The Rural Health Transformation (RHT) Program was authorized by the One Big Beautiful Bill Act (Section 71401 of Public Law 119-21) and empowers states to strengthen rural communities across America by improving health care access, quality, and outcomes by transforming the healthcare delivery ecosystem. 

Through innovative system-wide change, the RHT Program invests in the rural health care delivery ecosystem for future generations. RHT Program funding is $50 billion to be allocated to approved states over five fiscal years, with $10 billion available each fiscal year, beginning in fiscal year 2026 and ending in fiscal year 2030.

The funding opportunity was coordinated through each state’s governor’s office, with states responsible for administering the funds in ways that best meet their local needs. In Oklahoma, Gov. Kevin Stitt designated the Oklahoma State Department of Health as the lead agency. The program has been shaped through collaboration with multiple state agencies and external partners, and this collaborative approach will continue throughout the life of the program.

Oklahoma’s RHT Program offers an opportunity to transform how health care is delivered in rural areas. It supports easier access to care, stronger community partnerships, more local health workers and modern technology that helps providers connect and coordinate. 

An infusion of dollars will bridge funding gaps across a wide range of rural communities and provider types in Oklahoma’s 59 rural counties, as defined by the Oklahoma Office of Rural Health and aligned with HRSA rural designations—a large portion of Oklahoma that stands to benefit from the RHT Program.

Of the 77 counties in Oklahoma, 59 counties are designated as rural based on the U.S. Department of Agriculture Economic Research Service’s 2013 Rural-Urban Continuum Codes.  This is the same designation used in Oklahoma’s RHT Program application.

• Adair, Alfalfa, Atoka, Beaver, Beckham, Blaine, Bryan, Caddo, Carter, Cherokee, Choctaw, Cimarron, Coal, Cotton, Craig, Custer, Delaware, Dewey, Ellis, Garvin, Grady, Grant, Greer, Harmon, Harper, Haskell, Hughes, Jackson, Jefferson, Johnston, Kingfisher, Kiowa, Latimer, LeFlore, Lincoln, Love, McClain, McCurtain, McIntosh, Major, Marshall, Mayes, Murray, Noble, Nowata, Okfuskee, Okmulgee, Ottawa, Pawnee, Pontotoc, Pushmataha, Roger Mills, Seminole, Stephens, Texas, Tillman, Washita, Woods, Woodward 

Rural communities and residents outside of the designated counties will also be eligible to benefit from the RHT Program through expanded access to care, more technologically connected health systems, better financial sustainability of the healthcare ecosystem, and more.

Oklahoma proposed six core initiatives and 20+ associated programs based on CMS strategic goals and approved use of funds: Rural Health Transformation (RHT) Program | CMS

• Innovating the care model:
  • Making it easier for people to access care where they live. This looks like using telehealth, supporting residents with rides to care, adding more people to care teams, and investing in local health infrastructure
• Moving upstream: 
  • Investing in community-led health and wellness support, including connections to care and new ways to keep people healthy with chronic disease prevention and management programs. 
• Growing next-gen rural talent: 
  • Bringing in more doctors, nurses, and health care workers to rural Oklahoma. This includes “grow your own” programs that emphasize health care professional careers and bring new talent into rural communities.
• Facilitating regional collaboration: 
  • Strengthening partnerships of rural providers to team up and share resources, use better technology, and help with health care management.
• Shifting to value: 
  • Supporting a pathway to risk sharing through technical assistance, building the right systems needed and quality incentive programs. 
• Building health data utility: 
  • Investing in technology, such as electronic health records, that allows systems to talk to each other and use data to better understand and improve patient care.

• Request for Information: Over 400 responses on rural health challenges and funding priorities. These responses were not official proposals/applications but opportunities for Oklahoma residents and organizations to provide input into Oklahoma’s application.
• Listening Sessions: Four sessions across the state to capture local insights and needs. 
• Association Consultations: Meetings with professional and provider associations to understand member needs and opportunities for transformation. 
• Tribal Consultation: Collaborative discussions with Tribal Nations and the Indian Health Service (IHS), engaging more than 60 representatives statewide. 
• Targeted Interviews: Over 40 interviews with rural providers, educational institutions, community-based organizations, and national experts. 
• State Steering Committee: Convened a cross-agency leadership group—including the Department of Health, Department of Human Services, Office of Rural Health, Health Care Authority, Department of Mental Health and Substance Abuse Services, Health Workforce Training Commission, State Department of Education, the Office of the Governor, and a Legislative Liaison 

This outreach gave us a clear picture of rural health needs: workforce shortages, technology gaps, transportation barriers, chronic disease, and the need for more coordinated care.

