Michigan files $1 billion RHTP proposal naming 80+ subrecipients while reserving nearly $600M for competitive bids
Deep dive into detail with video explainer on our new YouTube channel.
As is usual for a Monday morning, there were no Sunday updates in any of the published information in the 50 states. (Plenty of Friday evening info-drops though). Here’s the second in a series of stste-by-state explainers. See also a video overview on our new YouTube channel.
Michigan has submitted its Rural Health Transformation Program proposal to CMS, laying out how the state plans to deploy $1 billion over five years across 75 of its 83 counties. On Friday evening the state published the Budget Narrative they submitted to CMS.
The overall submission — a 60-page project narrative plus a 30-page budget narrative — is one of the most detailed state-level RHTP blueprints publicly released to date. The proposal names specific subrecipients for a portion of Year 1 funding while keeping a substantial competitive procurement calendar ahead for the majority of the funds. The proposal remains subject to CMS review and approval.
The money
Michigan’s Budget Period 1 (BP1) total request is $173,128,201.02. This figure will be reconciled based on the formula CMS uses for the 50% of RHTP funding allocated by rural population, rural facility density, and the proportion of hospitals serving low-income patients. Michigan makes a strong case on rural heft: 75 of 83 counties are rural in whole or in part, the state has the seventh-largest rural population in the nation (more than 20% of residents live in rural areas), and 10 of the 18 hospitals operating at negative margins in the state have Obstetric (OB) units.
Five-year total: $1 billion, distributed across four overarching initiatives, a 5% tribal carve-out, and program management infrastructure.
Where Year 1 goes
The named subrecipients
The proposal calls out specific subrecipients with dollar allocations. Among the notable partners:
Michigan Health & Hospital Association — $8.625M combined across two initiatives. $6M for Hospital Hub & Spoke Pilot Projects, and $2.625M for Collaborative Care Integration. MHA serves as the intermediary for hospital-facing grants, reducing administrative burden on individual rural hospitals.
Michigan Public Health Institute — $2.546M. Named as the programmatic and fiscal implementation partner, staffing 9 Program & Data Monitoring Managers to oversee roughly 24 sub-initiatives.
Michigan Center for Rural Health — $2.625M. Serves as a central coordinating partner within Rural Health Clinics.
Michigan Primary Care Association — $2M. Leads the FQHC data integration cohort.
Michigan Health Information Network — $1M. State-designated HIE; leads interoperability TA for use-case onboarding across provider cohorts.
Upper Peninsula Health Care Solutions — $2M. Community Information Exchange (CIE) coordinating entity.
Michigan 211 — $1.5M. Operates the Rural Resource Directory Investment.
Northern Michigan Public Health Alliance — $3M. Largest single Michigan Hubs subrecipient.
Quality Behavioral Health Incorporated — $2.5M. Extends the existing Ludington opioid treatment program’s mobile medication units into Wexford and Grand Traverse counties.
Michigan State University — $1.5M. Mobile training.
Regional hubs under the Chronic Disease Collaborative Care Fund are explicitly named with dollar amounts: Thumb Alliance/Sanilac County Health Department ($1M), Michigan Health Improvement Alliance ($1.5M), UPCAP ($1.5M), Region IV AAA ($850K), Chippewa Luce-Mackinac Community Action Agency ($350K), and two county health departments — Berrien and Chippewa — at $150K each. Technical assistance to the Hubs is divided between Northern Michigan Center for Rural Health and Central Michigan University’s Rural Health Center for Excellence at $750K apiece.
Eight Family Resource Centers each receive identical $156,250 Year 1 allocations under the Collaborative Care Integration & Sustainability Fund. Twenty-four FQHCs appear in the budget, with eighteen at $50K each and six at roughly $16,667.
What’s still TBD — the competitive procurement calendar
Over $117 million per year is marked “TBD” in the budget narrative and will be awarded through competitive RFPs. The forecast includes:
Rural Tech Innovation Fund. Drives EHR adoption, telehealth expansion, AI integration, and remote monitoring deployment in rural facilities.
Rural Provider Recruitment, Retention & Capacity Fund — $16.7M. For physicians, advanced practice providers, and behavioral health clinicians.
