RHTP program materials. DSS has also prepared a Frequently Asked Questions (FAQs) document to assist. These are working documents. 

By establishing a shared understanding of ToRCH Care expectations, processes, and operational requirements, the Manual aims to be a comprehensive and continuously updated resource for all ToRCH Care Hubs.

Links:

Questions may be directed to DSS.RHTP@dss.mo.gov
 

MO HealthNet Division invites providers to share input on APMs

MO HealthNet Division has launched a survey to gather provider input on alternative payment models (APMs). The survey seeks feedback on providers’ past experiences with APMs, perceived challenges and benefits, and their readiness to implement these models. It is intended for hospitals, FQHCs, primary care and multi‑specialty practices, and specialist groups, though any provider with APM experience may participate.

Organizations that complete the survey may be invited to help shape future MO HealthNet APM initiatives. The survey, funded through the Rural Health Transformation Program (RHTP), is open to both rural and urban providers. It will remain open through June 19 and should be completed once per organization. Support materials are available, and questions may be directed to DSS.RHTP@dss.mo.gov.

Complete the survey by June 19 to help inform Missouri’s approach to alternative payment models.

ToRCH Care Roadshows

In May and June, team members from Missouri’s Rural Health Transformation Office launched the ToRCH Care Roadshows, a series of 12 in‑person sessions designed to connect directly with rural communities. The ToRCH Care Roadshows engaged rural healthcare providers, community organizations, and partners to strengthen collaboration and support improved access to care across Missouri.

View the RHTP ToRCH Care Roadshow Handout.

View the RHTP ToRCH Care Roadshows Frequently Asked Questions.

ToRCH Care Webinars

DSS invited rural healthcare providers, community-based organizations, and other stakeholders to participate in a series of informational webinars supporting Missouri’s implementation of the Rural Health Transformation Program (RHTP). Missouri is launching Transformation of Rural Community Health (ToRCH) Care, the state’s coordinated model to enhance rural healthcare delivery and improve community outcomes. 

There were four webinars hosted from April to May 2026. The webinars included an informational section, dedicated time for Q&A, and a testimonial from current ToRCH pilot partners. The presentations of the webinars are available below.

Rural Health Transformation: A Guide for Stakeholders
Strategic Goals

The Five Strategic Goals

The Centers for Medicare & Medicaid Services (CMS) has outlined five core goals that guide the RHTP. These goals provide a clear roadmap for the types of projects Missouri will pursue to transform its rural healthcare landscape.

Improve Rural Health: 

The goal is about stopping people from getting sick before it happens, as well as ensuring appropriate access to early identification and upstream interventions. It helps with projects that keep us healthy, looking at the main reasons for diseases like diabetes and heart problems, and make it easier to get important services like mental health and care for pregnant women.1

Sustainable Access: 

The goal is to keep rural hospitals and clinics open by encouraging them to work together. This means they will share resources, improve how they operate, and become
financially stable. This way, they can continue to be trusted places for healthcare in their communities.1

Workforce Development: 

The goal is to help fix the shortage of healthcare workers in rural Missouri. It supports programs that bring in, train, and keep skilled workers, such as doctors, nurses, community health workers, and technicians.1

Innovative Care: 

The goal is to create a Community Health Hub, which brings hospitals, clinics, and other community leaders together to meet the health needs of their specific community.
This will allow hospitals and clinics to get paid to help patients stay healthy in addition to helping treat them when they get sick.1

Tech Innovation: 

The goal is to use new technology to make healthcare better in rural areas. This means using things like video calls for doctor visits, keeping track of patients from far away, and safely sharing information. This will make healthcare easier and faster for people and doctors in rural areas.1

Programmatic Activities RHTP Timeline

Programmatic Activities RHTP Timeline

Note: Dates could be slightly updated as program implementation details are finalized.

