What State Program Staff Need to Know When Writing Rural Health Transformation Program RFPs
A guide to structuring caregiver support as a fundable, measurable initiative, and making it last beyond the grant window.
The Rural Health Transformation Program is the most significant federal investment in rural health infrastructure in a generation. States that get this right will reshape care for rural families for the next decade. States that rush it will produce programs that expire with the funding. Here is what the difference looks like, and how to land on the right side of it.
What the RHTP Actually Is (And What It Isn’t)
The Rural Health Transformation Program (NOFO CMS-RHT-26-001) is a CMS cooperative agreement that gives states funding to fundamentally redesign how rural health is delivered. According to Kaiser Family Foundation data, from 2017 to 2024, 62 rural hospitals closed compared to 10 that opened. A net reduction of 52 hospitals. These closures are contributing to the caregiver crisis where demand is high, but supply is low. This infusion of RHTP funding dollars is meant to transform health outcomes, not patch the system or develop pilots. Programs coming from RHT dollars have to be more than that.
CMS has structured the program around five priority areas:
- Making rural America healthier
- Building sustainable access and equity
- Developing the workforce
- Fostering innovative care models
- Advancing technology
States submit applications identifying specific initiatives, and they contract with subrecipients to deliver them. The funding window runs from federal fiscal years 2026 through 2031.
What it isn’t: A general rural health fund
Applications will not score well if they read as wish lists with vague outcomes, contain no clear subrecipient infrastructure or no sustainability plan. CMS reviewers are looking for specificity, evidence, and a credible path to sustainability after the federal money ends. State portals began opening in February of this year; it is critical that states start identifying technology, care delivery, and service partners now.
The Gap Most Applications Miss: The caregiver workforce
Every Rural Health Transformation plan will include something about workforce. Most will focus on recruiting and retaining clinical staff like nurses, physicians, and community health workers. But there is a parallel workforce consisting of 63 million family caregivers driving a significant share of rural health outcomes and often forgotten in grant applications.
In rural communities, unpaid family caregivers are often the only consistent care presence for people managing Alzheimer’s, diabetes, and behavioral and mental health conditions, yet only 11% have received any formal training. While 84% manage three or more daily living activities for the people in their care.
Rural communities carry a disproportionate Alzheimer’s burden, with higher prevalence than major metros and only 12% of patients with local access to a dementia specialist. Without training, peer support, or a resource available at 2am, the gap between family caregiver knowledge and the clinical system creates ED visits, early long-term care transitions, and preventable readmissions.
The RHTP aligns and permits funding for caregiver training and peer support under multiple priority areas. Reviewers are primed to recognize this, especially as CMS continues to push better management of chronic disease, aging-in-place, and value-based care frameworks.
Trualta recently shared documented results from deployed caregiver support programs operating across 33 states. When caregivers are highly engaged and given accessible, condition-specific training and peer support, the entire system benefits, even rural health systems. The question remains, will states build the social services and caregiving infrastructure to positively impact their counties?
Read about our $100M in quantified health savings.
The outcomes data under the health priority (ED reduction, LTC delay) is specific and verifiable, which is exactly what reviewers want to see. It’s what makes a great health program.
How RHTP Priorities Map to Caregiver Support
One of the most common application mistakes is treating the five priority areas as silos. They aren’t. Caregiver support, done well, touches all five — but for an RFP narrative, you should anchor it to one or two and go deep, not spread thin across all of them.
For most states, Make Rural America Healthy Again and Workforce Development are the strongest entry points for a funding opportunity. The caregiver certification angle under Workforce is concrete and creates real credentialing outcomes CMS can count.
See how the state of Iowa did it here.
Here is how Trualta directly lines up:
- Make Rural America Health Again: Trualta provides evidence-based training in chronic disease, behavioral health, and dementia management with measurable ED and LTC outcomes to report.
- Workforce Development: Certification programs that formalize caregiver competency and create legitimate career pathways, expanding the workforce without adding clinical headcount.
- Sustainable Access & Equity: Mobile-accessible, low-bandwidth tools that reach caregivers in the most isolated rural communities, including Spanish-language content.
- Innovative Care: Family care as part of the continuum, shifting care delivery from reactive institutional settings to supported home environments.
- Tech Innovation: Digital platforms that work without broadband, serve users 65+, extending the care team 24/7 without additional staff.
What a Strong Caregiver Support Initiative Looks Like in Practice
Specificity is the difference between an RFP that scores and one that stalls. Here is what a credible caregiver project narrative includes:
- A named subrecipient with deployment history, not a category (“a digital health vendor”)
- A defined rural population that includes counties, caregiver types, conditions (dementia is underrepresented and high-need)
- Concrete outcome metrics tied to baseline data you already have or can get before submission
- A launch timeline for programs that can be live within 60–90 days are more competitive than those that require 18 months of infrastructure build
- A sustainability path — specifically, what funding source takes over after FY 2031 (Medicaid HCBS, ACL/OAA Title III-E, and state dementia programs are the most common mechanisms)
- A sustainability path — specifically, what funding source takes over after FY 2031 (Medicaid HCBS, ACL/OAA Title III-E, and state dementia programs are the most common mechanisms)
Three Steps to Get Caregiver Support Into Your RFP/Application
- Identify your initiative bucket:
Choose the one or two priority areas where your state’s need and data are strongest. Anchor your caregiver initiative there. Do not try to map it to all five priorities. Focus on depth over breadth.
- Name your subrecipient early:
Identify your technology and service partners before submission. A letter of intent is typically sufficient at the application stage. Partners with multi-state deployment history and documented outcomes give reviewers something concrete to evaluate.
- Write the sustainability section first:
Most teams write sustainability last. But starting there forces you to design the initiative around what can actually survive FY 2031, which makes the entire application more credible and better structured.
Download the Full RFP/Application Guide
We built a step-by-step practitioner guide with ready-to-use narrative language, a full RHT priority crosswalk, metrics framework, and sustainability roadmap — designed specifically for state RHTP applicants.
The Rural Health Transformation fund window is real, the need is urgent, and the states that build caregiver support into their rural healthcare infrastructure now will still be seeing the outcomes in 2035. The families managing Alzheimer’s, diabetes, and behavioral health in rural communities can’t wait for the next funding cycle. Make your RFP count.
Resources:
- AARP and National Alliance for Caregiving. (July 2025). Caregiving in the US 2025. Washington, DC: AARP. https://doi.org/10.26419/ppi.00373.001
- Alzheimer’s Association. (2025). 2025 Alzheimer’s Disease Facts and Figures. Chicago, IL: Alzheimer’s Association. https://www.alz.org/alzheimers-dementia/facts-figures
- KFF. (2025). 10 Things to Know About Rural Hospitals. https://www.kff.org/health-costs/10-things-to-know-about-rural-hospitals/
- Trualta. (November 2025). Trualta Platform Utilization Data. Internal report.
- Centers for Medicare & Medicaid Services. (2026). Rural Health Transformation Program. NOFO CMS-RHT-26-001.
