About the Rural Health Transformation Program

A notice of funding opportunity was released on September 15, 2025, by the Centers for Medicare and Medicaid to help states “support rural communities across America in improving healthcare access, quality, and outcomes by transforming the healthcare delivery ecosystem.”  

Through this funding application, Massachusetts seeks to strengthen the rural health system and ensure every community has access to high-quality, sustainable care. 

Vision: A Commonwealth where rural communities thrive, and well-being is achievable for all. 

To advance this vision, the Rural Health Transformation Program proposal focuses on three overarching goals: 

• Expand access to essential healthcare services for rural residents.
• Improve health and well-being through targeted initiatives and partnerships.
• Strengthen systems, policies, and investments to meet the unique needs of rural communities. 

For additional information on the Federal Rural Health Transformation Program: Rural Health Transformation (RHT) Program | CMS 

Rural Health Challenges and Opportunities for Transformation 

In Massachusetts, 160 of 350 towns are classified as rural, covering over half the state’s land and home to roughly 10% of the population (700,000+), including many vulnerable groups such as seasonal workers, tribal members, older adults (60+), and low-income families.  

The DPH State Office of Rural Health (SORH) defines rural communities based on federal criteria, population size and density, and the presence of small or critical access hospitals. Areas are categorized as Rural 1 or Rural 2 and grouped into 18 rural clusters to guide state policy.  

Rural communities experience major healthcare disparities in access and outcomes due to limited providers, aging infrastructure, and systemic decline in local health services. These areas face higher chronic disease and behavioral health burdens, workforce shortages, and financial instability, resulting in poorer health outcomes compared to non-rural regions. Addressing these challenges requires targeted investments in workforce development, infrastructure, and access to primary and specialty care. 
 

Massachusetts' Application 

Massachusetts submitted an application to the Rural Health Transformation Program through the Executive Office of Health and Human Services (EOHHS). EOHHS led an interagency team to develop the application, including the Massachusetts Department of Public Health (DPH), the Massachusetts Medicaid program (MassHealth), DPH’s Office of Rural Health, the Massachusetts Executive Office of Economic Development’s Office of Rural Affairs, and input from other agencies throughout state government.   

Through longstanding relationships with key stakeholders and pre-established processes and groups to support direct engagement, the team held early engagement sessions with our state’s rural hospitals, rural federally qualified health centers (FQHCs), rural social service organizations, rural community-based organizations, and the Massachusetts Rural Council on Health. Additionally, the Commonwealth facilitated direct input for the application from trade associations, as well as organizations representing local administrators and municipalities throughout rural Massachusetts. 

To ensure broad opportunities for input from throughout the Commonwealth, EOHHS also posted a public Request for Information, which received responses from rural organizations, healthcare providers, social service organizations, rural municipalities, technology companies, expert consultants, non-profits, businesses, and educational providers.   

The RHTP application reflects a broad spectrum of input from partners across the state and is structured around seven Initiatives, each of which contains numerous activities, to transform rural healthcare in Massachusetts: 

1. Population Health Advancement: Improve clinical infrastructure, increase coordination and expand payment methodologies to advance rural health providers’ value-based care and efforts to lower cost and increase quality of care.
2. Innovation in Rural Care Models: Facilitate the introduction and redesign of models in rural Massachusetts to increase access, broaden service availability, and improve efficiencies in the delivery of health care.
3. Training Healthcare for Retention, Innovation, & Excellence (THRIVE): Strengthen the full continuum of the healthcare workforce in rural communities with targeted activities focused on workforce development, recruitment, and retention.
4. Healthy Rural Communities: Support community-informed and led prevention activities to increase opportunities and address gaps related to the root causes of health.
5. EMS Service Integration: Investments and programs to increase viability, integration, and expand role of EMS in rural communities.
6. Enhancing Technology Interoperability and Connectivity: Improving technological infrastructure of rural health providers to increase connectivity, create efficiencies, and support better outcomes.
7. Facility Modernization & Re-Use: Support minor renovations of rural facilities to optimize space and expand access. 

Following submission, EOHHS is awaiting additional feedback from our federal partners on our application, including how much funding may be awarded to the Commonwealth. If Massachusetts is awarded funding through the RHTP, these Initiatives will represent a substantial investment in improving rural health services across the Commonwealth. We invite all stakeholders to join us in this effort and to stay informed about progress and opportunities for engagement. As we move forward with the Rural Health Transformation Program, we will continue to seek input and feedback.