DateEvent
Mid-June, 2026Open Applications for Medical Clerkships​
June 25, 2026Release of Digital Readiness Survey results
July 2026Announcement of Hub Anchors
July - ~Oct 2026Hub onboarding process
July - Aug 2026Launch select procurements across pillars
Aug 30, 2026​Submit RHTP Annual Report
Aug - Sept 2026Announce select procurement awardees
Oct 30, 2026Obligate funding to CMS
Toolbox of Strategies

A Toolbox for Change: How Missouri Can Use RHTP Funds

The RHTP provides states with a broad and flexible "toolbox" of approved activities. To be approved, Missouri's plan must include investments in at least three of the eleven categories below.1 These categories directly align with the program's five strategic goals.
 

Prevention and Chronic Disease: 

Funding programs that use evidence-based methods to prevent and manage chronic conditions.
Example: Expanding the use of providers such as Pharmacists, Community Paramedics and Community Health Workers to address chronic diseases at their root cause. 
 

Provider Payments: 

Making payments to healthcare providers for services, particularly as part of new, innovative payment models. 
Example: A new payment model for providers to help prevent diseases at their root cause in addition to treating those conditions. 
 

Consumer Tech Solutions: 

Promoting technology that patients can use themselves to manage their health. 
Example: Using the latest technology tools, including Artificial Intelligence, to help predict and manage chronic diseases.
 

Training and Technical Assistance: 

Helping rural hospitals adopt advanced technologies like remote monitoring, robotics, or artificial intelligence. 
Example: Provide training to healthcare workers and others on the latest technology such as Artificial Intelligence to make their more efficient.
 

Workforce: 

Recruiting and retaining healthcare professionals in rural areas, with a requirement that they serve in the community for at least five years. 
Example: Connecting rural high school students who are interested in health care careers with internships and other healthcare related opportunities. 
 

IT Advances: 

Providing funds for significant upgrades to information technology, including software, hardware, and cybersecurity. 
Example: Connecting rural healthcare facilities with specialists using telemedicine for complex and urgent medical and behavioral health care.
 

Appropriate Care Availability: 

Assisting rural communities in determining the right mix of healthcare services they need to be sustainable. 
Example: Using a combination of technology such as telemedicine and additional workforce members such as community paramedics and pharmacists to connect patients with the right care at the right time at the right place.
 

Behavioral Health: 

Supporting access to mental health and substance use disorder treatment. 
Example: Funding the two-year college education for front-line behavioral health workers.
 

Innovative Care: 

Developing new models of care, including value-based payment arrangements. 
Example: Establishing local community-based health Hubs across the state in which hospitals, doctors, rural clinics, behavioral health providers and community-based organizations like food pantries and school-based clinics work together to improve the health of their community.
 

Fostering Collaboration: 

Creating strategic partnerships between rural facilities and other providers to improve quality, financial stability, and access to care. 
Example: Establishing regional networks run by a collaboration of hospitals, clinics, and behavioral health professionals to coordinate the care most needed in their region.
 

About Funding
How Much Funding is Available?

How RHTP Funding Works: The Two Streams of Support for Missouri

The RHTP will distribute a total of $50 billion nationwide over five federal fiscal years (2026-2030), with $10 billion made available each year.1

1. Baseline Funding (50% of Total)

Half of the program's total funds ($25 billion over five years) are designated as Baseline Funding.1 This money is divided equally among all states that have an approved application. This provides a stable, predictable funding stream that Missouri can count on each year to form the foundation of its transformation plan. If all 50 states are approved, this would amount to approximately $100 million per state annually.10

2. Workload Funding (50% of Total)

The other half of the program's funds ($25 billion over five years) is designated as Workload Funding.1 This funding is distributed competitively based on a formula that evaluates two things: a state's level of rural need and the quality of its transformation plan.1 This creates an opportunity for Missouri to earn significant additional funding by clearly demonstrating its rural health challenges and presenting a thoughtful, strategic, and high-impact plan for the future.

How Much Did Missouri Receive?

