Colorado Budget Narrative approved by CMS-- view detailed $$$ difference from draft
Oklahoma school-based grant applications due May 25
Note: starting Monday, April 27, 2026, the full contents of this newsletter will be available only to paid subscribers. The structure is as follows:
Default Substack pricing for monthly and annual. Both subscriptions give you full access to complete posts, full archive access, and quarterly reports similar to the one I published at the end of Q1
A higher “Founding Member” tier, includes one consultation and custom report on RHT topics & states that matter to you
I’m devoted to making certain that we deliver value to free subscribers as well— likely via summaries, legislation watch, and other general news. This is a work in progress— email me with feedback/ questions/ concerns - reply here or danx@civicoperator.com
I’m leaning in to this project and appreciate all of the feeback, subscribers, and support I’ve received since launching less than two months ago. Thank you!
In this issue:
Colorado posts Approved Budget Narrative— see detailed differences between the draft 5-year plan and the approved 18-month plan
Oklahoma pushes ROOTS Competitive Grants for schools at $10,000 each— applications due May 25
Legislation Watch
Missouri HB2011: The FY2027 Department of Social Services appropriations bill — the conduit through which Missouri’s $216 million in first-year RHTP money will reach the state’s MO HealthNet division. CMS approved Missouri’s Year 1 RHTP budget on April 7, but until lawmakers formally appropriate the funds, DSS cannot spend them. The largest single line in Missouri’s RHTP application is a $364 million “digital backbone” for data sharing across rural providers, with additional staffing for a new Rural Health Transformation Office that will run regional coordinating networks across the state. Missouri Independent
Missouri’s award — just over $216 million annually for five years — is one of the larger RHTP allocations in the country, and the Kehoe administration has framed it as a counterweight to looming Medicaid reductions. Director of the Department of Social Services Jess Bax said the funding could “change the landscape of healthcare access and outcomes for our rural communities.” KCUR
HB2011 is one of the 13 operating budget bills currently moving between chambers, and the latest tracking entry shows a Senate Message — meaning the House-passed version has been transmitted and the Senate is working its substitute. Final action is expected ahead of Missouri’s constitutional budget deadline.
Oklahoma ROOTS Competitive Grant: Rural Opportunities for Optimal Transformation in Students' Health — due May 25, 2026
The Oklahoma State Department of Education (OSDE) is seeking sixty (60) PK-12 rural school sites to apply for a six-month competitive grant to support Presidential Fitness Testing and best practices in physical education instruction aligned to the Oklahoma Academic Standards for Physical Education. The focus of the ROOTS grant is to improve the access to high-quality physical education instruction, fitness opportunities, and physical activities in rural schools and communities. The grant cycle will be from the Spring 2026 to Fall 2026 (April 15, 2026 through October 30, 2026). Click here to see a list of all eligible communities.
This program is part of the Oklahoma RHTP funding opportunities that are specifically for schools:
School-Based Health Services: This initiative has a 5-year total budget of approximately $15.1 million. Awards of $10,000 each will be granted to 100 schools per year to help them develop systems for Medicaid billing, alongside additional funding to help recruit school-based providers.
Presidential Fitness Preparation: This program has a 5-year total budget of approximately $4.2 million. Awards of $10,000 each will be granted to 60 schools each year to purchase gym equipment and tools to help students prepare for the Presidential Fitness Test.
“Grow Your Own” High School LPN Program: This initiative has a 5-year total budget of approximately $5.5 million. It will provide funding to expand practical nursing training programs to 10 additional rural high schools.
Colorado Rural Health Transformation Program (RHTP) Budget Update: What Changed?
The Colorado Department of Health Care Policy & Financing (HCPF) met directly with CMS in February and March 2026 Colorado to review Colorado’s original 5-year draft of the RHTP Budget Narrative, Here is a detailed breakdown of the critical differences between that and the Approved Budget Narrative.
The finalized Budget Narrative shifts focus away from the 5-year horizon to define an 18-month “Year 1” period of performance, which is explicitly stated as running from March/April 2026 through September 30, 2027. The revisions finalizing these differences were actively reviewed by the Advisory Committee during meetings on March 10 and March 17, 2026.
Alos: based on CMS feedback to decrease the number of individual grants and increase the award amounts, the final budget consolidates and renames several programs.
1. Scope and Total Funding Differences
Draft Version: Projected a hypothetical, wide-lens budget across the entire 5-year program, outlining how the total $1,000,000,000 would be distributed across all federal fiscal years.
Final Version: Narrows the scope to strictly detail the Year 1 award of $200,105,604.17.
2. Program Consolidations & Renaming (The “Diffs”)
Following CMS feedback to decrease administrative burden and increase award amounts by reducing the sheer number of individual grants, several programs were heavily consolidated in the final budget:
Chronic Disease Prevention: The “Chronic Disease Prevention & Management Programs” budget was reduced by $400,000 and merged directly into “Chronic Disease Prevention Training”.
EMS Coordination: “EMS Coverage Models” was merged with “EMS Transport Coordination” (shifting $400,000) to create a single “EMS Transport Coordination & Coverage” program.
Community Health Workers (CHWs): “Community Health Worker (CHW) Credentialing” was merged with “Increase Capacity of CHWs.” Additionally, a $4 million shift occurred as “Increase Continuing Education for CHWs/CHRs” was merged with “Education & Training Opportunities for Rural Clinicians” to form the “Community Health Worker (CHW) and Rural Clinicians Continuing Education Supports Program”.
Telehealth: “RPM and Telehealth Solutions” was folded into “Support for Telehealth Participation” (a $4 million shift).
Care Models: The heavily referenced “CARPE DIEM Model for Rural Hospitals” was broadened and officially renamed to the “Whole Person Health and Support for Alternative Care Models Program”.
Regional Networks: The “Regional Networks” initiative and the “Statewide Survey and Tracking Vendor” were combined into a unified “Statewide Survey, Tracking, & Regional Networks Program”.
3. Administrative and Staffing Adjustments
Reduced Administrative Caps: Despite the original draft calculating administrative overhead at 2.98%, the final Year 1 budget trims this operational fat even further down to 2.65%, keeping it exceptionally well below the CMS-mandated 10% maximum.
FTE Expansions: To better manage the program, the state increased its internal staffing request from 18.0 FTEs in the draft to 19.0 FTEs in the final version. New roles added include a Communication Specialist and a Statistical Analyst.
Vendor Restructuring: The draft budget proposed a massive 5-year, $8.15 million “Grant Financial Vendor”. In the final version, this is rescoped to a “Facilitation and Administrative Vendor” (HealthTech Solutions, LLC) budgeted specifically for Year 1 at $1,830,800.
4. Enhanced CMS Compliance & Guardrails
The final budget narrative introduced several highly detailed compliance mechanisms completely absent from the initial draft:
Standardized Contract Details: Following CMS directives, the final version mandates that every single contract must define the Method of Selection, Period of Performance, Scope of Work, Method of Accountability, and feature an Itemized Budget.
Strict Funding Caps: To align with CMS regulations, the final budget explicitly maps and enforces caps on Category B (direct provider payments, capped at 15%) and Category J (minor renovations, capped at 20%). Grantees are now required to separate these as distinct line items on their invoices to prevent duplicate reimbursement.
EHR Limitations: The final budget inserts specific language ensuring that Electronic Health Record (EHR) replacement cannot exceed 5% of the total budget, restricting it to “rip and replace” models rather than general enhancements.
