Montana administrative RFPs, North Carolina ROOTS Hub applications due, Oklahoma Summary, RI Budget Amendment, 4 South Carolina RFPs, Tennessee webinar materials; Legislation Watch
Rural Health Transformation Program Daily Brief, Aptril 3, 2026
Montana publishes RFPs on the RHTP Center of Excellence Initiative
This is a new type of RFP I’m tracking under the RHT program— administrative RFPs that relate to a state’s overall program goals rather than tied to specific initiatives.
The Department of Public Health and Human Services (DPHHS) is seeking proposals for two distinct components of Montana’s Rural Health Center of Excellence (CoE) as part of the new Rural Health Transformation Program (RHTP).
The first request is for proposals to create the CoE; the second is for proposals to support facilities in implementing CoE recommendations.
Interested organizations can find the procurement details on the Montana Department of Administration website.
This CoE will serve as the heart of the RHTP and will be driven by three primary objectives:
Data-Driven Strategy: The CoE will analyze rural health supply and demand to provide county- and facility-level recommendations, ensuring care delivery aligns with the specific needs of Montana’s rural and frontier communities.
Long-Term Sustainability: Guided by a stakeholder governance board, the CoE will help participating facilities develop roadmaps to achieve independent, positive operating margins without the need for ongoing state support.
Performance Incentives: Through a voluntary opt-in program, facilities that implement CoE recommendations and meet measurable improvements in care quality, patient access, and financial performance will be eligible for incentive payments. More information on how providers, facilities, and organizations can participate in the CoE and the associated funding opportunities will be released in the coming months.
North Carolina acknowledges ROOTS Hub application issues
Technical Difficulties Submitting ROOTS Hub Application Materials
We are aware of technical difficulties related to emailing ROOTS Hub application materials. It is recommended that applicants use Adobe to zip files and, if zipped files exceed 20MB, please break up the file attachments across multiple emails, labeling each email (e.g., email 1 of 3).
After you submit the application response, please send an email without any attachments to dhhs-ncroots.rfa@dhhs.nc.gov asking for confirmation that the application was received. If breaking up the application over multiple emails, please advise how many emails were sent. Please include a contact name and phone number.
Oklahoma publishes Quick Summary
Oklahoma published an updated Program Quick Summary Guide on April 1 laying out all 29 CMS-approved RHTP programs with confirmed Year One budgets and disbursement status for each. The $223,476,949 first-year allocation is now mapped program-by-program, and the procurement picture is sharper than any state has published to date.
The most actionable signal is the disbursement breakdown. Sixteen of the 29 programs are moving through inter-agency agreements — meaning funds flow directly between OSDH and partner agencies (OU, OSU, OHCA, OSDE, SWODA, HWTC, CareerTech) without competitive solicitation. One NOFO is live: the Community-Led Wellness Hubs Microgrants program, with $4M in Year One funding and applications due April 13, 2026. Three more programs — the Doula Program ($1.2M), Chronic Disease Management ($15.3M), and Rural Regional Reorientation Plan ($27.5M) — list NOFO as the planned disbursement mechanism but haven’t posted solicitation documents yet. Nine programs remain “Pending,” still in procurement design, including the massive Provider Collaborative Network ($43.1M Y1) and the Technology Cooperative for PCP and BH Providers ($13.8M Y1).
The Guide also reveals the full funding administrator roster for the first time. The Oklahoma Hospital Association appears as a formal RHTP funding channel — administering $7M across CHW expansion and lung cancer screening via subrecipient agreements. OU and OSU are co-administering three programs worth $28M combined in Year One, anchored by the $22.1M Rural Residency Programs standing up six new training sites. The Regional Collaboration bucket leads all categories at $75.1M Y1, driven by the still-forming Rural Health Collaborative Nonprofit that will anchor a statewide Clinically Integrated Network.
For anyone tracking RHTP procurement nationally: Oklahoma is front-loading. The Rural Regional Reorientation Plan alone is deploying $27.5M in Year One — a fifth of its 5-year total. And with 12 programs still awaiting procurement design or NOFO publication, the state’s solicitation pipeline will be active well into FY 2027.
Rhode Island publishes Budget Amendment Summary as of 4.2.2026
Rhode Island has filed a $142.7 million budget amendment SFY 2026–2027, reflecting spending plans under the state's $156 million Year 1 RHTP award following final CMS approval. The top-line allocation goes to value-based payment transition ($32.2M) and rural workforce ($28.0M), followed by health IT modernization ($16.7M) and the state's novel hospital-at-home program ($16.2M). The budget also bakes in a policy reform package that includes rolling back Certificate of Need requirements, expanding scope of practice for pharmacists and dental hygienists, and joining interstate licensure compacts — all conditions to keep the full federal award flowing.
South Carolina publishes RFPs on 4/5 of its RHT Program
Connections to Care
Expands digital infrastructure by implementing electronic health records, remote patient monitoring, telehealth services and a statewide resource database platform to improve care coordination and access
Leveling Up
Scales successful pilot programs statewide, focusing on chronic disease management, pediatric care quality and workforce development
Wellness Within Reach
Deploys mobile health units, crisis response teams and pop-up clinics to bring care directly to underserved populations
Shoring Up to Sustainability
Strengthens rural healthcare systems through targeted investments in workforce recruitment and retention, facility upgrades, and provider training
Tech Catalyst Fund
Supports rural health technology startups and community-based innovations to drive long-term health and economic improvements. Funding opportunities for the fifth of South Carolina’s RHTP initiatives, the Tech Catalyst Fund, will be announced through a future stage of SCDHHS’ RHTP implementation.*
Tennessee posts info from their first webinar.
