One state wants to build its first medical school. Another wants to launch accountability tools for price transparency. These are among the most distinctive proposals in CMS’ $50 billion Rural Health Transformation Program, which awarded funds to all 50 states in December.
CMS allocated half of the fiscal 2026 funds equally across all states, with the remaining half awarded based on rural population size and proposed policy actions. Each state is assigned a CMS project officer, and states are required to submit yearly progress reports.
While several states focused their proposals on workforce recruitment and retention, rural facilities modernization and new care delivery and payment models, a few states proposed unique projects, according to the Rural Health Transformation Program state project abstracts, published in December. States were required to submit a one-page summary of their proposed project. Budget amounts and requested funds in each state’s abstract are hypothetical.
Meanwhile, 1 in 3 rural hospitals are at risk of closure, and leaders are growing skeptical of the funds. As Van Loskoski, CEO of Stevens County Hospital in Toccoa, Ga., recently put it: “Make no mistake; it is not called the Rural Hospital Stabilization Program. It’s called the Rural Health Transformation Program, and that means, in title and intention, that pool of funds is intended to change the way that healthcare is delivered in rural areas.”
Below are six unique rural health transformation proposals:
1. Delaware: The state’s first medical school with a rural health track. One of Delaware’s project goals is to create the state’s first medical school with a primary care-rural health track, establishing “train here, stay here” programs with education awards for medical students and residents, as well as expanding training programs for nurse practitioners, physician assistants, community health workers and other critical roles. Of Delaware’s $1 billion investment over five years, $274 million would go toward the medical school and training programs, and $60.25 million will be for education awards and recruitment.
2. Hawaii: Rural Respite Network. Hawaii faces significant rural healthcare challenges, as 95.1% of its land is rural and services are concentrated in Honolulu. One unique aspect of the state’s transformation plan is to expand its medical respite model to rural areas to reduce preventable hospital use among unhoused or post-acute patients with low medical acuity.
3. North Dakota: Suicide prevention as a standalone metric goal. North Dakota is the only state to include suicide prevention as one of its main goals of its transformation plan. It aims to prevent chronic disease, restore health and reduce cost through increased activity and reduced obesity, reduced chronic disease and suicide prevention. The state would use $85.9 million of its fund to launch Eat Well ND and ND Moves Together programs to put evidence-based practices in nutrition, physical activity and behavioral health at the center of everyday life.
4. Rhode Island: Hospital at home. One of Rhode Island’s 13 health initiatives focuses on hospital-at-home programs that will enable hospitals to deliver acute-level care in patients’ homes, supported by remote monitoring and EMS partnerships.
5. Vermont: Price transparency and insurance competition. Price transparency and insurance competition combine to form one of Vermont’s five core initiatives. The state plans to tackle increasing healthcare costs and affordability barriers by investing in new accountability tools and strategies.
6. Wyoming: SNAP restrictions. While several states focused on healthy food initiatives, Wyoming is the only one to include restricting the use of SNAP to buy unhealthy food as part of its proposal. It is part of one of the state’s four major goals: to improve metabolic, cardiovascular and behavioral health outcomes.
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