On September 15, 2025, the Centers for Medicare and Medicaid Services (CMS) released the Notice of Funding Opportunity (NOFO) for the Rural Health Transformation Program (RHT Program), a $50 billion initiative established under the One Big Beautiful Bill Act (H.R. 1) signed into law on July 4, 2025. The NOFO included significant guidance to states on how, and under what criteria CMS will distribute the $50 billion fund. The application submission deadline is set for November 5, 2025, and the expected award date is December 31, 2025, which is also the earliest start date for funded projects. CMS has indicated in webinars with states that they may engage in conversations during the review period on submission details such as proposed budgets.

The NOFO document provides a comprehensive overview of the required formats and narratives for submission. Applicants must include a project summary, project narrative, and budget narrative, each with specific page limits. Additionally, various attachments such as an endorsement from the governor of each applicant state, business assessment, and program funding duplication assessment are required.

Scoring criteria for the RHT Program are detailed, with factors divided into initiative-based and policy-based categories. These criteria assess the quality of proposed initiatives and the state’s existing policies. The full details can be found in the NOFO and subsequent FAQ documents published by CMS and located here.

Following the grant award, states will need to act quickly on a full range of rural health transformation implementation activities. These include program design and planning, technology enablement, workforce development and training, monitoring and evaluation, reporting, and ongoing technical assistance. 

 Key Grant Implementation Activities:

Public Consulting Group (PCG) is here to help states with their RHTF grant program design as well as implementation.