What Nonprofits Need to Know About the Rural Health Transformation Program

You may have seen the news that Montana is receiving a significant federal investment to support our rural health system. Following the first public stakeholder meeting on January 22, we learned more about the state’s plan, the partners involved, and the opportunity this five-year program presents to our state.  

The RHTP was created by Congress as part of H.R. 1, the federal reconciliation bill. The program includes $50 billon nationwide – $10 billion per year from 2026 through 2030 – to provide state grants to support and strengthen rural healthcare systems. The program was created, in part, as an attempt to mitigate the impacts of significant Medicaid cuts also included in H.R. 1, estimated at more than $900 billion over the next decade.  

While these one-time grants will not replace long-term funding losses for Montana’s health system, they offer a rare opportunity to invest in Montana’s rural health infrastructure, workforce, technology, and community-based care models.    

Montana will receive $233 million in the first year, placing the state on track to receive nearly $1.2 billion over five years. For 2026, Montana received the 4^th highest award in the nation.  

Each year, $5 billion in funding will be distributed evenly across all states, while the remaining $5 billion will be awarded through a competitive Notice of Funding Opportunity. Awards are based on factors such as the rurality of the state, the needs of the state’s rural healthcare system, and proposed or ongoing initiatives.  

Montana will submit their first report to the federal Centers for Medicare & Medicaid Services (CMS) in August 2026, which will inform the state’s funding award for 2027. Decisions about how funding is used in later years are likely to be a topic of discussion during the 2027 Legislative Session.  

Montana’s RHTP plan reflects five core initiatives: Workforce Development, Sustainable Access, Innovative Care Models, Community Health and Prevention, and Technology Innovation. Each initiative has different activities, priorities, metrics, and timelines.  

Program materials, updates, and additional information will be posted on the state’s RHTP website at ruralhealth.mt.gov. Check back regularly as implementation moves forward.  

While the RHTP is focused on strengthening Montana’s rural health system, its impact extends well beyond hospitals and clinics. Nonprofits across many mission areas are deeply connected to the health and well-being of rural communities. 

Staying informed and engaged can help ensure that community voices are reflected in implementation—and that funding is used in ways that strengthen local capacity, improve outcomes, and support the people and places you serve. 

Montana DPHHS will partner with outside organizations to implement various rural health projects. The first Requests for Proposals (RFPs) are expected to be released in March 2026. Most funding opportunities will be offered through a competitive procurement process and posted at bids.mt.gov. 

In addition, there may be grant or direct funding opportunities available for rural communities and local providers. These opportunities will be announced at ruralhealth.mt.gov as they become available.  

Implementation of the RHTP will be informed by a stakeholder advisory committee convened by the MSU Office of Rural Health. This committee includes representatives from Tribal Nations, health associations, state agencies, and other rural health partners. The committee serves in an advisory role and does not have decision-making authority.  

A key component of the RHTP will also be a Center of Excellence (CoE), which will provide targeted recommendations and financial incentives to strengthen rural health facilities. The CoE will be overseen by a governing board that includes state legislators and representatives from rural health facilities. Unlike the stakeholder committee, this governing board will have decision-making authority related to the CoE. DPHHS expects to appoint board members in the next few months.   

Members of the public can submit questions, comments, or feedback about the RHTP by emailing HHSRuralHealthTransformation@mt.gov.