Make Rural Texans Healthy Again
Grants to rural hospital districts and rural hospitals for prevention, wellness and nutrition programs aimed at diabetes, heart disease, chronic respiratory disease and obesity.
RHTP state profile · Texas
Texas Rural Health Transformation Program
Texas received $281.3 million in Year 1 of the $50 billion federal Rural Health Transformation Program, 1st of 50 states. The Texas Health and Human Services Commission (HHSC) runs the program, called Rural Texas Strong, which funds six initiatives across Texas's 202 rural counties, from prevention grants for rural hospital districts to workforce bonuses and equipment upgrades.
Year 1 awards, all 50 statesTX: $281.3M
Texas $281.3MNew Jersey $147.3M
$281.3MYear 1 award, 1st of 50
6Funded initiatives
202 / 254Texas counties are rural
HHSCTexas Health and Human Services Commission
Spending data in the RHTP Year One Report covers December 29, 2025 to July 31, 2026, the latest CMS reporting window.
At a glance
Texas's program at a glance
The award is fixed for the year. Spending moves every quarter, so Texas'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$281,319,360, 1st of 50 states
Run byTexas Health and Human Services Commission
Budget Period 1December 29, 2025 to October 30, 2026
Initiatives6
Rural counties202 of 254
Spending data through July 31, 2026Texas's section of the Year One Report →Initiatives
What does Texas's RHTP fund?
Texas's RHTP, called Rural Texas Strong, funds six initiatives across prevention, patient technology, AI and telehealth, workforce, cybersecurity and equipment. Every funding opportunity HHSC posts maps to one of these six.
Rural Texas Patients in the Driver's Seat
Patient portals and connected home devices, run by provider networks in which at least 60% of members are rural.
Lone Star Advanced AI and Telehealth
AI tools for documentation, billing and prior authorization, plus local telehealth hubs, starting with maternal health, behavioral health and preventive screening.
The Next Generation of the Small Town Doctor and Team
Workforce funding for high school career paths, scholarships, relocation or signing bonuses and new residencies, with at least one award per rural county.
Unified Care Infrastructure and Rural Cyber Protection
Managed cybersecurity for rural providers, including threat detection, 24/7 monitoring and staff training, through state-listed security vendors.
Infrastructure and Capital Investments for Rural Texas
Equipment purchases and replacements such as lab, imaging, beds, generators and defibrillators, with preference for U.S.-made equipment.
Recipients by initiative are in Texas's section of the RHTP Year One Report.
Source documents
Texas'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 Texas solicitation.
PDFHHSCRural Texas Strong Revised Project NarrativeHHSC's revised Year 1 plan, including all six initiatives and Texas's policy commitments.PDFHHSCBudget Period 2 Project NarrativeHHSC's Year 2 plan, submitted to CMS in August 2026.PDFHHSCRural Texas Strong Fact SheetHHSC's two-page summary of the program and its six initiatives.PDFCMSCMS 50-State SpotlightsCMS's short profile of each state's program, including Texas's.PDFCMSCMS State Project AbstractsEach state's own summary, side by side.
Rural county (202)Other counties (52)
Eligibility
Which Texas counties are eligible for RHTP funding?
Texas's plan makes its 202 rural counties eligible: every county with 68,750 or fewer residents in the 2020 Census, out of 254 counties statewide. Those counties are home to nearly 3.7 million people. Each solicitation sets its own eligibility, such as rural hospital districts for Make Rural Texans Healthy Again or rural health care providers for the workforce initiative, which HHSC plans to fund in every rural county.
How to apply
How can Texas providers apply for RHTP funding?
Texas providers apply through grant applications and procurements from the Texas Health and Human Services Commission, posted on the HHSC Grants page and on the Electronic State Business Daily (ESBD), the state's procurement site. 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 six.
- Watch for new rounds.Sign up for Rural Texas Strong email updates, and check the HHSC Grants page and ESBD. HHSC lists estimated dates on its program page.
- Check who can apply.The technology initiatives are open only to networks of two or more clinically integrated networks, ACOs or cooperatives, and the cybersecurity work only to vendors on the state's managed security services list.
- 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 HHSC directly.Email RuralTexasStrong@hhs.texas.gov. HHSC is not meeting with potential vendors or applicants during procurements.
Federal terms
Four rules that shape every award
Federal terms follow the money down to every Texas 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 Texas's RHTP funding pay for?
Texas's RHTP funding can pay for work on existing facilities, uncovered care, technology and administration, within federal caps on each use. Applied to Texas's Year 1 award, the maximums are:
Capital and infrastructure20% of award
About $56.3M
Provider payments15% of award
About $42.2M
Administrative costs10% of award
About $28.1M
Rural Tech Catalyst Fund10% or $20M, whichever is less
$20.0M
Replacing an existing EMR system5% of award
About $14.1M
Provider payments and capital
Provider payments cover services insurance doesn't pay for, quality bonuses and outcome-based payments tied to Texas'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
Texas's policy commitments carry deadlines
Texas made two policy commitments in its application. One is done: Texas Medical Board nutrition education rules took effect September 3, 2026. Its SNAP restriction on candy and sweetened drinks was already approved before it applied and took effect April 1, 2026. CMS can reduce or recover funding if the remaining commitment slips.
