Written by Jolie Ritzo, Interim CEO, Civitas Networks for Health®
The Unique Challenges and Opportunities to Improve Health in Rural America
Rural America is home to vibrant communities and is where over 20% of Americans live, but when it comes to health care, these areas often face unique and persistent challenges. Rural hospitals, clinics, and other providers regularly operate with limited resources and recurring workforce shortages, and serve populations with high rates of chronic disease, lower incomes, and upstream drivers of health that are compounded by the effects of geography.
As a result, rural providers have long been under financial and operational strain despite delivering care that is essential to the health and well-being of their communities.
Yet what Civitas Networks for Health® members and other key stakeholders in rural health have learned from years of doing work on the ground, is that while more money from localities, states, and the federal government is vital, funding alone is not enough. Rural providers need to ensure that they have seats at the table where decisions are made, as well as access to helpful resources, new technology, and expertise to strengthen their capabilities along the full spectrum of patient-centered care. This is necessary to improve long-term sustainability.
The One Big Beautiful Bill Act (OBBBA) and the Opportunities Ahead
The July passage of the OBBBA legislation has already begun to alter the health and social service landscape nationwide. Providers, payers, states, and numerous other key stakeholders are preparing for significant Medicaid and SNAP cuts that will disproportionately affect rural communities, where access to care and social services is already under considerable strain. To partially offset these cuts, the law carves out $50 billion specifically for the Rural Health Transformation Program (RHT). Amidst the broader challenges, this funding represents a unique opportunity for each state to reimagine how care is delivered in rural areas, working with rural providers and others from across the wider health sector statewide to develop and implement “rural health transformation plans” for approval by CMS that align with federal funding priorities in the law. These priorities cover not just clinical care and treatment, but the mechanisms by which they can be made more effective: “data and technology-driven solutions,” “measurable quality improvement” activities, and “projects that support innovative models of care”—all core competencies of Civitas members and partners.
Distribution of Funds
The RHT funding will be divided equally among approved states—50 percent of $25 billion—and the remaining 50 percent ($25 billion) will be allocated based on rural population metrics, facility counts, and other factors that the CMS administrator deems appropriate. The first $25 billion, which amounts to $5 billion annually, will be distributed to approved states from 2026 through 2030. For the remaining $25 billion, the administrator has $5 billion per year, which must be allocated to at least one-fourth of the states based on the following criteria:
- the percentage of the state population that is in a rural census tract
- the proportion of rural health facilities in the state compared to the number nationwide
- the number of “deemed disproportionate share” hospitals in the state
- other conditions the administrator deems appropriate
It's Time for Innovative Solutions
States have the chance to build new systems that better serve their rural residents, and with RHT’s short turnaround (an expected early November deadline to CMS), states are seizing the opportunity. At least 24 states have already taken official action, issuing RFPs to solicit ideas and exploring new models for transformation under the leadership of their State Medicaid Agencies, Governors’ Offices, or State Offices of Rural Health. Civitas members–Quality Improvement Organizations (QIOs), Health Information Exchanges (HIEs), Health Data Utilities (HDUs), Regional Health Improvement Collaboratives (RHICs), All-Payer Claims Databases (APCDs), and more–have responded to these calls with detailed proposals and conducted their own outreach, highlighting fundable solutions built from existing trusted infrastructure to state agency decision-makers and providers that emphasize critical data insights, collaboration, and measurable progress toward both federal and state goals.
Building on What Already Exists.
Federal investments and incentives over the last two decades—HITECH, Medicare’s quality programs, Medicaid MES/MMIS—alongside states and the private sector have laid strong foundations for state and regional health data infrastructure and related services. Funding from these programs has been used to establish digitization and network connectivity in many rural areas, but most rural facilities continue to lag behind their urban and suburban counterparts. Other facilities, like behavioral health clinics, were left out of previous funding opportunities and, accordingly, tend to be even further behind.
The RHT is a chance to close these gaps, and in many cases, Civitas members are at the center of this work.
Our HIEs and emerging HDUs, as well as RHICs, QIOs, and APCDs and affiliated organizations have long track records supporting rural hospitals and clinics, built on proven service delivery and the trust that comes from being neutral public and nonprofit actors. For rural facilities, Civitas members represent point-to-point exchanges, access to medical records, claims processors, technical support, population health tools, improvement partners, and patient navigators that provide essential links to the wider health system, including the state agencies charged with implementing RHT in short order.
Examples of Key Services
Since OBBBA was enacted, many of our members have focused their efforts on expanding this linkage by putting forward an array of potential proposals for partnership. The specifics within each state vary. The following examples are representative of what members have shared with Civitas through discussion forums and individual conversations:
- Supporting the technical onboarding and subscription needed for higher levels of HIE/HDU service and connectivity (secondary use cases, notification applications, etc.)
- Expanding the reach and capabilities of rural closed-loop referral systems that connect rural facilities to providers of upstream services (nutrition, housing, employment, etc.)
- Creating customizable rural health dashboards that can aggregate clinical and non-clinical data by population geography for use by both state agencies and rural facilities
- Deploying in-person technical assistance teams to rural facilities to provide clinical measurement and coordinated care training, with a focus on opioids and substance abuse
- Building out technical infrastructure for connecting rural facilities and providers to new or planned state registries, such as those for hospital bed capacity and advanced directives
- Improving connectivity between state health agencies, rural hospitals, and local public health agencies through shared access to digital tools and regular convenings
- Providing technical assistance to rural facilities to mitigate cybersecurity risk and improve compliance with federal regulations like the HIPAA Security Rule
These specific examples are promising not only because they leverage members’ strengths and respond directly to the needs of rural facilities while building on already developed partnerships, but also because they closely align with the technical requirements of CMS:
- Making use of infrastructure, technologies, and systems that were successfully seeded by earlier rounds of federal and state investment
- Involving coalitions of public, nonprofit, and private-sector organizations (such as HIEs, QIOs, health systems, community-based organizations, and local PHAs) with complementary but distinct roles and services
- Facilitating participation in HHS modernization activities and policies beyond those which RHT states explicitly (like TEFCA or alignment with the new CMS Interoperability Framework)
- Improving rural facilities’ participation in and compliance with CMS’ clinical quality measure programs (like the Hospital IQR and OQR programs)
- Helping both rural providers and state authorities prepare for OBBA policy changes scheduled to take effect starting next year (Medicaid work requirements, eligibility checks)
Civitas’ Role in Driving Collaboration
As states proceed with the RHT and navigate OBBBA’s health policy changes more broadly, Civitas is committed to being a resource for our members, affiliates, and the wider health data and health improvement community. Through our events and learning communities, we have served as a platform for both member organizations, partners, and state leaders to learn more about RHT, and to explore the alignment between member capabilities and Program objectives. Our resources, regular member blogs, and case studies attest to the effectiveness of our members’ work.
Civitas believes that there is no need to start from scratch. By working with public and nonprofit health data improvement organizations, states can move faster and with greater confidence toward their transformation goals. Civitas will continue to support and provide convenings for our community and the broader industry to come together as we forge a path forward in rural health transformation.
Staying Connected
The RHT represents a critical opportunity for states and providers to reshape rural care delivery via health data infrastructure and services modernization in partnership with like-minded organizations. Many Civitas members are already experienced partners of choice with ideas and capabilities to share—and as the national organization representing these entities and working on their behalf, Civitas encourages actors across health care to join us in strengthening this effort to help ensure that the Program is as successful as possible.
For more information or to get involved:
- Contact us:
- Explore our resources: www.civitasforhealth.org