Missouri Department of Social Services (DSS) announced that the Centers for Medicare & Medicaid Services (CMS) has approved $216,276,817.66 in Year 1 (through September 30, 2027) funding for the state’s Rural Health Transformation Program (RHTP), marking a major step forward in strengthening and stabilizing rural health care across the state. The funding launches full implementation of Transformation of Rural Community Health (ToRCH) Care – Missouri’s statewide transformation strategy. 

To view the Year 1 budget narrative and funding breakdown, visit the MO RHTP Year 1 Fund Distribution.

Funding Timeline

Funding Timeline

Funding is awarded in five annual budget periods. A key feature of the program is its flexibility; for each budget period, Missouri will have until the end of the following federal fiscal year (September 30) to spend the awarded funds.1 For example, funds awarded for the first budget period in early 2026 can be spent until September 30, 2027. This will require careful planning for complex, multi-year projects.

For each budget period, recipients will have until the end of the following fiscal year (September 30) to spend awarded funding.

  • Recap: Budget Period will start on December 31, 2025. The Federal Fiscal Year begins October 1, but the subsequent Budget Period funding for RHTP will be distributed in November of each fiscal year. 
Funding timeline. For each budget period, recipients will have until the end of the following fiscal year (September 30) to spend awarded funding. Recap: Budget Period 1 will start on December 31, 2025, and Subsequent Budget Periods will start on October 31 of each fiscal year.
Key Limitations

Prohibited Uses

RHTP funds cannot be used for the following:

  • New Construction: Building entirely new facilities is not allowed. However, funds can be used for renovations, alterations, or equipment upgrades in existing buildings.1
     
  • Supplanting Funds: The money is intended for new or expanded activities. It cannot be used to replace or substitute existing state, local, or private funding for a project that is already underway or budgeted.1
     
  • Duplicating Billable Services: Funds cannot be used to pay for clinical services that are already reimbursable through programs like Medicaid, Medicare, or private insurance. The goal is to transform care delivery, not just pay for more of the same services.1
     
  • Lobbying: Federal funds cannot be used for activities designed to influence the passage of legislation or other government actions.1
     

Program-Specific Funding Caps

CMS has also set limits on how much of a state's annual award can be spent on certain categories. These caps ensure a balanced investment across different aspects of healthcare transformation.

Spending Category

Maximum Allowed

Administrative Costs (State-level program management, oversight)10% of the state's total annual award1
Capital Expenditures (Renovations, equipment upgrades)20% of the state's total annual award1
Provider Payments (For direct healthcare services not otherwise billable)15% of the state's total annual award1
Replacing an Existing Certified EHR System5% of the state's total annual award1
"Rural Tech Catalyst Fund" Initiatives (Funding for health tech startups)The lesser of 10% of the annual award or $20 million1
Calculating Missouri's Award

The Federal Scoring Formula

The amount of competitive "Workload Funding" Missouri receives each year is determined by a formula that combines two distinct scores. Understanding this formula is key to maximizing the state's award.

Score 1: The Rural Facility and Population Score (The "Need" Score)

This score is a snapshot of Missouri's existing rural healthcare needs and challenges. It is calculated by CMS only once at the beginning of the program and will not change over the five years1. It is based on several data-driven factors, including:

  • The total number of people living in rural areas of the state.1
  • The number and proportion of rural health facilities, such as Critical Access Hospitals and Rural Health Clinics.1
  • The level of uncompensated care provided by hospitals in the state.1
  • The percentage of the state's total population that lives in rural areas.1
  • The state's total land area and the presence of very remote "frontier" areas.1
  • The percentage of hospitals that receive Medicaid Disproportionate Share Hospital (DSH) payments.1

Score 2: The Technical Score (The "Plan and Performance" Score)

This score measures the quality, strategic vision, and ultimately the performance of Missouri's transformation plan. This score is recalculated by CMS every year based on the state's progress.1 This annual rescoring is the program's core accountability engine. It turns the RHTP from a simple grant into a dynamic, performance-based partnership. 

