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
Texas’s RHTP Program
Key Initiatives & Focus Areas
- AI deployment strategy for rural healthcare
- Competitive distribution process through HHSC
- Telehealth and remote care expansion
- Rural workforce development and recruitment
- Broad eligibility for local governments, hospitals, and community health centers
Unique Aspects of Texas’s Program
- Largest state award nationally at approximately $281 million per year
- Branded as "Rural Texas Strong" — strong program identity
- Explicit AI deployment strategy for rural healthcare — innovative approach
- Competitive distribution process managed through HHSC
- Originally requested $200M/year but awarded significantly more
- Broad eligibility: local governments, rural hospitals, community health centers, and more
How Technology Supports RHTP in Texas
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 Texas:
- 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 Texas 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 Texas
RHTP funds flow from CMS to Texas 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 Texas should contact Texas Health and Human Services Commission (HHSC) 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 Texas
How much did Texas receive for RHTP?
Texas received approximately $281 million in FY2026 — the largest state award nationally — with a five-year total exceeding $1.4 billion. The "Rural Texas Strong" program is administered by the Health and Human Services Commission (HHSC).
What is Rural Texas Strong?
Rural Texas Strong is Texas's branded RHTP program, featuring AI deployment for rural healthcare, telehealth expansion, workforce development, and a competitive distribution process. It's the largest state RHTP program at $281M annually.
How does Texas's RHTP use artificial intelligence?
Texas's Rural Texas Strong program includes an explicit AI deployment strategy for rural healthcare, using AI-driven tools for diagnostics, care coordination, clinical decision support, and operational efficiency in rural facilities.
Who is eligible for Rural Texas Strong funding?
Texas has broad eligibility including local governments, rural hospitals, community health centers, FQHCs, Rural Health Clinics, behavioral health providers, and other organizations. HHSC manages competitive distribution.
How do Texas providers apply for RHTP funding?
Texas distributes RHTP funds through a competitive process managed by HHSC. Providers should monitor pfd.hhs.texas.gov for application announcements and the Texas Hospital Association for program updates.
What technology does Texas's RHTP support?
Rural Texas Strong supports AI-driven health tools, telehealth infrastructure, remote patient monitoring, EHR modernization, health information exchange, and interoperability platforms for rural and frontier providers.
Why did Texas receive the largest RHTP award?
Texas's $281 million award — exceeding its $200M request — reflects the state's vast rural geography, large rural population, significant healthcare challenges, and a strong transformation plan submitted to CMS.
What is the Rural Texas Strong five-year plan?
Rural Texas Strong projects over $1.4 billion in RHTP funding through FY2030, supporting a comprehensive transformation of rural healthcare across the state including AI, telehealth, workforce, and infrastructure investments.
Ready to Build RHTP-Ready Infrastructure in Texas?
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.