While no single plan can address every challenge, the RHT Program creates an opportunity to better understand health needs in rural Oklahoma and invest in meaningful, locally driven solutions. It lays the foundation for lasting change, but continued collaboration will be essential.

We encourage communities and stakeholders to engage in ongoing dialogue and collaboration, working together toward addressing the complex realities of rural health care. 

Yes, Oklahoma secured $223.5 million for the first year of the five-year grant.

Oklahoma envisions bringing better care to ALL rural Oklahomans—where they live, work, and play—by filling funding gaps across the state’s 59 rural counties. 

Mothers and children will gain access to much-needed obstetrics services, seniors will see expanded long-term care options, Tribal communities will benefit from stronger connections to care, and those living with chronic conditions like diabetes or behavioral health challenges will have more consistent support. 

This infusion of resources will strengthen hospitals, clinics, and providers across rural Oklahoma, creating a healthier future for every community.

Even counties with urban centers will benefit through regional collaborative initiatives that strengthen the sustainability of local services, support the health care system and improve access across the full-service area. 

Oklahoma received funding beyond the $200 million originally planned, requiring us to revise the budget to include an additional $23 million. This revision has been submitted, and CMS is now in a 30-day review and approval period.

After approval, funding opportunities will be posted to the RHT Program website as they become available.

In the meantime, we are actively working on engaging our partner agencies, stakeholder groups, and local partners to begin the next steps for program implementation.

The state has prioritized improving access to health care. Specific programs aimed at expanding access include transportation support, investments in workforce, and the expansion of technology that enables residents to receive their health care locally.

We will post information about how to apply for RHT Program funding on the Oklahoma RHT Program webpage as it becomes available.

Yes, some entities were identified in advance to lead certain programs. This was done intentionally and in accordance with state procurement laws to ensure funds could be allocated quickly and responsibly.

In several cases, state agencies other than the Oklahoma State Department of Health, such as the Oklahoma Health Care Authority, were selected because they already have the subject-matter expertise or operational infrastructure needed to manage specific initiatives. Using established interagency agreements allows those agencies to receive funds and determine the most appropriate implementation approach, including issuing RFPs or NOFOs when needed.

For many other programs not delegated to another state agency, funding will be awarded through a competitive RFP or NOFO process.

Our application summary clearly outlines how funds will be used and identifies the agency responsible for administering each program, providing transparency into both funding decisions and oversight.

This approach helps avoid delays, ensures compliance and allows programs to move forward efficiently while maintaining transparency and accountability.

Leveraging partner agency knowledge and experience was essential to building strong, effective and sustainable programs. 

Yes, you can view our application here.

Oklahoma will place progress updates on the RHT Program webpage.

Oversight for the funding will include quarterly and annual reports, communications and reporting to our CMS partners, and monthly visits with our CMS officer. The legislature will also be able to view funding progress.

Yes, reporting is a requirement. 

The annual reporting is consistent with other CMS grant opportunities and is structured to ensure states use funding consistent with the terms of the cooperative agreement. CMS uses these reports to track progress on state initiatives, evaluate compliance with cooperative agreement terms, and inform decisions on future funding amounts.  

For the RHT Program, states will also report quarterly and annually on progress on their work plans, timelines, milestones, and achievement of measurable outcomes. 

The specific outcomes and milestones, which Oklahoma will be required to report to CMS, will be determined by the final terms of the awarded cooperative agreement. 

To support quick implementation, strong compliance and timely progress, BCG will continue to support Oklahoma’s RHT Program. Their expertise has been critical to this work so far and will remain valuable as Oklahoma launches and manages a large, complex federal grant exceeding $1 billion.

Learning from others’ experiences is essential, including what is working well and where challenges remain in your community.

We encourage Oklahomans to attend meetings, ask questions and get involved. While every community will take its own approach to improving rural health, we hope collaboration will connect every plan and every community. 

Dates for RHT Program community meetings will be posted on the RHT website.

Yes, entities based in areas outside of the identified rural counties may receive funding; however, the work done with the funding will need to benefit the identified rural areas of the state.  

Residents of rural communities in non-rural counties will also be eligible to participate in many programs targeted toward individuals.

Yes, there were several funding limitations set by CMS, including items like new construction, provider payments to replace payment for clinical services that could be reimbursed by insurance, pre-award costs, and more.

More information on funding restrictions can be found on the CMS FAQ webpage.