Ignite innovation in Washington's rural hospitals
Technology, revenue cycle help, maternal, emergency and specialty services, and a sustainable payment model co-designed with rural hospitals.
RHTP state profile · Washington
Washington Rural Health Transformation Program
Washington received $181.3 million in Year 1 of the $50 billion federal Rural Health Transformation Program, 41st of 50 states. The Washington State Health Care Authority (HCA) runs the program with the Department of Health and the Department of Social and Health Services. It funds six initiatives for 1.1 million rural residents across 30 counties, from rural hospital innovation and Tribal health to workforce and behavioral health.
Year 1 awards, all 50 statesWA: $181.3M
Texas $281.3MNew Jersey $147.3M
$181.3MYear 1 award, 41st of 50
6Funded initiatives
30 / 39Washington counties are rural
HCAWashington State Health Care Authority
Spending data in the RHTP Year One Report covers December 29, 2025 to July 31, 2026, the latest CMS reporting window.
At a glance
Washington's program at a glance
The award is fixed for the year. Spending moves every quarter, so Washington'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$181,257,515, 41st of 50 states
Run byWashington State Health Care Authority
Budget Period 1December 29, 2025 to October 30, 2026
Initiatives6
Rural counties30 of 39
Spending data through July 31, 2026Washington's section of the Year One Report →Initiatives
What does Washington's RHTP fund?
Washington's RHTP funds six initiatives across rural hospitals, community care, Tribal health, technology, workforce and behavioral health. HCA shares the work with the Department of Health (DOH) and the Department of Social and Health Services (DSHS), and every funding opportunity maps to one of these six.
Prevent disease and manage care in community settings
Community health workers, dementia-capable communities, caregiver training, mobile care and community health hubs outside the clinic.
Invest in the health of Native families
Tribal-led care, Tribal health workforce, transportation to off-reservation care, care coordination agreements and health IT, set aside for Tribes.
Adopt technology and data solutions to enable health improvements
A provider technology and cybersecurity fund, telehealth, remote monitoring and an expanded Project ECHO.
Develop Washington's rural workforce to support rural communities
Training and recruitment for nurses, primary care providers and community health workers, including rural residencies and grow-your-own programs.
Expand and sustain Washington's rural behavioral health system
Mobile crisis teams, a move to the CCBHC model, youth support and recruitment and retention for opioid treatment programs.
Recipients by initiative are in Washington's section of the RHTP Year One Report.
Source documents
Washington'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 Washington solicitation.
PDFHCAWashington RHT Program Project NarrativeThe full plan from HCA, including all six initiatives, rural definitions and Washington's current policies.PDFHCAWashington RHT Program Updated BudgetThe revised Year 1 budget CMS approved in February 2026, by initiative.PDFHCARHT Program Update Webinar, September 2026HCA's status update on Year 1 funding opportunities, contracts and caps.PDFCMSCMS 50-State SpotlightsCMS's short profile of each state's program, including Washington's.PDFCMSCMS State Project AbstractsEach state's own summary, side by side.
Rural county (30)Other counties (9)
Eligibility
Which Washington counties are eligible for RHTP funding?
Washington's plan serves 1.1 million rural residents across 30 of the state's 39 counties, the counties the state Office of Financial Management (OFM) classes as rural by population density and land area. The plan also uses the federal FORHP definition, under which 22 counties are fully rural, and some opportunities, such as DOH's community health hubs, give those 22 counties priority. Each solicitation sets its own eligibility, and organizations outside rural areas can take part if their work clearly benefits rural residents.
View OFM's rural county list →How to apply
How can Washington providers apply for RHTP funding?
Washington providers apply through requests for applications (RFAs) and other procurements from HCA, posted on its Bids and Contracts page, and through opportunities from DOH and DSHS. State bids also post on WEBS, Washington's Electronic Business Solution. Tribes receive funds through a separate Tribal set-aside. Providers and vendors don't apply to CMS directly.
- Match the work to an initiative.Funding only goes to activities already in Washington's plan; the state can't add new ones.
- Watch for new rounds.Sign up for HCA's RHT email updates and check the HCA Bids and Contracts page and WEBS. As of November 5, 2026, HCA says it is not accepting applications on any competitive bids.
- Register in WEBS and SAM.gov.Vendors must register with WEBS to see state bids, and SAM.gov registration is standard for federally funded grants and contracts.
- Plan for federal rules.Grant recipients follow federal grant, reporting and audit rules, and send RFA questions only to the RFA coordinator. A Single Audit applies at $1 million or more in federal spending a year.
- Ask HCA directly.Email HCARuralHealth
Transformation Program@hca.wa.gov for questions that aren't about an open RFA.
Federal terms
Four rules that shape every award
Federal terms follow the money down to every Washington 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 Washington's RHTP funding pay for?
