What Is the Rural Health Transformation Program?
The Rural Health Transformation Program (RHTP) is a landmark $50 billion federal initiative created under Section 71401 of the One Big Beautiful Bill Act (Public Law 119-21). Administered by CMS, the program distributes $10 billion annually from FY2026 through FY2030 to all 50 states through cooperative agreements — no state matching funds required.
RHTP is designed to transform rural healthcare by investing in infrastructure, technology, workforce, and care delivery models that create lasting, sustainable improvements for rural communities. Learn more about RHTP on our hub page.
Five Strategic Goals
Hawaii’s RHTP Program
Key Initiatives & Focus Areas
- Inter-island telehealth connectivity
- Behavioral health and substance use services
- Health IT modernization and data sharing
- Workforce recruitment for neighbor islands
- Emergency medical services modernization
Unique Aspects of Hawaii’s Program
- Island geography creates unique healthcare access challenges between neighbor islands
- Heavy reliance on telehealth for inter-island specialist access
- Native Hawaiian health disparities require culturally responsive solutions
- Tourism-dependent economy creates variable demand for rural health services
- Limited provider pool on neighbor islands drives workforce innovation
How Technology Supports RHTP in Hawaii
The Interoperability Challenge
Rural healthcare facilities face significant technology gaps compared to their urban counterparts. Nationally, only 48% of rural hospitals have achieved basic interoperability, compared to 62% of urban hospitals. This data-sharing gap directly impacts care quality, coordination, and outcomes for rural patients.
RHTP’s Strategic Goal 5 specifically targets technology innovation, including a Technology Innovation Catalyst Fund that supports interoperability, telehealth, remote patient monitoring, AI-enabled health tools, and cybersecurity.
How Julota Addresses RHTP Technology Requirements
Julota is a cloud-based SaaS interoperability platform purpose-built for the challenges rural healthcare organizations face. Here’s how Julota supports RHTP goals in Hawaii:
- FHIR-Native Interoperability: Julota’s platform supports HL7 FHIR APIs and G10 compliance, meeting the interoperability standards required by RHTP and the 21st Century Cures Act. Learn about Julota’s platform.
- Health Information Exchange Connectivity: Connect rural providers across Hawaii to state and regional HIEs, enabling real-time data sharing that improves care coordination and reduces duplication.
- Care Coordination & Closed-Loop Referrals: Julota’s closed-loop referral management ensures patients don’t fall through the cracks — critical for rural communities where follow-up can require long-distance travel.
- MIH-CP & Community Paramedicine Support: Julota’s MIH-CP solution supports the mobile integrated health and community paramedicine models that many states are funding under RHTP.
RHTP Eligibility in Hawaii
RHTP funds flow from CMS to Hawaii through a cooperative agreement. The state then distributes funds to eligible subrecipients through competitive processes.
Eligible Organization Types
- Critical Access Hospitals (CAHs) — Rural hospitals with 25 or fewer beds
- Federally Qualified Health Centers (FQHCs) — Community health centers serving underserved populations
- Rural Health Clinics (RHCs) — Clinics in designated shortage areas
- Community Behavioral Health Providers — Including Certified Community Behavioral Health Clinics (CCBHCs)
- Emergency Medical Services (EMS) — Ambulance services and first responders
- Tribal Health Organizations — Indian Health Service and tribal facilities
- Local Health Departments — County and regional public health agencies
- Universities and Training Programs — Workforce development partners
How to Apply
Organizations in Hawaii should contact Hawaii Department of Health for subrecipient application details. Most states distribute RHTP funds through competitive RFP processes that require demonstrating alignment with the state’s approved Rural Health Transformation Plan.
Key compliance requirements include SAM.gov registration, adherence to 2 CFR 200 uniform guidance, and commitment to quarterly and annual reporting on performance metrics and milestones.
Key Questions About RHTP in Hawaii
How much RHTP funding did Hawaii receive?
Hawaii received $188,892,440 in FY2026 RHTP funding, awarded by CMS on December 29, 2025. Hawaii's unique island geography and rural health challenges on the neighbor islands factored into its allocation.
What is Hawaii's Rural Health Transformation Program?
Hawaii's RHTP focuses on inter-island telehealth connectivity, behavioral health, health IT modernization, workforce recruitment, and emergency medical services to serve rural communities across the neighbor islands.
Who is eligible for RHTP in Hawaii?
Eligible organizations include hospitals, FQHCs, Rural Health Clinics, Native Hawaiian health organizations, behavioral health providers, and other healthcare organizations serving Hawaii's rural island communities.
How does RHTP address Hawaii's inter-island healthcare challenges?
RHTP funds support telehealth infrastructure for inter-island specialist consultations, remote patient monitoring, and health information exchange to connect providers across Hawaii's island chain.
What technology does Hawaii's RHTP support?
Hawaii's RHTP supports inter-island telehealth systems, remote patient monitoring, EHR modernization, health information exchange, and cybersecurity improvements for rural and island healthcare facilities.
How can Hawaii providers apply for RHTP funding?
Hawaii providers should contact the Hawaii Department of Health for RHTP subrecipient application information and monitor state announcements for Request for Applications opportunities.
Ready to Build RHTP-Ready Infrastructure in Hawaii?
Julota helps rural healthcare organizations meet RHTP interoperability requirements with a cloud-based platform that connects providers, enables data sharing, and supports care coordination across your community.