Transportation Blueprint — $13M across sub-pilots. NEMT ($2M), maternal health transport ($2M), behavioral health transport ($2M), plus a $7M pilot track.
University-Led MSW Scholarship + BSW-to-Clinical MSW Stipend — $12M combined. Multi-year rural service obligations attached.
Rural behavioral health expansions — $8.7M. Crisis Stabilization Units ($2M), CCBHC expansion ($3M), Intensive Outpatient Programs ($3.7M).
Maternal health — $7M. Mobile maternal health support pilot ($2M) + maternal health provider recruitment/training ($5M).
Community Paramedic Training — $2.5M..
Based on the Stage 0 – Stage 1 timeline, most of these solicitations are expected to begin development and issuance between FY26 and FY27.
Three distinctive design choices worth flagging
The 5% tribal carve-out with equal-share allocation
Michigan structured a dedicated 5% share ($8.65M in BP1) distributed as even allocations of roughly $665,878 to each of the 13 federally recognized Michigan tribes. Twelve of the thirteen sit in rural counties; the 13th — American Indian Health & Family Services — is included as an urban Indian organization serving rural-origin tribal residents.
State legislation as a sustainability lever
Michigan identifies a pending state-level bill as a mechanism for sustaining RHTP workforce investments. Section D.3 of the Other Required Information table cites House Bill 5108 of 2025, introduced October 22, 2025, which would expand pharmacist scope of practice. If enacted, expanded pharmacist scope becomes a rural access mechanism that outlasts the five-year RHTP grant period.
A 12-FTE implementation spine inside MDHHS + MPHI
Michigan budgets one Program Director at MDHHS plus, contracted through MPHI, one Grant Administrator, nine Program & Data Monitoring Managers, and one Partnership Analyst — exactly 12 FTE of dedicated staff for the five-year build-out. The underlying logic: overseeing nearly two dozen sub-initiatives spread across dozens of subrecipients, a 5% tribal carve-out, and a continuous RFP issuance cadence requires substantial grant operations support.
Implementation timeline at a glance
Key stages from the implementation plan:
Stage 0 (FY26): Setup, staff assignment, project plan and grant application development.
Stage 1 (FY26-27): Targeted outreach, baseline data collection, RFA launches, and contract execution.
Stage 2 (FY27-28): Supervised implementation, ongoing TA, and mid-point analysis.
Stage 3 (FY28-29): Ongoing data collection, monitoring, and sustainability strategy development.
Stage 4 (FY29-30): Full program maturity and refinement.
Stage 5 (FY31): Track and report final outcomes, implement sustainability plans.
What to watch
CMS review outcome. The proposal is explicitly “subject to CMS review and approval”. Approval dates and any scope-of-work modifications CMS requires will be the first inflection point.
MDHHS procurement cadence. Expect a burst of competitive Requests for Proposals (RFPs) as the state moves into “Stage 1” of its implementation timeline. A major item to watch is the Rural Tech Innovation Fund, which is designed to drive EHR adoption, telehealth, and AI integration for rural providers.
HB 5108 progress. Introduced on October 22, 2025, this bill would expand the scope of practice for pharmacists. A hearing, vote, or cross-chamber movement would strengthen the sustainability narrative inside the approved plan.
13 tribal sub-agreements. MDHHS must negotiate parallel agreements with each of the 13 federally recognized tribes under the 5% carve-out; the pace of these executions will be visible public markers.
Implementation hiring. 12 FTEs of new grant-operations capacity need to come online quickly. Watch for Michigan’s state job postings (for the MDHHS Program Director) and Michigan Public Health Institute (MPHI) hiring announcements (for the 11 contracted grant administration and program monitoring roles).
Sources
Michigan 1-page and 2-page RHT Project Summaries
Notes on methodology
Explainers are based on documents published by CMS and the state. We use a series of tools and processes to discover, parse, and analyze these documents to feed our databases and provide the raw text in these explainers. Content is fact-checked via multiple LLMs and human review, under an overall editorial policy that centers simple facts over broad claims. Video overviews are generated solely from documents published by the state using the Google Notebook LM.
