Hometown Connections
Hub-and-spoke partnerships between rural hospitals and care sites, including Centers of Excellence, Health Hubs, school-based services and the Best and Brightest workforce recruitment and medical equipment program.
RHTP state profile · Iowa
Iowa Rural Health Transformation Program
Iowa received $209.0 million in Year 1 of the $50 billion federal Rural Health Transformation Program, 15th of 50 states. The Iowa Department of Health and Human Services (Iowa HHS) runs the program, called Healthy Hometowns, which funds five initiatives across rural Iowa, from regional health hubs and cancer care to health information exchange and EMS.
Year 1 awards, all 50 statesIA: $209.0M
Texas $281.3MNew Jersey $147.3M
$209.0MYear 1 award, 15th of 50
5Funded initiatives
77 / 99Iowa counties are rural
Iowa HHSIowa Department of Health and Human Services
Spending data in the RHTP Year One Report covers December 29, 2025 to July 31, 2026, the latest CMS reporting window.
At a glance
Iowa's program at a glance
The award is fixed for the year. Spending moves every quarter, so Iowa'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.
Year 1 award$209,040,063, 15th of 50 states
Run byIowa Department of Health and Human Services
Budget Period 1December 29, 2025 to October 30, 2026
Initiatives5
Rural counties77 of 99
Spending data through July 31, 2026Iowa's section of the Year One Report →Initiatives
What does Iowa's RHTP fund?
Iowa's RHTP, called Healthy Hometowns, funds five initiatives across regional care networks, cancer prevention and treatment, co-located care, health data sharing and EMS. Every Healthy Hometowns funding opportunity maps to one of these five.
Combat Cancer: Prevent and Treat
Cancer Health Hubs, new screening and treatment equipment, and prevention programs such as radon testing and mitigation, FIT tests and skin cancer screening.
Communities of Care
Rural sites that co-locate at least three types of providers, with community health workers who coordinate care and manage chronic disease.
Health Information Exchange
Sustains and expands the statewide health information exchange so patient records follow patients across unaffiliated systems and Health Hubs.
EMS Community Care Mobile
An EMS system assessment, mobile integrated health pilots that bring care to homes, and telehealth-supported transport for high-risk mothers and newborns.
Recipients by initiative are in Iowa's section of the RHTP Year One Report.
Source documents
Iowa's full plan is public
The approved plan has more detail than any summary: goals, partners, metrics and timelines for each initiative. Read it before responding to an Iowa solicitation.
PDFIowa HHSIowa RHT Program Project NarrativeThe full Healthy Hometowns plan from Iowa HHS, including all five initiatives and Iowa's policy commitments.PDFIowa HHSIowa RHT Project SummaryIowa HHS's short overview of the plan and its expected outcomes.PDFIowa HHSHealthy Hometowns Year 1 UpdateIowa HHS's October 15, 2026 progress presentation, with Year 1 obligations and planned Year 2 awards.PDFCMSCMS 50-State SpotlightsCMS's short profile of each state's program, including Iowa's.
Nonmetro (rural) county (77)Metro county (22)
Eligibility
Which Iowa counties are eligible for RHTP funding?
Iowa's Healthy Hometowns funding goes to areas the federal Office of Rural Health Policy treats as rural, which covers all 77 of Iowa's 99 counties that sit outside metro areas, plus rural census tracts inside some of the other 22. Iowa HHS solicitations ask applicants to confirm each site is rural with HRSA's Rural Health Grants Eligibility Analyzer. About 47.5% of Iowans live in rural census tracts.
Check an address in HRSA's rural eligibility tool →How to apply
How can Iowa providers apply for RHTP funding?
Iowa providers apply through competitive requests for proposals (RFPs) from Iowa HHS, listed on its Funding Opportunities page and submitted through IowaGrants. One Year 2 round, the Cardiovascular Health Hub Program, is open until November 17, 2026. Providers and vendors don't apply to CMS directly.
- Match the work to an initiative.Funding only goes to work that fits one of the five.
- Watch for new rounds.Sign up for Healthy Hometowns updates, and check the Iowa HHS Funding Opportunities page, IowaGrants and State of Iowa Bid Opportunities.
