Key Focus Areas in State Rural Health Transformation Program Initiatives
The federal Rural Health Transformation Program (RHTP), a $50 billion initiative encouraging states to innovate in rural health care, represents a pivotal moment for rural systems nationwide. All 50 states submitted applications by the November 5 deadline, each detailing strategies to expand access, improve quality, and build sustainable rural health systems.
After analyzing 37 state applications that are now publicly available, Coral has identified emerging models, unexpected approaches, and promising experiments that signal where rural health care is headed. Our State Initiative Tracker includes this analysis, a state-by-state initiative matrix, and an inventory of links to public applications.
What's striking is the near-universal focus on certain priorities:
| Initiative Category |
Number of States (of 37) |
|---|---|
| Health Care Workforce | 37 |
| Telehealth & Digital Infrastructure | 36 |
| Mobile / EMS / Mobile Health | 29 |
| Chronic Disease Prevention & Management | 34 |
| Maternal & Child Health | 28 |
| Payment Models / VBP / Financial Reform | 30 |
| Infrastructure & Facility Modernization | 32 |
This convergence reveals a shared understanding of what rural health transformation requires, even as states take different approaches to implementation.
Health Care Workforce
Workforce development is the foundation of rural transformation, and states are moving beyond traditional recruitment. Many are redesigning care teams by expanding roles for pharmacists and community health workers and building high school–to–health career pathways. The focus is shifting from hiring more clinicians to creating new workforce models altogether.
Telehealth & Digital Infrastructure
Telehealth shows up in nearly every application, but states are starting from very different places. Some are still working on broadband and basic video visits, while others are piloting AI tools, predictive analytics, and regional data platforms that connect EHRs across rural systems. A small but growing group intends to test remote monitoring at scale and build command centers to track patients across multiple facilities.
Mobile / EMS / Mobile Health
States are moving beyond traditional referral networks toward more coordinated, community-embedded rural systems. Many proposals describe shared governance, pooled specialist coverage, centralized telehealth hubs, and even “virtual hospital” models that link multiple sites. At the same time, states are expanding mobile clinics, school-based dental units, pharmacist-led outreach, and community paramedicine to bring care directly into homes and communities. Together, these shifts point to a more integrated and decentralized approach to rural care delivery.
Chronic Disease Prevention & Management
States are pushing further upstream with chronic disease prevention and management, embedding care coordinators in community settings, partnering with food and housing organizations, and offering screening in non-clinical spaces. This emphasis on prevention and social needs could significantly reshape rural care over time.
Maternal & Child Health
Maternal health plans are among the most detailed components of many applications, and they closely parallel the priorities emerging through TMaH. States are combining hospital obstetric investments with expanded doula and midwifery services, tele-OB support, and regional collaboratives with defined transfer protocols. The breadth of these strategies signals that maternal health is not only an urgent need but also a proving ground for the kind of integrated, multi-setting care delivery that both RHTP and TMaH are aiming to advance.
Payment Models / VBP / Financial
States recognize that rural transformation depends on more stable and flexible payment structures. Proposals include global budgets for rural hospitals, shared savings arrangements, infrastructure payments outside fee-for-service, and short-term stabilization funds. The common goal is predictable revenue that supports prevention and small-volume care without putting providers at financial risk.
Infrastructure & Facility Modernization
Physical infrastructure is another recurring focus. States outline plans to renovate hospitals and clinics, modernize diagnostic and maternity units, and upgrade EMS and public health facilities, often alongside digital investments such as telehealth-ready spaces. These capital projects are designed to support new care models and make rural sites more attractive places to work.
What Emerges from the Applications
Taken together, the applications show both convergence and experimentation. States share a common view of the core challenges, but they are testing different combinations of workforce, technology, payment, and care models tailored to local context. These are proposed strategies and what ultimately gets implemented will depend on CMS award decisions and budget negotiations between states and the federal government. This compendium maps that landscape so state leaders, health systems, and partners can see where strategies align, where they diverge, and where there may be opportunities to collaborate on the next generation of rural health care.
At Coral Health Advisors, we help states and partners navigate this transformation with strategic insights that illuminate emerging opportunities. Contact our team to discuss how our analysis can inform your rural health strategy.