A typical grant provides funding based on an initial application, with reporting focused mainly on compliance. The RHTP, however, ties future funding directly to present performance. If Missouri successfully implements its planned initiatives and meets its policy commitments, its Technical Score—and its Workload Funding—can increase in subsequent years. Conversely, a failure to make progress or follow through on commitments can lead to a lower score and reduced funding. This structure creates a powerful incentive for the state and its partners to not only write a strong plan but to execute it effectively, requiring robust project management and transparent reporting from day one.

MO Approach to Rural Health Transformation
Vision & Core Objectives

Vision

Rural Missourians have access to the high-quality care they need, through or from a well-aligned delivery system that is built to last.

Core Objectives

DSS is organizing and prioritizing initiatives in the application according to three overarching objectives:

Access to Care: 

Ensure rural Missourians can access primary and behavioral health providers close to home, community-based maternity options, with connections to specialists and complex care enabled by telehealth and provider interoperability
 

Health Outcomes:

Strengthen healthcare quality through integrated care coordination, aligned incentives, and evidence-based practices – so rural Missourians consistently experience seamless, high-value care 
 

Sustainability:

Strengthen the long-term sustainability of rural providers through targeted investments in infrastructure, adoption of innovative technologies, and payment models that reflect the realities of rural care delivery

Initiatives

Missouri’s Initiatives

  • Rural Health Network and Hubs
     
  • Tech and Data Interoperability
     
  • Rural Health Workforce Pathways
     
  • Provider Transformation & Sustainability
     
Rural Health Network and Hubs

Rural Health Network and Hubs

Create community hubs supported by regional networks as the backbone that connects every rural resident to seamless high-quality care through:

  • Access expansion through and beyond traditional providers (e.g., pharmacy, Emergency Medical Services (EMS), Mobile Integrated Healthcare–Community Paramedicine (MIH-CP), Local Public Health Agencies (LPHA))
  • Care coordination integrating physical, behavioral and social health services
  • Technical assistance and programs tailored to local needs
Rural Health Workforce Pathways

Rural Health Workforce Pathways

Create an integrated rural health workforce pipeline that connects education, training, and employment to grow and retain Missouri’s healthcare talent locally, including efforts on:

  • New entry points into health careers through high school, college, and training programs
  • Expanding maternal and behavioral health training opportunities
  • Clinical placement and retention supports across rural communities
Tech and Data Interoperability

Tech and Data Interoperability

Create a statewide backbone for data interoperability that connects hubs, providers, and local partners to coordinate care, including:

  • Hub data integration
  • Community Information Exchange (CIE) for closed-loop referrals and shared care plans
  • Data standards and compliance
  • Public health connectivity
Provider Transformation & Sustainability

Provider Transformation & Sustainability

Ensure the long-term financial, operational, and sustainable future of Missouri’s rural healthcare system through:

  • Strategic infrastructure access modifications
  • Alternative payment innovations
  • Operational innovation and tech-enablement
Transformative Framework for Missouri’s Rural Health Network
Key Resources
Background Information

Background Information

  1. Notice of Funding Opportunity Webinar, accessed October 15, 2025, https://www.cms.gov/files/document/rht-program-applicants-webinar-presentation.pdf
     
  2. Rural Health Transformation Program Summary, accessed October 13, 2025, https://www.ruralhealth.us/nationalruralhealth/media/documents/advocacy/2025/rural-health-transformation-program-summary.pdf
     
  3. CMS Releases State Guidance On Rural Health Transformation Program, accessed October 13, 2025, https://www.mohospitals.org/newsroom/cms-releases-state-guidance-on-rural-health-transformation-program/
     
  4. Missouri Department of Social Services Invites Public Comment on Rural Health Transformation Program - GovDelivery, accessed October 13, 2025, https://content.govdelivery.com/accounts/MODSS/bulletins/3ef7bd9
     
