Oregon is preparing for one of the most significant rural health opportunities in recent years through the Oregon Rural Health Transformation Program (RHTP). The program was created under H.R. 1 as a one-time, five-year effort to expand support for rural communities and rural health system transformation. The Centers for Medicare and Medicaid Services (CMS) will oversee the program as a cooperative agreement. For more information on CMS cooperative agreements, visit the Centers for Medicare and Medicaid Services website.
Oregon has not yet been awarded RHTP funding. The state submitted an application to CMS, and the information below reflects the Oregon Health Authority’s (OHA) proposed plan if Oregon receives funding.
Oregon’s Proposed Initiatives for the Rural Health Transformation Program
OHA shaped its proposed initiatives through community engagement and tribal consultation. These initiatives will guide implementation only if Oregon is awarded RHTP funding. As a result, rural partners can begin planning early and understand how the state expects to distribute support.
1. Regional Partnerships and System Transformation
OHA plans to strengthen rural regional networks through shared services, hub-and-spoke models, and system-wide collaboration.
2. Healthy Communities and Prevention
Proposed work includes building new access points, expanding successful care delivery models, and integrating behavioral health and chronic disease prevention into local systems.
3. Building Workforce Capacity
OHA highlights training, recruitment, and retention strategies to help clinicians live and work in rural communities. This includes “grow your own” programs that start in K–12 education.
4. Technology and Data Modernization
This initiative focuses on stronger data systems, better connectivity, and tools that support rural care teams, such as AI-enabled technology and closed-loop referrals.
5. Tribal Initiatives
Oregon’s nine federally recognized tribes will lead dedicated efforts to strengthen tribal health infrastructure and community care.
Proposed Funding Distribution Plan
Oregon outlined a two-phase approach for distributing funds under the Oregon Rural Health Transformation Program. These plans are hypothetical and depend on CMS approval.
Phase 1: FY26 to FY27
Catalyst Awards (About 40%)
- Distributed through a Request for Applications in early 2026
- Supports ready-to-launch projects that align with any initiative
Immediate Impact Awards (About 20%)
- Direct allocations for projects with significant short-term impact, such as new residency programs
- No application process required
Regional Sustainability (About 20%)
- Supports a subcontractor to help build regional networks and shared solutions
Phase 2: FY28 to FY30
Phase 2 follows the same structure but increases expectations for collaboration and long-term sustainability.
- Competitive Catalyst Awards: Encourages collective applications.
- Sustained Awards: Offers continued funding for successful Phase 1 projects.
Key Timeline for Oregon’s RHTP Application
These dates reflect anticipated milestones if CMS awards Oregon’s application.
- December 11, 2025: Deadline for non-binding Intent to Apply survey
- December 31, 2025: Expected Notice of Award from CMS
- Q1 2026: OHA releases the public RFA
- Q2 2026: Award decisions expected
- Second half of 2026: Award period begins
Proposed Multiyear Budget Framework
Oregon outlined the proposed budget allocations below. States applied using a hypothetical $200 million annual budget. CMS is expected to announce award decisions on December 31, 2025.
| Initiative | BY1 | BY2 | BY3 | BY4 | BY5 |
|---|---|---|---|---|---|
| Regional Partnerships | $40,000,000 | $40,000,000 | $40,000,000 | $40,000,000 | $55,000,000 |
| Healthy Communities | $75,000,000 | $75,000,000 | $55,000,000 | $50,000,000 | $50,000,000 |
| Workforce | $37,600,000 | $30,000,000 | $45,000,000 | $35,000,000 | $35,000,000 |
| Technology and Data | $7,400,000 | $15,000,000 | $20,000,000 | $35,000,000 | $20,000,000 |
| Tribal Initiatives | $20,000,000 | $20,000,000 | $20,000,000 | $20,000,000 | $20,000,000 |
Restrictions and Requirements (If Awarded)
If Oregon receives RHTP funding, OHA must follow several federal rules. These requirements help ensure funds support long-term rural transformation rather than replacing existing funding streams.
- Not for Medicaid reimbursement: Funds cannot support reimbursable services or duplicate federal sources.
- Not an offset for H.R. 1 cuts: RHTP funds cannot replace or supplement Medicaid cuts.
- Workforce commitments: Any workforce member supported with RHTP funding must serve rural communities for at least five years.
- Outcome reporting: Each initiative must report at least four outcome metrics.
- Performance-based payments: CMS may adjust yearly funding based on first-year performance.
Final Notes on the Oregon Rural Health Transformation Program
The Oregon Rural Health Transformation Program represents a major opportunity for rural providers, tribes, and community partners. Although Oregon has not yet received funding, early planning will help organizations respond quickly once CMS releases decisions and OHA posts the public RFA.
For support with program planning, application preparation, or rural health strategy, connect with Burrows Consulting.
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