Request for Information (RFI):

The Rural Health Transformation Program

RESPOND

Request for Information

The Cicero Institute is a public policy 501(c)3 that advocates for entrepreneurial, market based solutions to public policy issues, primarily focused on state government. We also provide expertise and technical assistance to state lawmakers and executive branch leaders. Consistent with that philosophy, the Cicero Institute is seeking proposals for the Rural Health Transformation Program under the One Big Beautiful Bill Act (OBBA). The insights collected through this RFI will be collected, published and shared with state Health and Human Services secretaries, Medicaid Directors and legislators as they develop their state-specific Rural Health Transformation Plans for submission to the Centers for Medicare and Medicaid Services (CMS).

We seek innovative, evidence-based, and actionable ideas that align with the OBBA’s authorized uses of the Rural Health Transformation Fund. Responses should be concise and focused, outlining specific proposals that address the unique healthcare challenges in rural communities.

Submission Guidelines:

• Responses are limited to no more than 1,000 words.
• Please clearly indicate which category or categories your proposal addresses. You may propose a plan that fits multiple categories. However, please make separate proposals for different ideas or concepts. There is no limit on the number of proposals an entity may submit.
• Submissions should include a brief description of the proposed initiative, its potential impact on rural healthcare, and a general plan for implementation.

Parameters of the Rural Health Transformation Program 

The Rural Health Transformation Fund, established by the One Big Beautiful Bill Act (OBBBA) of 2025, allocates $50 billion over five years to states to support rural healthcare. Administered by the Centers for Medicare and Medicaid Services (CMS), the program provides $10 billion annually for fiscal years 2026-2030. States must submit comprehensive rural health transformation plans to CMS by December 31, 2025, to be eligible for the grants.  

The funds are to be distributed to states through a two-part formula. Fifty percent (50% or $25 billion) will allocated equally among all states with an approved plan, while the remaining fifty percent (50% or $25 billion) will be distributed at the discretion of the CMS Administrator. The Administrator’s decision is based on factors like a state’s rural population percentage, the proportion of rural health facilities, and the financial situation of its hospitals.

Official federal guidance is expected soon. Early public remarks and discussions have emphasized that the funds are intended for sustainable, long-term transformation, not just temporary relief. States are encouraged to use the funding to invest in new technologies, promote innovative care models, and address systemic challenges facing rural healthcare. The guidance stresses the importance of stakeholder engagement in developing state plans. While the law outlines general categories for use, CMS has substantial discretion in evaluating and approving state plans. They will monitor implementation to ensure funds are appropriately distributed and used for their intended purpose.

Please address your proposal to one or more of the following categories outlined in OBBBA:

1. To improve access to hospitals, other health care providers, and health care items and services furnished to rural residents of the state;
2. To improve health care outcomes of rural residents of the state;
3. To prioritize the use of new and emerging technologies that emphasize prevention and chronic disease management;
4. To initiate, foster, and strengthen local and regional strategic partnerships between rural hospitals and other health care providers in order to promote measurable quality improvement, increase financial stability, maximize economies of scale, and share best practices in care delivery;
5. To enhance economic opportunity for, and the supply of, health care clinicians through enhanced recruitment and training;
6. To prioritize data and technology driven solutions that help rural hospitals and other rural health care providers furnish high-quality health care services as close to a patient’s home as is possible;
7. That outlines strategies to manage long-term financial solvency and operating models of rural hospitals in the State; and
8. That identifies specific causes driving the accelerating rate of stand-alone rural hospitals becoming at risk of closure, conversion, or service reduction
9. Other: A proposal that is generally consistent with the goals of the RHTF but not explicitly stated.

RESPONSE DUE DATE

Responses are due by 9/16/2025 at 11:59pm ET. Responses after that time may be reviewed, accepted and shared but only those received by the deadline are guaranteed to be reviewed and considered for the initial publication. Responses will be summarized, published and shared with interested parties, primarily state Health and Human Services leaders and legislators.