Rural Health Transformation Program: Lessons from Year One and Priorities for Year Two

Rural communities across the country continue to face challenges related to healthcare access, workforce shortages, aging facilities, and financial sustainability. As the first year of the Rural Health Transformation Program (RHTP) comes to a close, many states are entering a new stage of the initiative. The focus is shifting from getting programs up and running to managing them over the long term. 

While it is still too early to measure long-term changes in rural health outcomes, year one has provided valuable lessons about implementation, oversight, and program management. As states move into year two, now is a good time to step back and evaluate what is working, what needs attention, and where resources should be focused next.

1. Is Your Program Ready for Overlapping Funding Cycles?

One of the biggest changes in Year 2 is that states are no longer focused on a single funding cycle.

Year 1 was largely about planning, launching programs, and getting funding out the door. In Year 2, states are balancing two priorities: managing funds that have already been awarded while preparing for the next round of funding.

That means tracking active projects, responding to recipient questions, reviewing reports, and monitoring spending, all while running another application and award process.

Before Year 2 gets fully underway, states should ask:

• Do we have enough staff and resources to support multiple funding cycles at once?
• Are our processes built to handle increased reporting and oversight responsibilities?
• Where are we already seeing bottlenecks or capacity challenges?

What worked during program launch may not be enough to support the growing demands of ongoing administration.

2. Are Your Monitoring and Reporting Processes Keeping Pace?

As funding reaches providers and community organizations, oversight becomes increasingly important.

Many award recipients are managing federal funding requirements for the first time. States play an important role in helping recipients understand expectations, track spending, and provide the documentation needed to support program compliance.

Year 2 is a good opportunity to review existing monitoring and reporting processes and identify gaps before they become larger challenges. States should assess whether they have the tools, staffing, and processes needed to track expenditures, monitor performance, and support recipients throughout the life of their awards.

States may also want to revisit their risk assessment approach. Not every recipient or project carries the same level of risk, and a risk-based approach can help agencies prioritize oversight, monitoring, and technical assistance where it may be needed most.

Consider:

• Are monitoring activities happening consistently across all recipients?
• Do reporting requirements provide the information needed to track progress?
• Is technical assistance available for recipients who need additional support?
• Which recipients or projects may require closer monitoring?

As funding reaches more recipients, states will need clear processes for monitoring spending, tracking progress, and helping organizations navigate federal requirements to avoid issues that could put funding at risk. How Are You Measuring Progress Today?

RHTP was designed as a five-year initiative, and meaningful transformation takes time.

Many organizations used Year 1 funding to address foundational needs, such as facility improvements, workforce recruitment, technology upgrades, and other investments needed to strengthen rural healthcare services. These investments may not produce measurable changes in outcomes overnight, but they help create the foundation necessary for long-term progress.

Rather than focusing solely on long-term outcomes, states can begin documenting early indicators of progress, such as:

• Facilities upgraded or modernized
• Workforce positions filled
• New partnerships established
• Services expanded
• Communities reached through new programs

These milestones do more than track progress. They help tell the story of how RHTP funding is being used in rural communities. While it may be too early to point to transformational health outcomes, states can begin documenting the projects, partnerships, and investments taking shape across their healthcare systems. 

Capturing those stories now can also help states communicate progress to providers, communities, and federal partners while building support for the long-term goals of the program.

3. What Lessons Should Shape Future Funding Cycles?

Most states are moving into Year 2 with plans that look similar to their original strategies. There is still limited data available to support major changes. However, that does not mean states should wait to begin gathering feedback. 

Year 2 is an opportunity to start identifying what recipients, stakeholders, and program administrators are experiencing on the ground.

Questions worth asking include:

• What challenges did applicants encounter during Year 1?
• Which processes created unnecessary administrative burden?
• Where are recipients seeking additional guidance or support?
• What trends are beginning to emerge across funded projects?

The answers may not change Year 2, but they can help inform decisions in future funding cycles.