Rural Health Transformation

 
 
 
 
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Overview


The Rural Health Transformation Program (RHTP) is a $50 billion federal opportunity to improve health care in rural areas across the 50 states.

RHTP is a once-in-a-generation opportunity to modernize rural health care and make it more sustainable. Nebraska received a preliminary notice of award from the Centers for Medicare & Medicaid Services (CMS) for approximately $218.5 million in the first year. 

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    Updates

    Nebraska received $218.5 million for the first year of a five-year grant. DHHS received a revised notice of award from the Centers for Medicare and Medicaid Services (CMS) dated February 27, 2026, for Nebraska's updated plan and budget. This approval allows DHHS to access the federal funds to launch Nebraska's seven initiatives. ​

    A project of this size and scope requires participation from many stakeholders across multiple fields. Nebraska intends to release multiple Requests for Applications (RFAs) over the next five years to provide organizations with multiple opportunities to apply for funds and assist in implementing this important work. There will be additional opportunities for applications in each funding year.


    Get Involved

    Application next steps and timeline

    DHHS aims to open RFAs throughout the year, starting in March. 

    • Funding awards are expected to begin in Spring 2026.
    • There will be additional opportunities for applications in each funding year.


    Timeline: Updated 2/17/2026

    Future funding opportunities may be added. View the Timeline PDF​.​​

    Nebraska Rural Health Transformation InitiativesEligible to Respond to RFANotesRFA Release Date
    Initiative 1: Make Rural Nebraska Healthy Through Food as Medicine
    1.1 School Kitchen Modernization Grant Any public or private elementary, middle, or high school in rural or frontier counties.Interagency agreement with the Department of Education, and they will release the RFA

    Project to supply equipment for schools to serve whole fresh food
    TBD – dependent on NDE.  
    1.2 Regional Food Pantry Development Non-profit organizations and co-ops Increase the availability of whole fresh foods.3/9/2026
    1.3 Farm-to-School Procurement & TA Local rural farmers, ranchers, and food suppliers.Interagency agreement with the Department of Education, and they will release the RFA

    Project to enhance kitchen-ready local supply chain for rural schools
    TBD – dependent on NDE.  
    1.5 Nebraska Kids Fitness & Nutrition Local Health Department and Tribal Partners - targeted, narrow RFA release to continue work started by the LHD in 2025.  Local activities focusing on health literacy and healthy behaviors.3/16/2026
    Initiative 2: Regionalized Rural Access and Navigation
    2.1b EMS Regionalization Emergency Medical Service agencies who are ready and willing to participate as regional lead agencies.Assessments will identify regions, then EMS region lead agencies will help identify areas to standardize (medical direction, equipment, protocols, and tiered response structures). May 2026 (after assessments conducted)
    2.2b Rural Jurisdictional StockpilesLocal Health Departments willing and able to manage inventory Ensure rapid access to essential medical supplies during emergencies and reduce reliance on federal deployments.1/21/2026
    2.3a Community Health Worker Networks Local and Tribal Health Departments Represents phase 1.  Phase 2 release will target other rural clinic settings.1/8/2026
    Initiative 3: Rural Workforce Acceleration
    3.1 Rural Provider Recruitment and Retention IncentivesIndividual health care providersIncentive payments to eligible licensed healthcare providers for 5-year service commitment in a rural facility (eligibility includes license type, serving Medicaid patients).Ongoing 
    3.3 Rural Health Care Workforce Incentive & Sustainability Local and state governments, Indian tribes, institutions of higher education, or other eligible organizations in rural Nebraska who can meet the requirements of a SNAP E&T training program. Start-up grants for new SNAP E&T training sites.3/9/2026
    Initiative 4: eHealth and Mobile Care
    4.2a Oral Health (NE Teeth Forever) Local and Tribal Health DepartmentsProvide for and expand access to preventive oral health services in rural, frontier, and tribal communities through community-based delivery models.1/8/2026
    4.4a Chronic Disease Management Rural Clinics, Federally Qualified Health Centers (FQHCs), Certified Community Behavioral Health Clinics (CCBHCs), Local Health Departments (LHDs), Critical Access Hospitals (CAHs), Rural Emergency Hospitals (REHs), Rural Hospitals (non-CAH), Tribal Health FacilitiesProjects to expand community-based education, care navigation, and self-management support for individuals living with chronic conditions, often through community health workers.2/24/2026
    Initiative 5: Rural Emergency Behavioral Health
    5.3 Modification of Existing Clinical Facilities for Crisis Stabilization Centers.Non-profit organizations rendering BH crisis services.Provide funding for equipment and enhancements to hospitals and behavioral health providers to expand crisis response, stabilization, and substance use withdrawal services in rural areas.Mid-March 2026

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    News

    DHHS News Release: March 11, 2026, DHHS Releases RFAs for RHTP Funding Opportunities

    Governor's News Release: December 29, 2025, Gov. Pillen Touts Huge Rural Health Transformation Program Award



    Applications and Proposed Initiatives

    As part of its application, Nebraska proposed seven statewide initiatives that reflect ideas and feedback from hundreds of stakeholders and community partners. These initiatives outline how Nebraska could use RHTP funds to strengthen the state's rural health infrastructure, address workforce gaps, and ensure access to care through consumer-facing technology.

