Rural Health Transformation Fund: Grant Programs, Eligibility, RPM, and CCM Models

The Rural Health Transformation Fund is CMS's most significant response to this crisis. Created through the One Big Beautiful Bill Act and backed by $50 billion in funding over five years, the fund is already distributing awards to all 50 states. Applications and state-level grant opportunities are currently open.

This guide explains what the Rural Health Transformation Fund is, how it differs from the Rural Health Transformation Program, who qualifies, how to navigate the application process, and why Remote Patient Monitoring (RPM) and Chronic Care Management (CCM) are the most strategically valuable investments you can make with these funds.

What Is the Rural Health Transformation Fund?

Before diving into eligibility and application guidance, it's worth clarifying a distinction that trips up many providers: the difference between the Rural Health Transformation Fund and the Rural Health Transformation Program.

The Rural Health Transformation Program (RHTP) is the CMS administrative framework - the policy, governance structure, and set of rules that govern how the initiative operates.

The Rural Health Transformation Fund is the financing mechanism - the $50 billion pool of money that flows through the program to states, and from states to providers. Both terms appear in CMS documentation and in search results, and they refer to different aspects of the same initiative. Providers interact primarily with the fund through their state's implementation.

The fund was established under Section 1945B of the Social Security Act and is administered through state Medicaid agencies in partnership with CMS. Qualifying states receive annual allocations - $10 billion per year from 2026 through 2030 and are responsible for developing and implementing their own rural health transformation plans within CMS guidelines.

Program Scale and Timeline

• $50 billion total allocated over 5 years (2026–2030)
• All 50 states are participating - CMS has already announced initial award distributions
  State-level implementation plans are being finalized, and NOFOs are being released on a rolling basis
• Applications at the state level are currently open in many states; provider eligibility windows vary by state

Rural Health Transformation Fund Program Types

CMS requires that each participating state use RHT funds for at least 3 of the 10 approved use cases. Understanding which use cases your state is prioritizing is the first step in identifying where your proposal fits and where the most available funding is.

The 3 program types most states are expected to anchor their rollouts around:

1. Chronic Disease Management

Many states are structuring grant programs specifically targeting the chronic conditions that drive the highest rural healthcare costs: hypertension, diabetes, heart failure, and COPD. These are also the conditions for which Remote Patient Monitoring and Chronic Care Management deliver the most measurable clinical and financial impact.

2. Telehealth Infrastructure Expansion

Because distance is one of the defining barriers in rural care delivery, most states will prioritize technology-enabled care adoption. This includes funding for EHR upgrades, RPM hardware and software, and the care coordination systems that allow small rural facilities to serve patients without requiring in-person visits.

3. Workforce Development

The rural workforce shortage is acute. States can use RHT funds to recruit clinical talent, provide loan repayment, support health training programs, and expand the range of providers - pharmacists, community health workers, and care coordinators who are authorized to deliver care under supervision.

All 10 Approved Use Cases for Rural Health Transformation Funds

Source: CMS Rural Health Transformation Program guidelines. States must implement at least 3 use cases; they may propose additional CMS-approved initiatives.

The common thread across all 10 use cases is sustainability: CMS is not funding one-time capital projects. It is funding programs that improve long-term outcomes per dollar and build capacity that persists after the grant period ends.

Provider Eligibility for the Rural Health Transformation Fund

Because the RHT program is administered at the state level, CMS does not define a single set of provider eligibility requirements. Instead, each state develops its own eligibility criteria within CMS's framework. That said, the types of providers most likely to qualify for state subawards and grants include:

• Critical Access Hospitals (CAHs) - federally designated hospitals with 25 or fewer acute care inpatient beds serving rural communities
• Rural Health Clinics (RHCs)- CMS-certified outpatient clinics located in rural, underserved areas
• Federally Qualified Health Centers (FQHCs)- community-based providers serving medically underserved populations
• Small rural hospitals and independent physician practices with a significant rural patient panel
• Private clinics operating in rural or frontier areas - eligibility varies by state; check your state's plan
• ACOs and value-based care organizations serving rural Medicare beneficiaries
• The key eligibility driver across all these provider types is whether your patient population is rural and underserved. State plans typically require providers to demonstrate:
• A defined rural service area (often tied to HRSA or USDA rural definitions)
• A patient panel with high chronic disease prevalence or limited access to specialty care
• Operational or financial indicators consistent with rural health challenges
• A clear plan for how funds will be used in alignment with the state's RHT priorities

Rural Health Transformation Fund Application Process

This is the area where most online guidance falls short. CMS allocates funds to states, not directly to providers. This means the "application process" you need to navigate is your state's procurement and grant process, not a federal portal.

