The Rural Health Transformation Fund: What States Are Funding in 2026

CMS is moving tens of billions of dollars into every state to stabilize rural healthcare heading into 2026—not through across-the-board rate increases, but through targeted investments in workforce, technology, care coordination, and alternative payment models.

In this episode, Alex Yarijanian breaks down what the Rural Health Transformation Program / Rural Health Fund (RHTF) actually is, what state strategies reveal about the future of rural access, and why this matters far beyond rural hospitals—impacting payer strategy, provider contracting, network adequacy, and healthcare economics.

You’ll hear key highlights from state plans including California, Texas, Florida, New York, and Illinois, plus the cross-state themes showing up everywhere: hub-and-spoke models, shared services, EMS reform, telehealth hubs, and AI-driven admin reduction (including automated fax processing).

What You’ll Learn

1. What the Rural Health Transformation Program actually is
2. Why this funding wave is different (state plans are concrete and approved)
3. What state strategies reveal about access risk + reimbursement limits
4. How payers should interpret this as a network adequacy / access signal
5. Why providers should see this as both opportunity + accountability shift

State Highlights Covered

California

1. Hub-and-spoke maternal + specialty access models
2. Example of rate + infrastructure working together (Health Plan of San Mateo specialty rate increases)

Texas

1. Technology as a force multiplier
2. AI-enabled specialty access, telehealth coordination, clinically integrated networks
3. Tech becomes a parallel lever to reimbursement in high-dispute markets

Florida

1. Remote patient monitoring (RPM) + community paramedicine
2. Utilization management upstream in MA-heavy environments

New York

1. Patient-centered medical homes + workforce pipelines
2. Care coordination over unit cost expansion in concentrated payer markets

Illinois

1. Integrated primary + behavioral health infrastructure
2. EMS treat-not-transport models
3. Alternative models as a response to inflation vs lagging rates

Key Cross-State Themes

1. Hub-and-spoke models are returning at scale
2. Shared services (centralized EHR, billing, analytics) to reduce admin burden
3. AI...