    Nebraska Initiatieve - Click to view an accessible PDF.
    View an accessible PDF.



    Funding Uses 

    Nebraska Rural Health Transformation Initiatives
    Initiative 1: Make Rural Nebraska Healthy Again Through Food as Medicine
        1.1 School Kitchen Modernization Grant supplies equipment for schools to serve whole fresh food
        1.2 Regional Food Pantry Development to increase availability of whole fresh foods
        1.3 Farm-to-School Procurement & TA enhances kitchen-ready local supply chain for rural schools
        1.4 Healthy Menu Design training for rural schools, hospital cafeteria staff, and clinic dieticians
        1.5 Nebraska Kids Fitness & Nutrition Day focuses on health literacy and healthy behaviors
    Initiative 2: Regionalized Rural Access and Navigation
        2.1 EMS & Perinatal Regionalization for referrals and provider-pairing program for high-risk cases
        2.2 Community Paramedicine program with billing support and workforce development
        2.3 Rural Health Hubs and Community Health Worker Networks across health care settings
        2.4 Veteran EHR Coordination to connect VA scheduling staff to local clinics and hospitals
        2.5 CAH to REH Conversion to ensure health care stays local  
    Initiative 3: Rural Workforce Acceleration
        3.1 Rural Provider Recruitment & Retention such as hiring incentives and apprenticeships
        3.2 Rural VR & Skills Acceleration Network to test competency during training
        3.3 Rural Health Care Workforce Incentive & Sustainability start up grants for new training sites
        3.4 School-Age Health Care Pipeline educating youth about jobs in health care
        3.5 Subsidized Short-Term Provider Housing to support employers in recruiting workforce  
    Initiative 4: eHealth and Mobile Care
        4.1 Mobile Maternal Care & Training in maternity deserts to decrease morbidity and mortality
        4.2 Oral Health programs including new student rotations and mobile services
        4.3 Technology-Enhanced Pharmacy Services for medication reviews and patient adherence data
        4.4 Chronic Disease Management & Remote Patient Monitoring in facilities and at home
    Initiative 5: Rural Emergency Behavioral Health
        5.1 Integrated Primary Care providing behavioral health services in clinics
        5.2 Telehealth Crisis Responders for Law Enforcement is 24/7 access to counselors for triage
        5.3 Modification of Existing Clinical Facilities for Crisis Stabilization Centers
        5.4 Behavioral Health Nursing Homes Pilot provides enhanced payments for complex care needs
    Initiative 6: Assisted Living Facility (ALF) Special Needs Population Incentive Model
        6.1 Incentive Payments for Memory Care and Complex Care including training and programming
        6.2 Facility Modernization Grant to support needs of staff and residents
    Initiative 7: Nebraska Rural Health Technology Catalyst Fund and Partnership Initiative​


    Background

    H.R.1, signed into law on July 4, 2025, enacted the Rural Health Transformation Program (RHTP), which allows for the allocation of funding to support the provision of health care in rural areas.​ ​​​​​

    RHTP fundi​ng consists of $50 billion ($10 billion per fiscal year) to be distributed to states ​​from fiscal year 2026 through fiscal year 2030. 

    $25 billion will be distributed equally amongst all approved states. The remaining $25 billion will be ​allocated by the CMS based on a variety of factors, including:

    • The state's rural population
    • The proportion of rural health facilities in the state
    • T​he situation of certain hospitals in the state
    • Other factors specified in the CMS Notice of Funding Opportunity (NOFO)​​

    Important Dates​

    • July 4, 2025H.R.1 was signed into law, establishing the RHTP.
    • September 15, 2025: CMS posted the Notice of Funding Opportunity (NOFO) for the RHTP.
    • November 5, 2025: States that choose to apply for RHTP funding must do so by this date.
    • December 31, 2025: CMS must approve or deny applications by this date.
    • January 30, 2026: Revised plan documents submitted to CMS for approval. ​


    Why RHTP Funding Matters for Nebraska

    ​​​With 37% of Nebraskans liv​​ing in rural areas, RHTP funding ​​has the potential to make a significant impact in our state. 88 out of Nebraska's 93 counties are rural, with 30 of these ​classified as frontier counties. 


    Contact Us

    Email: DHHS.RHTP@nebraska.gov

     

     

    The Rural Health Transformation Program is supported by Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services (US HHS) as part of a financial assistance award totaling $218,529,075.01 with 100 percent funded by CMS/US HHS. The contents are those of the Nebraska Department of Health and Human Services (DHHS) and do not necessarily represent the official views of, nor an endorsement, by CMS/US HHS, or the U.S. Government.

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