Washington's RHTP funding can pay for work on existing facilities, uncovered care, technology and administration, within federal caps on each use. Applied to Washington's Year 1 award, the maximums are:
Capital and infrastructure20% of award
About $36.3M
Provider payments15% of award
About $27.2M
Administrative costs10% of award
About $18.1M
Rural Tech Catalyst Fund10% or $20M, whichever is less
About $18.1M
Replacing an existing EMR system5% of award
About $9.1M
Provider payments and capital
Provider payments cover services insurance doesn't pay for, quality bonuses and outcome-based payments tied to Washington'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
Washington's program commitments
Washington 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 six program commitments. One is done.
Rural advisory committee
Convene a rural advisory committee to recommend changes to state law, rules and investments
First met June 2026; 13 members, meets quarterlyTribal health funding
Fund Tribal-led care through a dedicated initiative, with the Governor's Indian Health Advisory Council deciding how funds are shared among 29 Tribes
$19 million budgeted in Year 1Year 1 spending
Grant recipients use their Year 1 funds
Rural CCBHC clinics
Support two new rural clinics in the CCBHC payment model
CCBHC transition contracts in process as of September 2026Rural clinical residencies
Add at least four rural clinical residencies
Rural hospital payment model
Bring at least 25% of rural hospitals into a value-based payment model, with half in the co-design by Year 3
Washington already belongs to the physician, nurse, psychology, physician assistant, physical therapy, social work and occupational therapy licensure compacts. It does not belong to the EMS compact.
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 Washington's spending data
Use the numbers in Washington'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 Washington 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 Washington'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 Washington announcements
HCA reports that its first two RFAs have closed, $11.05 million for provider technology and cybersecurity and $10.71 million for maternal, emergency and specialty services at 36 rural hospitals, with mobile crisis and CCBHC contracts in process.
HCA announces the 13-member Rural Health Transformation Advisory Committee, which first met in June 2026 and meets quarterly.
HCA extends three RFA deadlines by two weeks because of wildfires in eastern Washington.
HCA opens an RFA for maternal, emergency and specialty services at rural hospitals.
DOH invites local health jurisdictions and Tribes to apply for $500,000 in Community Center Hubs for Health contracts.
HCA opens RFAs for a provider technology fund and an opioid treatment program workforce incentive.
CMS approves Washington's revised $181 million Year 1 budget, which keeps every activity in the plan.
Gov. Bob Ferguson announces Washington's $181 million Year 1 award.
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
- Jul 31, 2026End of the first CMS reporting window; Year One Report spending data runs through this date
- Oct 30, 2026Budget Period 1 ends
- Nov 30, 2026Quarterly reports due; CMS refreshes funding data
- Dec 2026Next HCA RHT webinar
- Sep 30, 2027Year 1 funds must be spent
- Dec 31, 2028Rural CCBHC clinics target
- Dec 31, 2029Rural clinical residencies target
- 2030Final year of the five-year program
Implications
What this means
For rural hospitals
Rural hospitals hold the largest initiative, about $60 million a year, and 36 rural hospitals were eligible for the first maternal, emergency and specialty services round. Watch for a rural hospital specialty care procurement and for the payment model co-design HCA is running with rural hospitals.
For partners and vendors
Washington routes much of its money through sole-source contracts, interagency agreements with DOH and DSHS, and subrecipients such as Project ECHO and Washington State University. Planned procurements include community-based and long-term care workers, dementia workforce, EMS interfacility transport, community center refits, grow-your-own training and rural workforce incentives, posted on HCA's Bids and Contracts page or WEBS.
For applicants and grantees
Register in WEBS and SAM.gov before a round opens, and send RFA questions only to the RFA coordinator. Recipients report on Washington's CMS metrics, can't use funds for construction or to replace existing funding, and must spend Year 1 funds by September 30, 2027.
FAQ
Washington RHTP FAQs
Who runs Washington's Rural Health Transformation Program?
The Washington State Health Care Authority (HCA) runs Washington's Rural Health Transformation Program, using federal funding from the Centers for Medicare & Medicaid Services (CMS). HCA shares the work with the Department of Health and the Department of Social and Health Services, posts funding opportunities and answers questions at HCARuralHealth
How much RHTP funding did Washington receive?
Washington received $181,257,515 for Year 1 of the Rural Health Transformation Program, 41st of 50 states. Every state got $100 million in baseline funding, and the rest of Washington's award was based on its rural needs, its current state policies and the strength of its plan. Later years depend on Washington's progress.
Can Washington RHTP funding pay for construction?
No. RHTP funds can't pay for new construction, demolition or major expansions. Up to 20% of Washington's award each year, about $36.3 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 Washington 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 Washington's plan, up to 15% of the award each year, about $27.2 million in Year 1. They can't raise rates for services providers already bill.
Where can I see how Washington is spending its RHTP funding?
The RHTP Year One Report tracks how much of Washington'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 made after July 31, such as provider technology and rural hospital service grants from HCA's summer RFAs, will appear after the next CMS refresh.
The Alliance
RHT Alliance members serving Washington
These RHT Alliance members serve Washington providers, with support that spans EHR and billing, 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 Washington's money as it moves
The RHTP Year One Report tracks obligations, initiatives and recipients for all 50 states after each CMS data release.