A momentous opportunity for healthcare in Montana

The Rural Health Transformation Program (RHTP) was created by H.R. 1, the One Big Beautiful Bill Act, passed by U.S. Congress in July 2025. The program will provide $50 billion in federal grants to help protect and enhance rural healthcare across the country. Funding will be released over the course of five years to states with approved applications. The Centers for Medicare and Medicaid Services (CMS) lists five strategic goals of the program, including make rural America healthy again, sustainable access, workforce development, and tech innovation.

Given its high rurality, Montana is projected to receive more than its equal share of those funds compared to many other states.

>>>If Montana’s application for the equally distributed funds is approved, the state will receive at least $100 million per year from the RHTP, making this a critical opportunity to secure momentous investments that enhance rural healthcare here

Securing RHTP Funds for Montana

The total amount awarded to Montana depends on application approval and determinations by CMS, partially based on factors like rural population, portion of rural health care facilities, and status of healthcare providers.

• Upon application approval, the state (DPHHS) will decide which entities receive funding using its rural transformation plan and application
• Hospitals in states with approved applications are eligible to receive RHTP funding as grant recipients along with a wide variety of healthcare providers and other entities

RHTP provides one-time funding that will end in 2030. Montana’s application from DPHSS outlined five core initiatives designed meet CMS compliance requirements and to address the unique challenges of rural health caredelivery in a sustainable manner, including:

• Workforce development
• Sustainable access
• Innovative Care Models
• Community health and prevention
• Technology innovation

>>> Local hospitals and healthcare providers benefit everyone in Montana’s rural communities. Funding from programs like RHTP could provide important investments for long-term operational, financial, and workforce challenges facing Montana’s rural healthcare system.

Securing RHTP Funds for Your Facility

At this time, it is unknown how much Montana will receive in RHTP funds or how the funds will be made available to eligible entities. DPHHS has indicated that should it be awarded funds, it will engage the Montana Department of Administration to conduct a procurement process to select the necessary partner(s) to perform the work outlined within the sections of its Rural Health Transformation Plan approved by CMS.

We believe the State will prefer to work with a smaller number of statewide partners to efficiently deliver program support and funding to distinct sections of Montana’s healthcare system, rather than working individually with thousands of healthcare providers and partners. MHA plans to respond to any request the State might issue for RHTP program support, with the goal of supporting distribution to the membership with a focus on rural hospitals and systems of care outlined in H.R. 1, especially those with limited resources to pursue and administer highly restricted federal funds.

MHA will post updates on funding opportunities for individual facilities. To sign up to receive updates and action alerts (members only), click here.

RHTP FAQs

Why was the program created?

The fund was appropriated to address concerns about how changes and cuts to the Medicaid program, also passed in H.R. 1, would impact rural healthcare across the U.S. The $50 billion RHTP fund isn’t permanent and will not fully cover the payment cuts projected in H.R. 1. In Montana, Medicaid helps keep people healthy and protects rural care:

• 20% of Montanans are covered by Medicaid (1 out of 5), including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities
• 65% of Montana enrollees (2 out of 3) live in rural areas, making this an important health coverage option for rural Montanans

How will the funds be distributed?

States must submit an application (one-time) to be considered for RHTP funding. CMS will administer the program and has full discretion to approve applications and distribute funds to states.

From 2026-2030, $10 billion will be allocated each fiscal year. Over the course of five years:

• $25 billion equally distributed to states with approved applications
• $25 billion distribution determined by CMS, partially based on set of factors including rural population, portion of rural health care facilities, and others

According to the DPHHS, it’s anticipated that funds are transferred to the State once a year. Awarded funds must then be used by the conclusion of the following budget period. Otherwise, they will be redistributed. Funding can be paid out as subawards or subcontracts to other organizations and entities to execute initiatives with strong State oversight. As of October 2025, DPHHS has not yet made decisions about specific subawards or subcontracts.

When will the funds be distributed?

State applications were due to CMS by November 5, 2025. It is anticipated that CMS will approve or deny applications by Dec. 31, 2025 and funding will be delivered to states in federal fiscal year 2026.

• July 2025: RHTP fund created after H.R.1 passed by Congress
• August 2025: MHA submits multi-partner response to DPHSS RHTP Request for Information
• September 2025: DPHHS prepares the state’s RHTP application with input from stakeholders
• November 5, 2025: DPHHS submits Montana’s RHTP application to CMS
• December 31, 2025: Expected CMD awardee decision
• As soon as December 31, 2025: Fund distribution to states begins
• January-March 2026: Anticipated RFP/procurement process for DPHHS to select partner(s) to help facilitate program and fund distribution; MHA plans to submit proposal on behalf of membership
• January- June 2026: Anticipated funding opportunities/funding distribution begins for member facilities; watch for updates and action alerts from MHA
• 2026-2030: $10 billion RHTP funds allocated each fiscal year

What are the funding priorities?

RHTP permits states with approved applications to use funds for a wide range of purposes based on CMS-required elements. Generally, to gain CMS approval for funding the state plans must meet at least 3 usage priorities/allowable activities outlined in the bill. CMS noted five strategic goals of the program:

• Make rural America healthy again: Support rural health innovations and promote preventive care.
• Sustainable access: Ensure rural providers can become long-term access points for care by improving efficiency and sustainability.
• Workforce development: Build and retain a strong rural health care workforce.
• Innovative care: Test new models of care delivery to improve rural health outcomes and lower the cost of care.
• Tech innovation: Expand use of technologies that promote access and efficiency in rural settings.

How do I secure funds for my facility?

At this time, it is unknown how much Montana will receive in RHTP funds or how the funds will be made available to eligible entities. DPHHS has indicated that should it be awarded funds, it will engage the Montana Department of Administration to conduct a procurement process to select the necessary partner(s) to perform the work outlined within the sections of its Rural Health Transformation Plan approved by CMS.

We believe the State will prefer to work with a smaller number of statewide partners to efficiently deliver program support and funding to distinct sections of Montana’s healthcare system, rather than working individually with thousands of healthcare providers and partners. MHA plans to respond to any request the State might issue for RHTP program support, with the goal of supporting distribution to the membership with a focus on rural hospitals and systems of care outlined in H.R. 1, especially those with limited resources to pursue and administer highly restricted federal funds. MHA will post updates on funding opportunities for individual facilities. To sign up to receive updates and action alerts, click here.