- Confirm your site is rural.Iowa HHS RFPs require applicants to certify rurality with HRSA's Rural Health Grants Eligibility Analyzer.
- Plan for federal rules.Grant recipients follow federal grant, reporting and audit rules. A Single Audit applies at $1 million or more in federal spending a year.
- Ask Iowa HHS directly.Email healthyhometowns@hhs.iowa.gov.
Federal terms
Four rules that shape every award
Federal terms follow the money down to every Iowa recipient.
Grants and contracts carry different obligations
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.
New rounds follow CMS budget approval
States can't post funding opportunities until CMS approves their budget, so windows can open months into a budget period.
Workforce incentives need a rural commitment
Recruitment and retention payments require clinicians to commit to serving rural communities for at least five years.
Recipients must disclose the federal funding
Under the Stevens Amendment, websites, social posts and other public materials about a funded project must name the federal funding.
Allowable costs
What can Iowa's RHTP funding pay for?
Iowa's RHTP funding can pay for work on existing facilities, uncovered care, technology and administration, within federal caps on each use. Applied to Iowa's Year 1 award, the maximums are:
Capital and infrastructure20% of award
About $41.8M
Provider payments15% of award
About $31.4M
Administrative costs10% of award
About $20.9M
Rural Tech Catalyst Fund10% or $20M, whichever is less
$20.0M
Replacing an existing EMR system5% of award
About $10.5M
Provider payments and capital
Provider payments cover services insurance doesn't pay for, quality bonuses and outcome-based payments tied to Iowa'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.
Off limits
- New construction, demolition and major expansions
- Cosmetic work such as painting, carpet or decor
- Clinician salaries at facilities that use non-compete clauses
- Home broadband installation and service
- Costs already covered by other federal or state funding
Policy commitments
Iowa's policy commitments carry deadlines
Iowa committed to four policy actions in its application. All four are done, through two laws signed in May 2026. CMS can reduce or recover funding if a commitment is reversed.
Certificate of need reform
Remove outpatient behavioral health facilities from certificate of need review
HF 2635 signed May 13, 2026Psychology licensure compact
Join the Psychology Interjurisdictional Compact (PSYPACT)
HF 2676 signed May 20, 2026Nutrition education for physicians
Add nutrition to physicians' continuing medical education requirements
HF 2676 signed May 20, 2026Presidential Fitness Test
Bring back the Presidential Fitness Test in schools
HF 2676 signed May 20, 2026; takes effect once federal guidance for the test is finalIowa already belonged to the physician, nurse, EMS and physician assistant licensure compacts before joining PSYPACT.
Years 2 to 5
$40B
Future awards depend on progress
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.
Unobligated money leaves the state
Funds not obligated by the end of a budget period can't be obligated later and are redistributed to other states.
Funds can be clawed back
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.
Oversight is growing
CMS's Office of Rural Health Transformation plans site visits in all 50 states in 2026. Audits start in 2027.
Method
Reading Iowa's spending data
Use the numbers in Iowa's section of the RHTP Year One Report to understand direction and pace, not as an audit.
Put to work is not paid out
Obligated money is signed to a contract or grant. Cash reaches recipients later.
Through July 31, 2026 only
The data covers December 29, 2025 to July 31, 2026, as Iowa reported it to CMS. Commitments made after July 31, 2026 are not counted yet.
Recipients sit inside line items
The CMS report has no recipient column. Search Iowa's line item descriptions by name.
Quarterly refresh
CMS updates the data after each quarterly state report, starting with the November 30, 2026 filing.
Announcements
Major Iowa announcements
Iowa HHS reports it has obligated its full Year 1 award of $209.0 million, among the first states to do so.
Iowa HHS opens the Year 2 Cardiovascular Health Hub Program RFP, with proposals due November 17, 2026.
Iowa HHS opens Year 2 RFPs for maternal health hubs, Communities of Care co-location sites and mobile integrated health.
Iowa HHS names awardees for cancer health hubs, workforce recruitment and medical equipment, and launches public dashboards of awards by county.