Here's how to approach it systematically:

Step 1: Find Your State's RHT Plan

Every participating state is required to submit an RHT plan to CMS describing how it will spend its allocation. Many states have made these plans public. Start at your state Medicaid agency's website and search for "Rural Health Transformation" or "RHT plan." CMS also publishes a program overview at cms.gov/priorities/rural-health-transformation-rht-program/overview.

Step 2: Monitor for NOFOs and RFPs

State-level funding opportunities are released through Notices of Funding Opportunity (NOFOs) and Requests for Proposals (RFPs). These documents describe eligible activities, funding amounts, application requirements, and deadlines. Key places to monitor:

• Your state Medicaid agency's grants portal
• Your state's HRSA-affiliated Primary Care Office website
• State Rural Health Associations - most states have one, and they often aggregate NOFOs
• CMS's Innovation Center and rural health program update pages

Mississippi's Telehealth Adoption and Provider Support (TAPS) program is an example of a state-level NOFO specifically targeting RPM and telehealth infrastructure. Other states are expected to release similar technology-focused opportunities in 2025–2026.

Step 3: Align Your Proposal with CMS Metrics

Winning proposals demonstrate clear alignment between the provider's planned use of funds and CMS's program goals. Your proposal should quantify:

• The size and demographics of your rural patient population
• Chronic disease prevalence and current gaps in disease management
• Which approved use case(s) does your program address, and how
• How you will measure outcomes (readmission rates, chronic disease control metrics, access improvements)
• Your plan for sustainability after the grant period - how the program will continue generating value without ongoing grant funding

Step 4: Emphasize the Sustainability Plan

The sustainability question is where many provider proposals fall short, and where the strongest proposals stand out. CMS and state administrators are explicitly looking for investments in programs that generate their own revenue after the grant period ends.

This is where Remote Patient Monitoring and Chronic Care Management have a structural advantage over one-time capital projects: both programs generate monthly Medicare reimbursement under their own CPT code sets. A rural clinic that uses RHT funding to launch RPM and CCM is building a care infrastructure that pays for itself ongoing, which is exactly what evaluators want to see.

How RPM and CCM Fit the Rural Health Transformation Framework

Among the care delivery investments that rural providers can make with RHT funds, Remote Patient Monitoring (RPM) and Chronic Care Management (CCM) occupy a uniquely strong position. They address the most common rural healthcare challenges directly, they qualify under multiple approved use cases, and they generate independent Medicare reimbursement that sustains operations after grants end.

Learn more about how CCM and RPM work together in a rural care model.

The Role of RPM in Rural Care

RPM allows your care team to continuously monitor patient vitals using connected devices - cellular-enabled blood pressure cuffs, glucometers, pulse oximeters, and weight scales that transmit data automatically without requiring patient-provided internet. This last point matters significantly in rural areas where broadband access is unreliable.

RPM directly addresses the two defining structural barriers in rural care:

• Transportation barriers: Patients in rural areas often travel 30–60+ minutes to reach a clinic. RPM replaces the majority of chronic disease monitoring visits with remote data transmission, reducing the transportation burden on patients while freeing clinic capacity for acute and complex cases.
• Clinical workforce constraints: RPM reduces unnecessary office visits and avoidable hospitalizations, letting your existing staff serve a larger patient panel. When combined with outsourced clinical monitoring support, as KangarooHealth provides, your team can scale RPM without adding headcount.

The Role of CCM in Rural Care

Chronic Care Management (CCM) is a Medicare benefit for patients with two or more chronic conditions expected to last at least 12 months. In rural areas, these patients often receive fragmented care from multiple providers with minimal coordination, creating gaps that lead to preventable hospitalizations and emergency visits.

CCM closes those gaps by requiring:

• A comprehensive electronic care plan that follows the patient across all care settings
• Active care coordination across providers and through care transitions - discharge, specialist referrals, post-ED follow-up
• At least 20 minutes of non-face-to-face care management services each month

The result is better chronic disease control, fewer avoidable hospitalizations, and a more sustainable care model in settings where in-person resources are already stretched. The benefits of CCM compound over time: as care plans become more established and patients more engaged, utilization costs fall while quality metrics improve.

