3 Innovative Approaches We’re Watching in RHTP Applications

In a matter of weeks, the federal Rural Health Transformation Program (RHTP) will begin a $50 billion, five-year effort to support rural health systems nationwide. All 50 states submitted applications in November, with awards to be announced by the end of 2025, and funding beginning to flow in 2026.

Based on our experience creating a statewide rural health sustainability blueprint for North Carolina, RHI reviewed the 43 publicly available state RHTP applications to identify promising approaches for pushing rural health planning forward. Three applications stand out for their innovative strategies – and each connects to fundamental principles that were validated through our work in North Carolina.

North Dakota: Integrating Health and Human Services Data for Whole-Person Care

North Dakota's application proposes implementing a statewide, centralized information hub to synthesize data from across Medicaid, SNAP, behavioral health, and other Health and Human Services programs. This integration represents a fundamental shift in how rural providers can understand and respond to patient needs. The data hub will give providers, case managers, and administrators a holistic view of patient and community needs, enabling earlier interventions, reducing crisis care, and improving outcomes.

This approach aligns directly with what we found in North Carolina: hospitals and health systems do not operate in a vacuum. Throughout our listening sessions across the state, stakeholders consistently emphasized that rural healthcare challenges are interconnected with transportation barriers, housing instability, food insecurity, and education gaps. North Dakota's data integration strategy recognizes this reality and builds infrastructure to address it systematically.

Louisiana: Expanding Advanced Care Capacity Across Rural Communities

Louisiana proposes funding 30 targeted rural capital investments, with the stated goal of enabling at least one facility per rural parish to shift from basic to advanced, tech-enabled care. This competitive grant program – requiring validation of concept in a data-driven needs assessment – will fund facility renovations, high-cost medical equipment, and IT upgrades. Parishes with a high burden of chronic disease and high percentage of households with broadband access will be prioritized. The state estimates that by Year 5, these investments will enable more than 3,000 new diagnoses following screenings and a 15% increase in rural asset utilization by service line.

Louisiana's approach recalls the framework we developed for North Carolina, which balanced three critical factors: proximity (ensuring services are close enough to patients), complexity (providing the fullest range of services that can be financially sustained, from routine to specialized care), and stability (avoiding duplicative services so that financially stable providers can invest in the services communities actually need). By targeting capital improvements in parishes where health burden and infrastructure capacity align, Louisiana creates a pathway for rural communities to access more advanced services while maintaining financial viability.

Maine: Structured Regional Planning to Right-Size Rural Services

Maine proposes looking beyond county lines to organize Rural Regional Planning Groups that include healthcare providers, government representatives, public health leaders, social service entities, and community members. The state plans to provide a structured, data-driven process using Maine's all-payer claims database to help these groups identify essential health services and assess community needs. The planning process will identify regional options for providing essential services, including preventive care and disease management, through physical sites, telehealth, and technology-enabled in-home and mobile care. The proposal includes hospital financial management programs with tailored technical assistance, followed by funding for capital and technology expenditures that align with sustainability plans.

This regional planning approach reflects a key finding from our North Carolina study: sustainability must go beyond county lines. Rural residents don't live their lives confined within county boundaries, nor do healthcare providers limit their services to a single county. In our analysis, we found that when we zoomed out from county-level data to regional perspectives, the outlook for healthcare sustainability changed considerably. Many neighboring counties that individually cannot sustain a hospital can collectively support essential services when analyzed as a region. Maine's structured approach to regional planning, grounded in all-payer claims data, prevents counties from operating in silos and enables coordinated solutions that match resources to actual patient flow patterns.

Looking Ahead

As these three examples demonstrate, states are approaching rural health transformation with strategies grounded in data, regional coordination, and systems thinking. North Dakota recognizes that health outcomes are shaped by social determinants. Louisiana is identifying financially viable approaches to deliver higher levels of care in rural communities. Maine sees that regional planning produces better outcomes than fragmented county-by-county approaches.

These concepts reflect lessons learned through our proven methodology in North Carolina. As RHTP funding begins flowing into rural communities in 2026, the Rural Healthcare Initiative will continue to track these programs and others, learning from innovative approaches that strengthen rural healthcare delivery across America.