California received $233.6 million in Year 1 of the $50 billion federal Rural Health Transformation Program, 3rd of 50 states. The California Department of Health Care Access and Information (HCAI) runs the program, called CalRHT, which funds three initiatives in rural areas of 57 of the state's 58 counties, from regional hub-and-spoke care networks to workforce and technology grants.
Spending data in the RHTP Year One Report covers December 29, 2025 to July 31, 2026, the latest CMS reporting window.
The award is fixed for the year. Spending moves every quarter, so California's section of the RHTP Year One Report tracks how much was put to work, and with whom, through July 31, 2026. It updates after each CMS data release.
California's RHTP funds three initiatives: a regional care model, rural workforce development, and technology and tools. Each initiative includes several programs, and every CalRHT funding opportunity maps to one of the three.
Regional hub-and-spoke networks, with hospitals as hubs and clinics, Tribal health programs and birth centers as spokes, plus proven models such as Project ECHO, OB Nest and perinatal psychiatry access.
A statewide workforce mapping tool, training pathways and clinical placements, family medicine obstetrics fellowships, and retention and relocation support for rural health professionals.
EHR modernization grants, telehealth, data exchange and cybersecurity upgrades, and a Rural Technical Assistance Center that helps providers adopt and share technology.
Recipients by initiative are in California's section of the RHTP Year One Report.
The approved plan has more detail than any summary: goals, partners, metrics and timelines for each initiative. Read it before responding to a California funding opportunity.
Rural areas in 57 of California's 58 counties can benefit from CalRHT funding, because the plan targets rural census tracts and Medical Service Study Areas rather than whole counties. HCAI uses the HRSA definition of rural, so a site's own location decides eligibility, not its county. Rural California is home to about 2.7 million residents, and each funding opportunity states its own geographic requirements.
Check a site in HRSA's eligibility analyzer →California providers apply through CalRHT grant programs posted on HCAI's Grant Funding Opportunities page, with applications submitted through the CalRHT portal on Submittable. All Year 1 grant programs have closed, and HCAI has not announced dates for the next round. Providers and vendors don't apply to CMS directly.
Federal terms follow the money down to every California recipient.
A subaward makes your organization a subrecipient that carries out part of the program, with federal reporting and audit requirements. A contract pays for goods or services, with lighter requirements.
States can't post funding opportunities until CMS approves their budget, so windows can open months into a budget period.
Recruitment and retention payments require clinicians to commit to serving rural communities for at least five years.
Under the Stevens Amendment, websites, social posts and other public materials about a funded project must name the federal funding.
California's RHTP funding can pay for work on existing facilities, uncovered care, technology and administration, within federal caps on each use. Applied to California's Year 1 award, the maximums are:
Provider payments cover services insurance doesn't pay for, quality bonuses and outcome-based payments tied to California's plan. They can't raise rates for services providers already bill.
Capital funds go to existing facilities: renovations, accessibility upgrades, HVAC and like-for-like equipment replacement.
California made no state policy commitments in its application, according to CMS, so none of its funding depends on new laws or rules. Its plan does make three program commitments. One is done.
Convene a public council of rural providers, facilities and consumers to advise the program
First meeting held July 28, 2026Set aside at least 5% of the budget for Tribal clinics and Tribal health programs
$11.65 million set aside in Year 1Grant recipients use their Year 1 funds
California does not belong to the physician, nurse, psychology, EMS or physician assistant licensure compacts.
Year 1 is not a guaranteed annual amount. CMS plans up to $40 billion more nationwide through 2030 and rescores every state each year on progress, data and policy actions.
Funds not obligated by the end of a budget period can't be obligated later and are redistributed to other states.
CMS can withhold, reduce or recover money for unallowable costs, unapproved plan changes or missed policy commitments. States get 90 days to fix a violation, and most decisions can't be appealed.
CMS's Office of Rural Health Transformation plans site visits in all 50 states in 2026. Audits start in 2027.
Use the numbers in California's section of the RHTP Year One Report to understand direction and pace, not as an audit.
Obligated money is signed to a contract or grant. Cash reaches recipients later.