Governor Reynolds signs HF 2676, which covers three of Iowa's RHTP policy commitments.
Governor Reynolds signs HF 2635, which removes outpatient behavioral health facilities from certificate of need review.
Iowa announces its intent to award more than $78.6 million for rural medical equipment and workforce recruitment, the first state to award RHTP funds.
CMS awards Iowa $209.0 million for Year 1.
Awards announced after July 31, 2026 are not in the CMS spending data yet. They will appear after the next CMS refresh.
Timeline
Key dates
- Dec 29, 2025Year 1 award; Budget Period 1 begins
- Jan 30, 2026First Year 1 awards announced
- May 13, 2026HF 2635 signed (certificate of need)
- May 20, 2026HF 2676 signed (fitness test, nutrition education, PSYPACT)
- Jul 31, 2026End of the first CMS reporting window; Year One Report spending data runs through this date
- Aug 31, 2026Annual report and Year 2 continuation application due to CMS
- Oct 9, 2026Iowa reports its full Year 1 award obligated
- Oct 30, 2026Budget Period 1 ends
- Nov 17, 2026Cardiovascular Health Hub proposals due
- Nov 20, 2026Most Year 2 award announcements expected by this date
- Nov 30, 2026Quarterly reports due; CMS refreshes funding data
- 2030Final year of the five-year program
Implications
What this means
For rural hospitals
Medical equipment drew Iowa's largest Year 1 commitment, about $123.8 million through the Best and Brightest program, alongside workforce recruitment and Centers of Excellence. The Cardiovascular Health Hub RFP is open until November 17, 2026, and maternal health hub awards are expected this fall.
For partners and vendors
Iowa has routed technical assistance and infrastructure through named partners, including the University of Iowa, the Iowa Primary Care Association and Converge Health, the state's new health information exchange vendor. Partnering with those leads and hub hospitals is one route in, alongside direct Iowa HHS RFPs. Cancer care, cardiovascular and maternal hubs, co-located care and EMS are the most active lanes.
For applicants and grantees
Build tracking for the measures Iowa reports to CMS before an award lands. Subrecipients can't opt out of reporting, and their results feed Iowa's annual rescoring. Iowa HHS publishes awards by county on its public dashboards.
FAQ
Iowa RHTP FAQs
Who runs Iowa's Rural Health Transformation Program?
The Iowa Department of Health and Human Services (Iowa HHS) runs Iowa's Rural Health Transformation Program, called Healthy Hometowns, using federal funding from the Centers for Medicare & Medicaid Services (CMS). Iowa HHS manages the state's plan, posts funding opportunities and answers questions at healthyhometowns@hhs.iowa.gov. The program is Iowa's share of the $50 billion federal Rural Health Transformation Program.
How much RHTP funding did Iowa receive?
Iowa received $209,040,063 for Year 1 of the Rural Health Transformation Program, 15th of 50 states. Every state got $100 million in baseline funding, and the rest of Iowa's award was based on its rural needs, its policy commitments and the strength of its plan. Later years depend on Iowa's progress.
Can Iowa RHTP funding pay for construction?
No. RHTP funds can't pay for new construction, demolition or major expansions. Up to 20% of Iowa's award each year, about $41.8 million in Year 1, can go to work on existing facilities, such as renovations, accessibility upgrades, HVAC replacement and like-for-like equipment replacement.
Can Iowa providers use RHTP funding to pay for patient care?
Only for care that insurance doesn't already pay for. Provider payments can cover nonreimbursed services, quality bonuses and outcome-based payments tied to Iowa's plan, up to 15% of the award each year, about $31.4 million in Year 1. They can't raise rates for services providers already bill.
Where can I see how Iowa is spending its RHTP funding?
The RHTP Year One Report tracks how much of Iowa'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. Iowa HHS also publishes Healthy Hometowns dashboards with awards by initiative and county, and Year 2 awards announced after July 31 will appear after the next CMS refresh.
The Alliance
RHT Alliance members serving Iowa
These RHT Alliance members serve Iowa 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.Follow Iowa's money as it moves
The RHTP Year One Report tracks obligations, initiatives and recipients for all 50 states after each CMS data release.