Financial Models: Building Sustainable Rural Remote Care Programs

The two-phase financial model is what makes RPM and CCM ideal RHT investments and what separates a strategically strong proposal from one that evaluators will view as grant-dependent.

Phase 1: Grant-Funded Launch

RHT funding can cover the upfront costs of deploying a remote care infrastructure: cloud-based care management platform, FDA-cleared connected devices, staff training, and initial patient onboarding. This is an appropriate use of rural health funding because the investment creates durable capability, not a one-time event.

Phase 2: Medicare Reimbursement for Ongoing Operations

Once your RPM and CCM programs are live, ongoing operations are funded by monthly Medicare reimbursement under CMS's CPT code structure. This is the sustainability mechanism that keeps your program running after the grant period ends.

RPM CPT Codes: Monthly Medicare Reimbursement

* National averages. Actual reimbursement varies by geography, payer mix, and annual CMS updates. Rural providers may receive enhanced rates in some geographies.

CCM CPT Codes: Monthly Medicare Reimbursement

* National averages. CCM add-on codes 99439 and 99437 can each be billed up to twice per month per patient.

For a rural clinic with 100 patients enrolled in RPM and 80 in CCM, the combined monthly Medicare billing revenue can reach $15,000–$25,000 per month, revenue that persists and scales with enrollment after the initial RHT investment is made.

That is the financial case CMS wants to see in your proposal: not just what you will spend the grant on, but how the resulting program will sustain itself.

KangarooHealth offers turnkey implementation of RPM, CCM, and other Medicare-reimbursable programs with no upfront cost, even without startup grant funding.

Common Implementation Challenges and How to Solve Them

Rural providers who have explored RPM and CCM often run into the same set of operational hurdles. Here is how to address each one:

Personnel Costs for Monitoring

RPM requires clinical staff to review incoming device data and act on outlier readings, a time-intensive function that most rural clinics don't have the staffing capacity for. The solution is outsourced clinical monitoring support. KangarooHealth's US-based clinical team provides remote monitoring services at a staffing ratio of 125–150 patients per nurse, enabling rural facilities to scale RPM without proportional hiring. This cost structure also looks strong in RHT proposals, since it demonstrates operational efficiency.

Rural Connectivity Limitations

Broadband access in rural areas is unreliable. Standard RPM devices that require patient-provided Wi-Fi will have data gaps in rural settings, undermining program integrity and billing compliance. The solution is cellular-enabled RPM devices that transmit patient data over cellular networks, no patient internet required. At KangarooHealth, all our RPM devices use cellular connectivity as the default.

Technology Adoption Among Elderly Patients

Most Medicare beneficiaries are older adults who may have limited experience with connected health devices. Device non-use is one of the most common reasons RPM programs underperform. The solution is structured onboarding: device demonstration, hands-on patient training, and follow-up check-ins in the first 30 days. KangarooHealth handles patient onboarding and ongoing device support, so your clinical staff doesn't carry that burden.

Documentation and Billing Compliance

RPM and CCM require monthly time tracking and CPT-code-specific documentation that most rural EHRs don't handle automatically. Incomplete or inaccurate documentation leads to underbilling, audit risk, and revenue leakage. KangarooHealth's platform automates time tracking and generates billing-ready documentation each month, so your billing team has what it needs without manual reconstruction.

How KangarooHealth Supports Rural Providers

KangarooHealth is a connected care platform built specifically for the operational realities of rural and resource-constrained providers. We've helped rural facilities across the country launch and scale RPM and CCM programs without requiring capital investment, additional clinical hires, or changes to existing workflows.

Our platform and services have collectively:

• Logged more than 200,000 remote monitoring hours
• Touched more than 13,500 lives through clinical monitoring
• Contributed to a 48% reduction in adverse events across enrolled patient populations

What We Offer

• All-in-one connected care platform CMS-compliant care management software supporting 50+ chronic conditions with customizable care pathways, automated time tracking, and EHR integration
• Cellular-enabled FDA-cleared RPM devices - blood pressure cuffs, glucometers, pulse oximeters, weight scales shipped directly to patients with no patient Wi-Fi required
• US-based multilingual clinical monitoring team staffed at 125–150 patients per nurse, providing remote monitoring and patient outreach so your team can focus on in-person care
• Full RPM and CCM program support, including PCM and APCM, with billing-ready monthly documentation generated automatically
• Structured patient onboarding device training, 30-day check-ins, and ongoing engagement to ensure high device utilization rates
• No upfront cost model - turnkey implementation with no capital investment required

If your practice is developing an RHT grant proposal, KangarooHealth can also provide data and outcome benchmarks from existing rural deployments to strengthen your application's sustainability narrative.