As a follow-up, on the RHTP website you can access the materials from the Rural Health Transformation Program (RHTP) Community Kickoff session below:
We’re also excited to continue the conversation in our second webinar, scheduled for April 15. You can register here:
Legislation Watch
Primary RHT Legislative Actions
West Virginia HB4740: Exempts the Department of Health from state purchasing restrictions when implementing the Rural Health Transformation Program, citing CMS compliance requirements and rigid federal deployment timelines that standard procurement rules would obstruct. The legislative findings explicitly reference the state’s commitments to CMS and the risk of losing funding if deployment targets are missed. It passed the House 92-1 and the Senate 33-0, and Governor Morrisey signed it on February 27 — making it one of the earliest RHTP-specific statutes enacted nationwide. (West Virginia Legislature)
Alabama HB591: Provides supplemental appropriations for Alabama’s Rural Health Transformation Program for the fiscal year ending September 30, 2026 — the current-year vehicle needed to begin spending the state’s $203.4 million CMS award administered through ADECA. It passed the House (Roll Call 1127, motion to read a third time and pass as amended adopted) and is now pending before the Senate Finance and Taxation General Fund Committee. (Alabama Legislature)
Alabama HB614: Appropriates funds for Alabama’s Rural Health Transformation Program for fiscal year 2027, establishing forward-year spending authority for the next tranche of the state’s RHTP award. It passed the House (Roll Call 1129, motion to read a third time and pass adopted) and is pending before the Senate Finance and Taxation General Fund Committee. (Alabama Legislature)
Alabama HB605: Creates the Rural Health Antitrust Immunity Act under the State Health Planning and Development Agency, authorizing rural health care providers to collaborate on service delivery, establishing a certification and supervision framework, and granting limited immunity from state and federal antitrust laws. The bill supports structural commitments Alabama made in its RHTP application to CMS — enabling the provider coordination necessary for its 11 rural health initiatives. It passed the House, crossed to the Senate, and was read for the second time and placed on the calendar. A companion bill, SB350, is moving in parallel. (Alabama Legislature)
Iowa HF2743: Creates the Iowa Rural Health Transformation Fund and grants the Department of Health and Human Services authority to distribute the state’s $209 million annual RHTP award under the Healthy Hometowns program. This bill supersedes the earlier HF2468, which was withdrawn. The Iowa House passed the bill (reported April 1) and it is now on the NOBA: House Floor, advancing to the Senate. Iowa was the first state in the nation to begin awarding RHTP subgrants, making this spending-authority bill a critical next step. (Iowa Legislature)
Mississippi SB2477: Requires competitive bidding for vendors, subcontractors, and other entities selected to provide goods or services funded through the Rural Health Transformation Program, with priority given to those located in super rural ZIP codes and counties outside metropolitan statistical areas. The bill was a transparency measure in response to the governor’s office awarding a consulting contract to BDO Government Services (formerly HORNE) before the legislature could establish oversight. Both chambers passed it unanimously, but Governor Reeves vetoed it. (Mississippi Legislature)
Appropriation & Budgetary Links
Idaho S1453: Appropriates funds to the Department of Health and Welfare for the Rural Health Transformation Program, providing the spending authority Idaho needs to draw down its $186 million first-year CMS award. JFAC voted 14-4 on March 31 to approve $3.7 million in federal funds for current-year program administration and 12 new limited staff positions, then separately approved roughly $295 million for fiscal year 2027 covering the remainder of the first-year grant and the full second-year allocation. The bill passed both chambers and has been signed by the Speaker and ordered delivered to the Governor. (Idaho Capital Sun)
Idaho H0920: Appropriates funds to the State Board of Education and the Board of Regents for health education programs in fiscal year 2027, including language that shifts $900,000 from the general fund to RHTP dollars and funds 15 new graduate medical education residency slots using federal Rural Health Transformation Program money. It passed the House 47-22 and the Senate 22-11, and the Governor signed it on April 2. (Idaho Legislature)
Kentucky HB500: Kentucky’s biennial budget bill covering fiscal years 2027-2028, providing appropriations for all state operations including the Cabinet for Health and Family Services, which administers the state’s $212.9 million RHTP award. The bill includes broad-based cuts of 4% in FY 2027 and 3% in FY 2028 with 2% salary increases for state employees. It passed both chambers and has been delivered to the Governor. (Kentucky Legislature)
Maryland SB282: Maryland’s omnibus budget bill for fiscal year 2027, encompassing all state agency appropriations including the Department of Health, which administers the state’s $168.2 million first-year RHTP allocation. The bill passed both chambers and has been enrolled. (Maryland General Assembly)
Ohio HB730: A capital reappropriations bill for the biennium ending June 30, 2028. The Senate Finance Committee attempted to attach amendments appropriating Ohio’s $404 million RHTP award, but the amendments were stripped on the Senate floor to meet the March 31 passage deadline. Speaker Huffman acknowledged the chambers could not reach agreement on the rural health language and opted to deal with it in a separate vehicle. The underlying reappropriations bill was signed by the Governor, but Ohio’s RHTP spending authority remains unresolved. (Ohio Capital Journal)