  5. Invitation to Comment: Rural Health Transformation Program - myDSS - MO.gov, accessed October 13, 2025, https://mydss.mo.gov/mhd/hot-tips/invitation-comment-rural-health-transformation-program
     
  6. Missouri Lawmakers Champion Rural Health, Unlocking Access to Quality Care for Rural Communities - Ways and Means Committee, accessed October 13, 2025, https://waysandmeans.house.gov/2025/09/23/missouri-lawmakers-champion-rural-health-unlocking-access-to-quality-care-for-rural-communities/
     
  7. DSS Seeks Input On Rural Health Transformation Program - Missouri Hospital Association, accessed October 13, 2025, https://www.mohospitals.org/newsroom/dss-seeks-input-on-rural-health-transformation-program/
     
  8. Billions on the Table: Missouri Invites Public to Shape Rural Health Future - Missourinet, accessed October 13, 2025, https://www.missourinet.com/2025/09/02/billions-on-the-table-missouri-invites-public-to-shape-rural-health-future/
     
  9. Missouri Department of Social Services seeking public help in planning for rural health innovatio... - YouTube, accessed October 13, 2025, https://www.youtube.com/watch?v=7B1VNbJueKc
     
  10. The $50 Billion Rural Health Transformation Program: What Providers Can Do Before Nov. 5, 2025, accessed October 13, 2025, https://www.lara.health/blog/the-50-billion-rural-health-transformation-program-what-providers-can-do-before-nov-5-2025
     
  11. Rural Health Transformation Program - Senate Finance Committee, accessed October 13, 2025, https://www.finance.senate.gov/download/rural-health-transformation-program_fact-sheet 
     

 

Program Status and Timeline

EventDate / DeadlineAdditional Resources
Registration for Digital Backbone Roadshow events open07/02/2026
Inside Missouri’s Rural Health Transformation Program (RHTP) Newsletter07/06/2026
Announce Investment in Home Visiting Services07/02/2026
ToRCH Care Hub Onboarding & Operations Procedures Manual Published 06/30/2026
Alternative Payment Models (APM) Survey closed6/26/2026
Digital Readiness Survey Assessment Report Released06/24/2026
Open Applications for Medical Clerkships06/18/2026
Hub Anchor Application Due6/18/2026
Hannibal Virtual Roadshow
  • 6/4/2026
Sedalia Virtual Roadshow6/3/2026
Rolla Virtual Roadshow6/2/2026
Ambient AI Request for Information (RFI)6/01/2026
West Plains Virtual Roadshow5/27/2026
Branson Virtual Roadshow5/27/2026
RHTP ToRCH Care RoadshowsMay-June 2026

 

Hub Anchor Application Webinar

April 17, 2026
ToRCH Care Hub Anchor Application Released 5/15/2026
ToRCH Care Hub Boundaries Map Released 5/15/2026
ToRCH Care Community Institutions Webinar5/13/2026
ToRCH Care Non-Hospital Clinical Providers Webinar5/6/2026
Inside Missouri’s Rural Health Transformation Program (RHTP) Newsletter05/04/2026
ToRCH Care Hospital Specific Webinar4/29/2026
Invitation for Bid for Vital Rural Hospital Repairs 4/27/2026
ToRCH Care Overview Webinar 4/22/2026
Digital Readiness Survey4/17/2026
RHTP Year One Budget Approved4/7/2026
MHA applauds Missouri’s RHTP award12/29/2025
Governor Kehoe Secures More Than $216M12/29/2025
Public Comment Invited on RHTP8/26/2025
RHTP Application Materials11/2025
Governor Kehoe's RHTP Endorsement10/31/2025

The Rural Health Transformation Program information provided by the Missouri Department of Social Services is supported by the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $216,276,817.66, with 100 percent funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, CMS/HHS, or the U.S. Government.