Strengthening the rural health workforce is a key goal of the Rural Health Transformation Program (RHTP). State applications for the RHTP are due today, November 5, 2025, with states expected to receive funding decisions from the Centers for Medicare & Medicaid Services (CMS) by the end of the year.RHTP are due today, November 5, 2025, with states expected to receive funding decisions from the Centers for Medicare & Medicaid Services (CMS) by the end of the year.

Rural health workforce challenges

While the US health care system faces a growing workforce shortage, rural communities are projected to be disproportionately impacted by this trend, with the number of rural physicians expected to decline 23% by 2030. Rural areas have approximately one-ninth of the number of providers per capita compared to urban areas, with 91% of rural counties facing a primary care physician shortage, and shortages of specialists across provider types, including maternity care, dental, and behavioral health.

Further complicating the lack of providers in rural areas is the closure of 110 rural hospitals over the last 20 years, leaving many communities without emergency or inpatient services, and requiring rural residents to travel long distances to access care. Many rural residents will delay or forgo care, ultimately leading to poorer health outcomes and widening rural and urban health disparities.

Opportunities for rural health workforce enhancements

Through the grant program, states are encouraged to design and implement strategies that sustainably expand the number of rural providers. Strategies that states could adopt through the approved uses of funds outlined in the RHTP Notice of Funding Opportunity (NOFO) include:

Supporting workforce pipelines and recruitment pathways, such as rural physician residency programs.
Increasing signing and retention bonuses for remote community providers, which benefit both the providers and the rural communities they serve.
Developing defined career and upskilling ladders to encourage providers to practice in underserved areas.

Per CMS, strong state RHTP applications will demonstrate strategies to bolster clinical roles in rural communities to help address key service gaps, such as modifying licensing requirements or implementing expanded scope of practice. The RHTP also encourages states to invest in technologies which can bring care closer to where rural residents live, such as remote patient monitoring or telemedicine. These efforts will help extend the care network through enhanced coordination and by connecting rural residents to specialized care regardless of location.

What’s next: putting plans into action

States should be informed about grant awards by December 2025. By January 2026, they must translate their initiatives into detailed work plans and implementation strategies. This will be a critical time for states to align stakeholders and partners, allocate resources, and design solutions that will deliver measurable, meaningful impact for rural communities in the years ahead.

As they launch RHTP workforce initiatives, states can consider the following to support implementation:

Engaging stakeholders throughout the implementation process to address emerging issues. Many states gathered wide-ranging input into the development of their RHTP application through town halls and other forums. The NOFO also required that states create a stakeholder engagement plan with a clear governing structure. Just as states incorporated feedback into their application, this feedback loop will be invaluable to ensure programs are implemented as intended, and challenges are addressed early.
Connecting with peers to support shared learning. States have a great deal to learn from each other as they work through the RHTP. While each state’s circumstance is unique, states face common threats to health care workforce development (e.g., housing affordability and competition for labor). Sharing lessons learned can help states refine their RHTP initiatives or consider adopting new strategies outside the program.
Ensuring outcome measure collection helps them tell their success story in the future. CMS required that states identify outcome measures for each initiative. Ensuring the validity of baseline reporting on workforce issues and building robust systems to monitor outcomes over time will help states build the case for successful strategies that need to transition to new funding streams when the RHTP ends.

More on the Rural Health Transformation Program

Aurrera Health is publishing a series of blog posts highlighting the impact of the forthcoming RHTP. We look forward to partnering with states and other stakeholders to identify and implement strategies that maximize the funding. If you would like to discuss how we can help, please reach out to Lauren Block.