Can Rural Health Transformation Program Funds Support Family Caregivers?
How caregiver enablement maps to all five RHTP strategic goals — and why building it as a layer, not a new program, keeps it defensible.
Short answer: Yes. Family caregiver support fits squarely within the approved uses of Rural Health Transformation Program (RHTP) funds, and it advances at least four of the program’s five strategic goals. States must commit RHTP dollars to three or more approved uses, and caregiver enablement reaches across workforce, sustainable access, prevention, and innovative care models at once. Here’s why—in most rural communities, the family caregiver is already the most widely deployed member of the care team. They are the part of the care delivery workforce no one has funded.
Every state that applied for the RHTP was approved, and it is a scramble to make something meaningful happen before the end of the year. State Rural Health Transformation teams, agencies supporting Medicaid, and Area Agencies on Aging are deciding which initiatives to fund in Year 1. The discussion has shifted from questioning the necessity of investment in rural health to how these investments, particularly through RHT funds, can enhance care and accessibility in rural communities. The investments made must hold up to CMS scrutiny, sustain themselves past the grant period, and show results. Caregiver support will do all three, and most state plans are overlooking it.
What the RHTP actually funds
The RHTP is a $50 billion program created under Public Law 119-21, distributing $10 billion a year to states from federal fiscal year 2026 through 2030. First-year awards average roughly $200 million per state, ranging from about $147 million to $281 million. Half the money is split evenly across approved states; the other half is allocated on rural need and the projected scale of impact.
One detail shapes how the money should be spent. The fund was created in part to offset an estimated $137 billion in rural Medicaid reductions over the next decade, so CMS is screening for initiatives that strengthen the health of rural America durably rather than patch a single budget cycle. These innovative care models do not earn bonus points for sustainability and measurable impact. Those are the scoring criteria for the Federal funding in the first place.
How caregiver support maps to the five RHTP goals
The RHTP defines five strategic goals, grounded in the statutorily approved uses of funds. Caregiver enablement is unusual in that it advances nearly all of them through a single, low-cost intervention.
| RHTP strategic goal | How caregiver enablement delivers against it |
| Workforce development | The family caregiver is the largest unpaid segment of the rural care workforce. Training and equipping them extends clinical capacity without new hiring or added indirect cost. |
| Sustainable access | In counties where clinics and hospitals have closed, a prepared caregiver is often the only consistent point of care between visits. Digital caregiver support functions as distributed access infrastructure. |
| Prevention and chronic disease management | Caregivers manage medications, monitor symptoms, and catch decline early. Skilled caregivers prevent the avoidable ED visits and readmissions that drive rural cost and poor outcomes. |
| Innovative care models | Caregiver enablement is a low-cost, high-reach model that pairs naturally with telehealth, remote monitoring, and community health worker programs already in state plans. |
| Technology and data | A platform delivers learning, peer support, and engagement data states can report to CMS, meeting the data-sharing expectations built into RHTP oversight. |
Note on eligibility: RHTP funds flow through cooperative agreements, and allowable uses are confirmed with each state’s assigned CMS project officer. The mapping above shows alignment with the program’s stated goals; states should validate specific budget lines with their officer before committing.
“But aren’t we just duplicating the rural healthcare programs we already fund?”
This is the first objection from any state finance lead, and it is the right one to raise. Federal grant rules prohibit supplanting, using new federal dollars to cover costs already paid for. A standalone caregiver program that mirrors an existing service invites exactly that scrutiny.
The answer is to build caregiver support as a layer on infrastructure the state already operates, not a new deployment. Added to an existing portal, Medicaid services, HCBS initiative, or AAA network, caregiver enablement extends reach rather than replacing a funded service. It runs lean, with no over-hiring and minimal indirect cost, which is also what reviewers want to see. And it leans on relationships states already trust, including AAAs, community organizations, and faith-based networks, which is where rural reach actually comes from.
The proof rural states are looking for
Foot-in-the-door credibility comes from deployed results, not projections. The evidence for caregiver enablement is unusually concrete, and some of it is rural-specific.
- Caregiver activity on Trualta runs 40% higher in rural communities than in urban ones. Where hospitals and clinics have closed, digital caregiver education is increasingly the only consistent care infrastructure available.
