Leveraging CMS’s Rural Health Transformation Program to Strengthen Rural Opioid Response

In late September the Centers for Medicare & Medicaid (CMS) launched a Notice of Funding Opportunity for the new Rural Health Transformation (RHT) Program, which was created under the One Big Beautiful Bill Act (OBBBA) to improve health care access, quality and outcomes in rural communities. This program will deliver up to $50 billion over five years (FY2026–2030) to states to reimagine rural health systems and make them more sustainable. States can use these funds to expand access to behavioral health and substance use disorder (SUD) treatment, invest in value-based care and telehealth initiatives, and bolster workforce recruitment, retention, and development programs. The need is significant — data shows that rural residents are nine times less likely to have access to buprenorphine, a medication for opioid use disorder, and face greater challenges accessing SUD prevention and treatment services compared to urban residents, which result in more inpatient hospital stays.

This new funding offers an important opportunity to reshape SUD care in rural communities. At the same time, it’s critical to remember that states already have significant resources through State Opioid Response (SOR) grants, the Substance Use Prevention, Treatment, and Recovery Services Block Grant (SUBG), and Opioid Settlement Funds. While each of these funding streams is vital, they are often managed in silos. By strategically aligning them with RHT, states can braid and blend funding to create durable rural systems of care that extend well beyond a single grant cycle.

Here are three strategies states can adopt to leverage RHT in concert with existing opioid funding.

1. Expand Treatment Access by Layering SOR and SUBG with RHT Investments

RHT allows states to use funds to expand access to opioid use disorder (OUD) treatment, by investing in infrastructure and systems needed in rural areas. By integrating this new funding with existing SOR and SUBG funds, states could bolster different parts of the SUD system. For example, states could use SOR to pay for providers delivering medications for OUD, SUBG could fund recovery housing and peer specialists, and RHT would outfit a rural clinic with telepsychiatry capacity and expand broadband access — ensuring all parts of the care continuum are covered.

2. Build and Retain a Rural Behavioral Health Workforce by Leveraging Settlement Funds Alongside RHT

Recruiting and retaining clinicians in rural areas is a core focus of RHT, with allowable uses including scholarships, loan repayment, and workforce training. Different funding streams could be used to pay for health workforce programs. For example, a state could launch a “Rural Opioid Workforce Corps” using settlement dollars for recruitment and training, RHT for infrastructure (loan repayment systems, telehealth platforms, and clinical supervision networks), and SOR/SUBG to support direct service delivery once providers are placed.

3. Create a Full Continuum: Prevention, Harm Reduction, and Overdose Response

RHT encourages prevention, chronic disease management, and consumer-facing technologies — all of which can support opioid prevention and response services. This can support ongoing work funded through grants and settlement funds. For example, a rural region could use SOR funds to distribute naloxone and train first responders, SUBG to support a school-based prevention program, opioid settlement funds to build a county overdose data dashboard, and RHT to integrate EMS, hospital, and public health data for a coordinated overdose response system.

Braiding Funds for Lasting Impact

Too often, opioid funding sources operate in silos, leading to fragmented care and short-term gains. The RHT Program gives states a chance to connect RHT with SOR, SUBG, and Opioid Settlement Funds, which each have unique roles, into a unified rural strategy.

By aligning these funding streams, states can do more than just respond to the current opioid crisis — they can build resilient, rural health systems that are equipped to handle broader behavioral health needs. The key is not to treat RHT as just another siloed effort, but as new scaffolding that allows all opioid funding sources to come together in ways that are greater than the sum of their parts.

Aurrera Health Group supports states in advancing opioid response efforts by strengthening policy and programmatic implementation including helping them expand access to treatment, implement overdose prevention and response strategies, and build recovery supports. Our firm understands the needs of rural communities and is ready to partner with states to develop federal applications for RHT and support states in their implementation to reduce the burden of SUD.

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Authors

Kelly Murphy [Managing Principal]