Regional Coordinating Networks and Hub Activation
Seven regional networks and 27 local community hubs that coordinate physical, behavioral and social care across 104 counties.
RHTP state profile · Missouri
Missouri Rural Health Transformation Program
Missouri received $216.3 million in Year 1 of the $50 billion federal Rural Health Transformation Program, 9th of 50 states. The Missouri Department of Social Services (DSS) runs the program, called ToRCH Care, which funds five initiatives across 104 rural and rural-adjacent counties, from 27 community care hubs to rural workforce training and hospital upgrades.
Year 1 awards, all 50 statesMO: $216.3M
Texas $281.3MNew Jersey $147.3M
$216.3MYear 1 award, 9th of 50
5Funded initiatives
104 / 114Missouri counties are rural or rural-adjacent
DSSMissouri Department of Social 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
Missouri's program at a glance
The award is fixed for the year. Spending moves every quarter, so Missouri'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$216,276,817, 9th of 50 states
Run byMissouri Department of Social Services
Budget Period 1December 29, 2025 to October 30, 2026
Initiatives5
Rural counties104 of 114
Spending data through July 31, 2026Missouri's section of the Year One Report →Initiatives
What does Missouri's RHTP fund?
Missouri's RHTP, Transformation of Rural Community Health Care (ToRCH Care), funds five initiatives across regional care networks, payment reform, health data, workforce and rural providers. DSS's MO HealthNet Division runs it through a new Rural Health Transformation Office, with support from the state health and mental health departments.
Alternative Payment Models
Payment models, built with payers and providers, that reward teamwork and outcomes such as fewer emergency visits and hospital stays.
Digital Backbone
A Rural Health Data Collaborative, electronic health record upgrades, interoperability and closed-loop referrals between care and social services.
Rural Health Workforce Programs
Pipelines to recruit, train and retain rural clinicians, including EMS training, maternal care staff, medical school clerkships and retention supports.
Provider Transformation
Tools such as remote monitoring and ambient AI, plus renovations that save at-risk facilities, restore local services and modernize care.
Recipients by initiative are in Missouri's section of the RHTP Year One Report.
Source documents
Missouri'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 a Missouri funding opportunity.
PDFDSSMissouri RHT Program Application NarrativeThe full plan from DSS, including all five initiatives and Missouri's policy commitments.PDFDSSMissouri RHT Program Application SummaryDSS's public summary of the plan.PDFDSSMissouri RHTP Year 1 Fund DistributionDSS's Year 1 budget by initiative.PDFCMSCMS 50-State SpotlightsCMS's short profile of each state's program, including Missouri's.
Rural or rural-adjacent county (104)Other counties (10)
Eligibility
Which Missouri counties are eligible for RHTP funding?
Missouri's program covers 104 of the state's 114 counties: 99 rural counties, with fewer than 150 residents per square mile and no large share of a central city, plus five rural-adjacent counties that act as regional anchors. Those five are Buchanan, Cape Girardeau, Christian, Jasper and Newton. The counties not covered are Boone, Cass, Clay, Cole, Greene, Jackson, Jefferson, Platte, St. Charles and St. Louis, along with the City of St. Louis. Each of the 104 counties belongs to one of 27 ToRCH Care Hubs.
View the Hub county groupings map →How to apply
How can Missouri providers apply for RHTP funding?
Missouri routes much of its RHTP funding through its 27 ToRCH Care Hubs and through competitive grants and bids from the Missouri Department of Social Services. Vendors register on MissouriBUYS, the state's procurement site. An $11 million workforce round is open, with provider proposals due through local Hubs by November 22, 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.
- Find your Hub.Many opportunities, including the current workforce round, run through the Hub Anchor or Program Coordinator for your county.
- Watch for new rounds.Sign up for DSS's RHTP email updates, and check the DSS bids page and MissouriBUYS.
- Register in SAM.gov.It is standard for federally funded grants and contracts.
- 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 DSS directly.Email DSS.RHTP@dss.mo.gov.
Federal terms
Four rules that shape every award
Federal terms follow the money down to every Missouri 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 Missouri's RHTP funding pay for?
Missouri's RHTP funding can pay for work on existing facilities, uncovered care, technology and administration, within federal caps on each use. Applied to Missouri's Year 1 award, the maximums are:
Capital and infrastructure20% of award
About $43.3M
Provider payments15% of award
About $32.4M
Administrative costs10% of award
About $21.6M
Rural Tech Catalyst Fund10% or $20M, whichever is less
$20.0M
Replacing an existing EMR system5% of award
About $10.8M
Provider payments and capital
Provider payments cover services insurance doesn't pay for, quality bonuses and outcome-based payments tied to Missouri'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
Missouri's policy commitments carry deadlines
Missouri committed to six policy actions in its application. One is done. CMS can reduce or recover funding if the rest slip.
Physician assistant licensure compact
Pass a law to join the PA Licensure Compact
HB 2974 signed July 13, 2026, in effect August 28, 2026SNAP sugary food restriction
Put a USDA waiver in effect excluding candy, desserts, soda and fruit drinks with less than 50% juice from SNAP purchases
USDA approved the waiver December 10, 2025. Start date moved to February 15, 2027Telehealth license or registration
Create a telehealth license or registration process for out-of-state providers
HB 2974 lets providers licensed in Missouri through reciprocity offer telehealth. A separate telehealth registration has not been confirmedScope of practice
Review scope of practice for nurse practitioners, physician assistants, pharmacists and dental hygienists, then change laws or rules
Nutrition education for physicians
Require at least one hour of nutrition continuing medical education
Rule amendment proposed November 2025Presidential Fitness Test
Align state school fitness rules with the Presidential Fitness Test
Missouri already belonged to the physician, nurse, EMS and psychology licensure compacts, and HB 2974 added the physician assistant, athletic trainer and dietitian compacts in 2026.