- Across partner programs, Trualta has surpassed $100 million in Quantified Health Outcomes savings, including a 20% reduction in unexpected hospital visits and a 15-month delay in long-term care placement.
- Peer-reviewed research backs the approach: integrating family caregivers into care coordination activity like hospital discharge planning reduces readmissions by roughly 25%, an estimated $3 billion in potential Medicare savings annually.
There is also a cheaper problem the funding can fix. Awareness. In rural areas, research from the Veterans Health Administration found that family caregivers often do not know what support exists, while rural healthcare providers assume those services are already reaching them. The gap is not always a missing program or even healthcare access. Sometimes it is a missing connection, and that is far cheaper to close.
Where to start in Year 1
Year 1 is about putting RHTP funding to work so neighboring states do not absorb the opportunity, and about establishing proof for the years that follow. A practical sequence:
- Start in counties and rural health clinics you already serve. Regional specificity, committing to double down where you have a footprint, lands better with reviewers than broad statewide claims.
- Layer onto an existing portal or AAA network rather than standing up something new. Lower lift for the state, lower supplanting risk, faster launch.
- Build reporting in from day one. Robust data-sharing is table stakes for these partnerships, so engagement and outcome metrics should be a day 1 feature.
- Confirm allowable uses with your CMS project officer early, and document the alignment to the strategic goals above.
Frequently asked questions
Yes. Caregiver support aligns with at least four of the five RHTP strategic goals, including workforce development and sustainable access, and states may direct funds toward three or more approved uses. States should confirm specific allowable uses with their assigned CMS project officer.
It does. Family caregivers are the largest unpaid segment of the rural care workforce. Training and equipping them extends the clinical capacity of healthcare providers in counties facing shortages, without new hiring or added indirect cost.
Build it as an add-on layer to an existing portal, Medicaid HCBS initiative, or AAA network rather than a standalone program. This extends the reach of funded health services rather than replacing them, which keeps it clear of federal supplanting rules.
Reduced avoidable emergency visits and readmissions, delayed long-term care transitions, caregiver engagement rates, and learning completion, all captured through the delivery platform and reportable to CMS.
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Trualta already serves as a rural infrastructure for caregiver support.
If your state is shaping its Year 1 RHTP plan, we can show you how a caregiver support layer fits your existing portal and goals. We have also created this guide to help you write Trualta into your Rural Health Transformation RFPs.
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Sources
- AARP and National Alliance for Caregiving. (July 2025). Caregiving in the US 2025. Washington, DC: AARP. https://doi.org/10.26419/ppi.00373.001
- Centers for Medicare & Medicaid Services. (2025). Rural Health Transformation (RHT) Program: Overview and Notice of Funding Opportunity. Baltimore, MD: CMS. https://www.cms.gov/priorities/rural-health-transformation-rht-program/overview
- Centers for Medicare & Medicaid Services. (December 29, 2025). CMS Announces $50 Billion in Awards to Strengthen Rural Health in All 50 States. https://www.cms.gov/newsroom/press-releases/cms-announces-50-billion-awards-strengthen-rural-health-all-50-states
- KFF. (February 2026). First-Year Rural Health Fund Awards Range From Less Than $100 Per Rural Resident in Ten States to More Than $500 in Eight. https://www.kff.org/state-health-policy-data/first-year-rural-health-fund-awards-range-from-less-than-100-per-rural-resident-in-ten-states-to-more-than-500-in-eight/
- Rodakowski, J., Rocco, P. B., Ortiz, M., Folb, B., Schulz, R., Morton, S. C., Leathers, S. C., Hu, L., & James, A. E. (2017). Caregiver Integration During Discharge Planning for Older Adults to Reduce Resource Use: A Metaanalysis. Journal of the American Geriatrics Society, 65(8), 1748–1755. https://doi.org/10.1111/jgs.14873
- U.S. Department of Veterans Affairs, Health Services Research. Family Caregiver and Clinician Perceptions of Resource Access in Rural Areas. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12759978/
- Trualta. (February 2026). Trualta Surpasses $100M in Healthcare Savings. Internal report / press release.
