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Historically, policy makers have faced challenges implementing accountable care in rural communities. Rural facilities and delivery organizations can face financial challenges, workforce shortages, and financial volatility. Facility closures and limited clinician availability can constrain access and choice and lead to long patient travel distances. These factors make rural accountable care especially sensitive to infrastructure gaps. In turn, rural providers can lack resources needed to perform in accountable care models, prompting dedicated programs to promote greater participation.
The emergence of the Rural Health Transformation (RHT) Program creates the rare opportunity to change these dynamics. Administered by the Centers for Medicare and Medicaid Services (CMS), the program will allocate up to $50 billion over five years to approved states to transform rural health care. CMS describes the program as supporting state-driven strategies to improve rural access, strengthen the rural health workforce, and modernize facilities and technologies.
In 2026, the first year of the RHT Program, CMS has made $10 billion available, awarding states with significant funds that must be dispersed within two years or be subject to redistribution by CMS (see exhibit 1).