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 Missouri's spending data
Use the numbers in Missouri'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 Missouri 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 Missouri'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 Missouri announcements
DSS awards about $39.4 million in Smart Growth and Service Line Modernization grants to 26 rural providers for labor and delivery, behavioral health, imaging and primary care.
DSS opens an $11 million rural workforce funding round, about $412,000 per Hub, for housing, training, retention and transportation.
DSS announces $1.46 million for childcare support for rural health workers and a certified nurse midwife training partnership.
DSS awards about $35 million for strategic minor renovations at 20 rural hospitals, and up to $4.2 million funds EMT and paramedic training for 437 people.
DSS selects 27 Hub Anchor organizations from 41 applications to lead the ToRCH Care Hubs.
Governor Kehoe signs HB 2974, joining the PA compact and extending telehealth to providers licensed by reciprocity, and HB 2372, which expands community paramedic care.
CMS approves Missouri's Year 1 budget of about $216 million.
CMS awards Missouri $216.3 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
- Apr 7, 2026CMS approves the Year 1 budget
- Jul 17, 202627 Hub Anchor organizations announced
- Jul 31, 2026End of the first CMS reporting window; Year One Report spending data runs through this date
- Aug 28, 2026HB 2974 takes effect, adding the PA compact
- Oct 30, 2026Budget Period 1 ends
- Nov 22, 2026Provider proposals due to Hubs for the $11 million workforce round
- Nov 30, 2026Quarterly reports due; CMS refreshes funding data
- Dec 7, 2026Hubs submit workforce proposals
- Feb 15, 2027SNAP food restriction begins
- Sep 30, 2027Deadline to spend Year 1 funds
- Dec 31, 2027SNAP, telehealth and scope of practice deadlines
- Dec 31, 2028Nutrition education and fitness test deadlines
- 2030Final year of the five-year program
Implications
What this means
For rural hospitals
Facility work drew Missouri's largest announced awards so far: about $35 million for strategic minor renovations at 20 rural hospitals and about $39.4 million for maternity, behavioral health, imaging and primary care upgrades. Watch for later Provider Transformation rounds, and get to know your local Hub, which shapes many local funding decisions.
For partners and vendors
Missouri routes much of its funding through 27 Hub Anchors, which include hospitals, health departments, universities and counseling centers, and through partners such as the Missouri Emergency Medical Services Association. Partnering with those leads is one route in. DSS buys statewide technology, such as the digital backbone, telehealth and ambient AI tools, through state procurements, so watch MissouriBUYS and the DSS bids page. Health data, workforce, maternal care and EMS are the most active lanes.
For applicants and grantees
Build tracking for the measures Missouri reports to CMS before an award lands. Subrecipients can't opt out of reporting, and their results feed Missouri's annual rescoring. Year 1 funds must be spent by September 30, 2027, and many awards depend on CMS approval of each budget.
FAQ
Missouri RHTP FAQs
Who runs Missouri's Rural Health Transformation Program?
The Missouri Department of Social Services (DSS) runs Missouri's Rural Health Transformation Program through its MO HealthNet Division and Rural Health Transformation Office, using federal funding from the Centers for Medicare & Medicaid Services (CMS). DSS manages the state's plan, called ToRCH Care, posts funding opportunities and answers questions at DSS.RHTP@dss.mo.gov. The Department of Health and Senior Services and the Department of Mental Health support the work. The program is Missouri's share of the $50 billion federal Rural Health Transformation Program.
How much RHTP funding did Missouri receive?
Missouri received $216,276,817 for Year 1 of the Rural Health Transformation Program, 9th of 50 states. Every state got $100 million in baseline funding, and the rest of Missouri's award was based on its rural needs, its policy commitments and the strength of its plan. Later years depend on Missouri's progress.
Can Missouri RHTP funding pay for construction?
No. RHTP funds can't pay for new construction, demolition or major expansions. Up to 20% of Missouri's award each year, about $43.3 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 Missouri 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 Missouri's plan, up to 15% of the award each year, about $32.4 million in Year 1. They can't raise rates for services providers already bill.
Where can I see how Missouri is spending its RHTP funding?
The RHTP Year One Report tracks how much of Missouri'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. Awards announced after July 31, including about $35 million in September 2026 for rural hospital renovations and about $39.4 million in October 2026 for service line upgrades, will appear after the next CMS refresh.
The Alliance
RHT Alliance members serving Missouri
These RHT Alliance members serve Missouri providers, with support that spans virtual nursing, virtual care, remote monitoring, health data, diagnostics, patient education, drone delivery 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.
Valkyrie UAS SolutionsLong-range drone delivery of medications, specimens and organs to rural hospitals.
VitalChatVirtual nursing and continuous audio and video care across hospitals.
WebMD IgniteMedically reviewed patient education and outreach, including its HEART rural program.Follow Missouri's money as it moves
The RHTP Year One Report tracks obligations, initiatives and recipients for all 50 states after each CMS data release.