Contact us today to speak with a KangarooHealth expert about real-world RPM and CCM outcomes for rural providers.

Frequently Asked Questions About the Rural Health Transformation Fund (FAQs)

These FAQs answer common questions about RHT funding eligibility, state-level access, grant approval factors, and how providers can use the program to launch or expand rural care initiatives.

Can Private Clinics Access Rural Health Transformation Funds?

Yes. Private clinics can access RHT funds through state-level subawards and grants. Because the program is administered at the state level, eligibility criteria vary. Check your state Medicaid agency's RHT plan for the specific requirements and available funding opportunities in your area.

How Much Rural Grant Capital Can a provider Receive?

CMS has not defined a per-provider cap. CMS awards the annual $10 billion allocation to states, and each state determines award sizes based on its implementation plan, available funds, and applicant need. Award amounts will vary significantly by state and program type. Review your state's NOFO when it is released for specific amounts.

Which States Offer Rural Health Transformation Fund Programs?

All 50 states are participating in the RHT program and receiving a share of the $10 billion annual allocation. The specific programs available to providers, and the timing of NOFOs and RFP releases, depend on each state's transformation plan. Some states, like Mississippi, have already announced specific programs targeting telehealth and RPM adoption.

What Rural Population Metrics Affect Grant Approval?

Common metrics evaluated in RHT grant proposals include:

• Size and density of the rural patient population served
• Chronic disease prevalence (diabetes, hypertension, heart failure, COPD rates)
• Healthcare worker density and nurse-to-patient ratios
• Emergency department utilization rates
• Access to care metrics, average travel time to a healthcare facility, and specialist availability
• Current gaps in care coordination or care management infrastructure

What is the Difference Between the Rural Health Transformation Fund and the Rural Health Transformation Program?

The Rural Health Transformation Program (RHTP) is the CMS administrative framework that governs the initiative, its policy rules, state requirements, and program structure. The Rural Health Transformation Fund is the financial mechanism- the $50 billion pool of money that flows through the program. Both terms appear in official documentation and in search results, which causes confusion. Providers access the fund through their state's implementation of the program.

Can a Provider Launch RPM and CCM Without Grant Funding?

Yes. Medicare reimburses RPM and CCM under their own CPT code sets, independently of any grant program. RHT funding can accelerate a provider's ability to launch these programs by covering upfront costs, but it is not a prerequisite. KangarooHealth offers turnkey implementation with no upfront cost, making it possible to launch RPM and CCM programs immediately and generate Medicare reimbursement from day one.

How does KangarooHealth help with the RHT application process?

KangarooHealth can provide rural outcome benchmarks, utilization data, and program documentation to support the sustainability narrative in your RHT proposal. We can also help you model the projected Medicare reimbursement your RPM and CCM program would generate after the grant period, the sustainability calculation that evaluators want to see.

Conclusion

The Rural Health Transformation Fund represents a generational opportunity for rural providers, $50 billion in federal investment directed specifically at the workforce, technology, and care coordination gaps that have been widening for decades. Applications and state-level NOFOs are open now.

But the providers who will capture the most long-term value from this program are those who use it to build infrastructure that continues generating revenue and improving outcomes after the grant period ends. That is the sustainability calculation CMS is explicitly asking for, and it's the frame that should shape every proposal.

Remote Patient Monitoring and Chronic Care Management (CCM) are the most strategically sound investments a rural provider can make with RHT funds. They address the defining challenges of rural care delivery, qualify under multiple approved use cases, improve the quality metrics CMS tracks, and generate monthly Medicare reimbursement that sustains operations indefinitely.

KangarooHealth provides the connected care platform, cellular-enabled devices, and US-based clinical support that rural providers need to launch and scale these programs with no upfront cost and no changes to your existing clinical team. Explore our RPM services and CCM and PCM programs to see what a sustainable rural care model looks like in practice.

Book a demo today to speak with a KangarooHealth expert about real-world rural outcomes, reimbursement projections, and how to structure an RHT proposal that wins.