Nutrition education for clinicians
Require nutrition and metabolic health continuing education, with Texas Medical Board rules adopted by December 31, 2026
Senate Bill 25 (2025); rules for physicians and physician assistants took effect September 3, 2026Presidential Fitness Test
Reinstate the Presidential Fitness Test in all Texas public schools
Governor Abbott's commitment; Texas law already requires a school fitness testTexas already belongs to the physician, nurse, EMS and psychology licensure compacts.
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 Texas's spending data
Use the numbers in Texas'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 Texas 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 Texas'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 Texas announcements
HHSC posts its list of Rural Texas Strong award recipients.
Texas announces $51 million for 68 rural hospital districts and authorities, $750,000 each, for prevention, wellness and nutrition programs.
HHSC submits its Budget Period 2 plan to CMS.
HHSC opens $56 million in competitive prevention and wellness grants for public and private rural hospitals.
HHSC opens $56 million in equipment and infrastructure grants for rural providers.
HHSC opens $99 million in rural workforce grants for scholarships, signing bonuses and new residencies.
CMS approves Texas's Year 1 budget of $281.3 million.
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 1, 2026SNAP candy and sweetened drink restriction takes effect
- Apr 7, 2026CMS approves Texas's Year 1 budget
- Jul 31, 2026End of the first CMS reporting window; Year One Report spending data runs through this date
- Sep 3, 2026Nutrition continuing education rules take effect
- Oct 30, 2026Budget Period 1 ends
- Nov 30, 2026Quarterly reports due; CMS refreshes funding data
- Jan 12, 2027Estimated deadline for patient technology and AI and telehealth proposals
- Jan 19, 2027Estimated deadline for cybersecurity offers
- Sep 1, 2028Presidential Fitness Test deadline
- 2030Final year of the five-year program
Implications
What this means
For rural hospitals
Make Rural Texans Healthy Again is Texas's largest initiative, and its first awards went straight to rural hospital districts. Watch for results of the competitive round for public and private rural hospitals, and for the next workforce and equipment rounds.
For partners and vendors
The patient technology, AI and telehealth, and cybersecurity initiatives are the main vendor lanes. The first two require applications from networks of providers, so partnering with a clinically integrated network or ACO is the route in. Cybersecurity work goes only to vendors already on the state's managed security services list.
For applicants and grantees
Build tracking for the metrics Texas reports to CMS before an award lands. Make Rural Texans Healthy Again moves to pay-for-performance in Years 4 and 5, tied to diabetes-related ER visits and diabetes education, and workforce recipients commit to five years of rural service.
FAQ
Texas RHTP FAQs
Who runs Texas's Rural Health Transformation Program?
The Texas Health and Human Services Commission (HHSC) runs Texas's Rural Health Transformation Program, called Rural Texas Strong, using federal funding from the Centers for Medicare & Medicaid Services (CMS). HHSC manages the state's plan, posts funding opportunities and answers questions at RuralTexasStrong@hhs.texas.gov. The program is Texas's share of the $50 billion federal Rural Health Transformation Program.
How much RHTP funding did Texas receive?
Texas received $281,319,360 for Year 1 of the Rural Health Transformation Program, 1st of 50 states. Every state got $100 million in baseline funding, and the rest of Texas's award was based on its rural needs, its policy commitments and the strength of its plan. Later years depend on Texas's progress.
Can Texas RHTP funding pay for construction?
No. RHTP funds can't pay for new construction, demolition or major expansions. Up to 20% of Texas's award each year, about $56.3 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 Texas 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 Texas's plan, up to 15% of the award each year, about $42.2 million in Year 1. They can't raise rates for services providers already bill.
Where can I see how Texas is spending its RHTP funding?
The RHTP Year One Report tracks how much of Texas'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, such as $51 million in September 2026 for 68 rural hospital districts, will appear after the next CMS refresh.
The Alliance
RHT Alliance members serving Texas
These RHT Alliance members serve Texas providers, with support that spans virtual nursing, virtual care, telehealth workflow, remote monitoring, EHR and health data, diagnostics, drone delivery, patient and family 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.
Valkyrie UAS SolutionsLong-range drone delivery of medications, specimens and organs to rural hospitals.
VitalChatVirtual nursing and continuous audio and video care across hospitals.
ViTel NetWorkflow platform for hub-and-spoke telehealth programs.
WebMD IgniteMedically reviewed patient education and outreach, including its HEART rural program.Follow Texas's money as it moves
The RHTP Year One Report tracks obligations, initiatives and recipients for all 50 states after each CMS data release.