RHTP Timeline

Key dates and deadlines for the Rural Health Transformation Program, from legislation through fund distribution and compliance reporting.

Jul 2025Federal

One Big Beautiful Bill Act Signed

President signs OBBBA into law (P.L. 119-21), establishing the $50B Rural Health Transformation Program over 5 years (FY2026–2030).

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Sep 2025Federal

CMS Publishes NOFO

CMS releases the Notice of Funding Opportunity on Grants.gov, detailing eligibility, scoring criteria, and reporting requirements.

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Nov 2025State

State Applications Due

Deadline for states to submit RHTP applications to CMS. All 50 states applied, each submitting one coordinated application.

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Dec 2025Federal

CMS Announces All 50 Awards

CMS announces FY2026 awards for all 50 states, totaling $10B. Awards range from $147M (NJ) to $281M (TX). CMS establishes new Office of Rural Health Transformation.

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Jan 2026State

State Implementation Planning Begins

States begin standing up program offices, hiring staff, and entering cooperative agreements with CMS. Timelines vary by state.

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Mar 2026State

States Open Sub-Award RFPs

Through spring 2026, most states released their first competitive RFPs/RFAs for RHTP sub-awards. Delaware opened initial RFPs in February; by late May 2026, more than 20 states had active solicitations (e.g. Florida, Texas, Utah, New Mexico, West Virginia, Louisiana, Minnesota, South Carolina).

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May 2026State

First State Sub-Award Decisions

North Carolina selected its NC ROOTS regional Hub Leads across all six Medicaid regions — among the first major RHTP sub-award decisions. New Hampshire completed awards for all five of its GO-NORTH intermediary hubs.

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Jun 2026Compliance

Compliance Framework Finalization

Estimated target for states to finalize compliance and reporting frameworks, including outcome metrics and audit procedures per 2 CFR 200 Subpart F.

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Sep 2026Compliance

Budget Period 1 Ends

First budget period (Dec 31, 2025 – Sep 30, 2026) closes. States submit SF-425 Federal Financial Reports for Year 1 spending.

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Oct 2026Federal

FY2027 Awards (Year 2)

CMS recalculates workload funding and announces second-year awards. States receive updated allocations based on Year 1 performance.

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Dec 2026Compliance

First Quarterly Reports Due

States submit quarterly progress reports to CMS covering initial implementation activities and early program metrics.

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Mar 2027Compliance

First Outcome Metrics Due

States report on minimum 4 quantifiable outcome metrics (access, quality, financial sustainability, workforce) — at least 1 at county level.

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Sep 2030Federal

Final Appropriation Year Ends

Last year of RHTP appropriations concludes. $50B fully distributed across all 50 states. States have until FY2031 to spend down final-year funds.

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