The data covers December 29, 2025 to July 31, 2026, as California reported it to CMS. Commitments made after July 31, 2026 are not counted yet.
The CMS report has no recipient column. Search California's line item descriptions by name.
CMS updates the data after each quarterly state report, starting with the November 30, 2026 filing.
HCAI names 108 recommended subrecipients across 45 counties for $166.7 million in Year 1 grants, pending final agreements.
Four CalRHT grant programs are open: Accelerator Partners, family medicine obstetrics fellowships, EHR Modernization, and Workforce Development Recruitment and Retention, with applications due August 14 to August 31.
The Rural Health Policy Council holds its first public meeting.
CMS awards California $233.6 million for Year 1, the third-largest award.
Awards announced after July 31, 2026 are not in the CMS spending data yet. They will appear after the next CMS refresh.
The Transformative Care Model drew the largest share of California's Year 1 grants, including Accelerator Partner awards and transformative payments to hospitals that anchor regional networks. Expect later rounds to build on those hub-and-spoke networks, and watch for help from the Rural Technical Assistance Center.
California routes much of its program through regional Accelerator Partners, such as university-led rural health collaboratives, and through state contracts, including the Rural Technical Assistance Center. Partnering with those regional hubs is one route in. EHR modernization, telehealth, e-consults and data exchange are the most active technology lanes.
A selection isn't final until HCAI's subrecipient agreement is signed, and costs before then aren't reimbursable. Build tracking for the measures California reports to CMS before an award lands, since subrecipients can't opt out of reporting. Year 1 funds must be used by September 30, 2027.
The California Department of Health Care Access and Information (HCAI) runs California's Rural Health Transformation Program, called CalRHT, using federal funding from the Centers for Medicare & Medicaid Services (CMS). HCAI manages the state's plan, posts funding opportunities and answers questions at CalRHT@hcai.ca.gov. The program is California's share of the $50 billion federal Rural Health Transformation Program.
California received $233,639,308 for Year 1 of the Rural Health Transformation Program, 3rd of 50 states. Every state got $100 million in baseline funding, and the rest of California's award was based on its rural needs, its existing state policies and the strength of its plan. Later years depend on California's progress.
No. RHTP funds can't pay for new construction, demolition or major expansions. Up to 20% of California's award each year, about $46.7 million in Year 1, can go to work on existing facilities, such as renovations, accessibility upgrades, HVAC replacement and like-for-like equipment replacement.
Only for care that insurance doesn't already pay for. Provider payments can cover nonreimbursed services, quality bonuses and outcome-based payments tied to California's plan, up to 15% of the award each year, about $35.0 million in Year 1. They can't raise rates for services providers already bill.
The RHTP Year One Report tracks how much of California's award was put to work through July 31, 2026, by initiative and recipient, using state-reported data from CMS, and is updated after each CMS data release. HCAI also posts its own list of Year 1 recommended subrecipients, which includes the $166.7 million in grants announced in October 2026.
These RHT Alliance members serve California providers, with support that spans virtual nursing, virtual care, remote monitoring, health data, diagnostics, patient education and grant writing.
Azalea HealthCloud EHR and billing with AI-assisted charting for rural hospitals and clinics.
CorstrataTelehealth access to board-certified wound, ostomy and continence nurses.
Equum MedicalTelehealth-enabled physician coverage across specialties.
Health Recovery SolutionsRemote patient monitoring and care management at home.
InterSystemsHealth data platforms and interoperability.
Medical Equipment SourceDigital pathology, mobile labs and lab equipment services.
Rural Health Transformation Funding NetworkGrant writing support for RHTP funding opportunities.
Self Care DecisionsEvidence-based triage that directs patients to the right level of care.
Solid StartsInfant feeding guidance and education for families, built by pediatric feeding specialists.
Teledentistry.com24/7 virtual dental evaluations and emergency triage.
VitalChatVirtual nursing and continuous audio and video care across hospitals.
WebMD IgniteMedically reviewed patient education and outreach, including its HEART rural program.The RHTP Year One Report tracks obligations, initiatives and recipients for all 50 states after each CMS data release.