March 2026: States launch rural health transformation programs
By State Health & Value Strategies - Princeton University / April 10, 2026
As Rural Health Transformation Program (RHTP) funds started to flow to states in March 2026, a flurry of state activity followed as states launched their RHTP programs. Some states were still in the information dissemination phase, such as Arkansas, which announced a dedicated RHTP webpage and Maine, which hosted a series of webinars for providers and community partners. Other states began soliciting applications for RHTP funds, including Indiana, Nebraska, North Carolina, Ohio, Oklahoma and South Dakota. State Health and Value Strategies continues to track state RHTP implementation and recently published a round up of how states are using the RHTP to advance food is medicine interventions.
In March 2026 states were also busy reporting Marketplace enrollment numbers. California, Maine, New Jersey and Rhode Island published enrollment data, and several noted a decline in enrollment compared to the previous year. Mental and behavioral health continued to be a focus of state activity in March, with California announcing a new round of funding to increase the number of treatment beds and Maryland funding peer-led recovery services in rural communities. North Carolina and Washington expanded access to coverage for justice-involved populations, with Washington announcing it was the first state to provide Medicaid coverage to incarcerated youth at the time of their release.
Other state action in March included initiatives related to affordability and efforts to address cost; coverage for non-citizen populations; expanding access to care; maternal and infant health; Medicaid innovations; protecting vaccine access; reproductive and women’s health; services for children and youth; services for individuals with disabilities; states react to federally policy; and waiver and state plan amendments, requests and approvals.
Affordability and Efforts to Address Cost
Colorado released three reports on the financial health of hospitals. The Colorado Department of Health Care Policy & Financing (HCPF) released three annual reports on the financial health of Colorado hospitals and the benefits delivered to communities. By promoting greater transparency in hospital financial practices, reimbursement structures, and health outcomes, HCPF aims to help control costs, identify and address emerging challenges, and support more effective policy decisions.
Coverage for Justice-Involved Populations
North Carolina funded a new mental health program for young people involved in the justice system. The North Carolina Department of Health and Human Services (NCDHHS), the Department of Public Safety, Alliance Health, and New Hope Treatment Centers are partnering on a pilot program to improve mental healthcare for young people involved in the justice system. The $3.5 million investment will fund a new mental health program at the Dillon Juvenile Detention Center in Butner.
Washington expanded Medicaid coverage to incarcerated youth upon their release. The Department of Children, Youth, and Families, in collaboration with the Health Care Authority, is the first state to provide healthcare services to youth exiting a carceral setting. Young people exiting Green Hill and Echo Glen will be eligible for Apple Health up to 90 days before their release and receive Medicaid discharge planning to support their health and reentry into their community.
Coverage for Non-Citizen Populations
New York clarified how immigration data is used by health programs in the state. New York State of Health published a statement clarifying when and how citizenship and immigration information are used when someone is applying for health coverage. The state also clarified how that information is shared when required by law.
For more information about H.R.1’s coverage eligibility changes for non-citizens, see SHVS resources here. SHVS also recently published an FAQ on H.R.1’s changes to non-citizen coverage as states plan eligibility and systems updates.
Expanding Access to Care
Mississippi is exempting small community hospitals from certificate of need requirements. Governor Tate Reeves signed legislation to establish a pilot program to exempt small community hosptitals from certificate of need requirements. The law will allow certain rural hospitals to open a new facility within five miles of its main campus.
Marketplace Enrollment
California reported 1.9 million consumers signed up for Marketplace coverage. Covered California, the state’s official health insurance Marketplace, announced that state subsidies created to make up for the loss of federal enhanced premium tax credits (ePTCs) kept renewals steady. Over 1.9 million Californians signed up for or renewed their insurance during the 20206 open enrollment period. For the lowest-income consumers who are eligible for state subsidies that match the expired ePTCs, renewal rates were in line with last year’s. For middle-income consumers who lost all ePTCs, the cancellation rate among renewing enrollees was 22%, double the 11% seen last year.
Maine reported the lowest overall enrollment since transitioning to a State-Based Marketplace. CoverME.gov, the state’s official health insurance Marketplace, published its 2026 Open Enrollment Overview report. As a result of the expiration of the ePTCs, the state saw the lowest overall enrollment since transitioning to a State-Based Marketplace in 2021.
New Jersey reported more than 500,000 residents enrolled in the Marketplace. More than 509,000 New Jersey residents enrolled in health insurance coverage for 2026 through Get Covered New Jersey, the state’s official health insurance Marketplace, during the open enrollment period. However, the state is cautioning that the full effect of the loss of ePTCs has not impacted the Marketplace yet and is predicting a material drop off in enrollment this Spring.
Rhode Island reported a 10% decline in Marketplace enrollment. HealthSource RI, the state’s official health insurance Marketplace, concluded its open enrollment period with a 10% decline in individual and family enrollments from the record-high close of last year’s open enrollment. Bronze plan selections rose steeply (from 21% to 32%) as silver and gold selection fell off (from 38% to 31% and 38% to 35% respectively).
With the loss of ePTCs, a handful of State-Based Marketplaces reported success with efforts to extend Marketplace affordability through state-funded Marketplace subsidies. SHVS published an issue brief which explores State-Based Marketplace subsidies to improve affordability, design options, and state action to date.
Maternal and Infant Health
Wisconsin extended Medicaid postpartum coverage to 12 months. Governor Tony Evers signed legislation to extend postpartum Medicaid coverage from 60 days to one year. Expanded postpartum coverage will be available for Wisconsin families starting July 1, 2026, following CMS review and approval of Wisconsin’s state plan amendment.
SHVS published an expert perspective highlighting the opportunity that the Rural Health Transformation Program provides for states to leverage federal funding to support investments to improve maternal health outcomes and reduce disparities.
Medicaid Innovations
Minnesota announces plan to streamline administration of human services. Governor Tim Walz announced a proposal to transform Minnesota’s human services system. The proposal would streamline Minnesota’s service delivery model, moving away from the complex, layered administration managed by a patchwork of counties, managed care organizations, and state agencies to a single, centralized entity.
New Mexico Medicaid now covers traditional healing practices for Native American members. New Mexico Medicaid now covers traditional healing practices for Native American Medicaid members in participating tribes, nations or pueblos, expanding culturally appropriate health services provided by certified traditional healers.
Mental and Behavioral Health
California announced a round of mental health and substance-use disorder treatment facility funding. Governor Gavin Newsom announced the next round of Bond Behavioral Health Continuum Infrastructure Program awards, with a $1.18 billion investment to fund an additional 66 projects across 130 behavioral health facilities. The state has now delivered a combined 6,919 residential treatment beds and 27,561 outpatient slots.
Maryland funded peer-led recovery services in rural communities. Lieutenant Governor Aruna Miller announced the expansion of substance-use recovery services across Maryland’s rural communities through $1.6 million in awards to prepare people who have lived experience in recovery for careers as Certified Peer Recovery Specialists.
New Mexico is seeking community input on the transition of the Comprehensive Addiction and Recovery Act program. The New Mexico Health Care Authority (HCA) will host an online public feedback session on the transition of the Comprehensive Addition and Recovery Act(Cara) program to the agency. The session is intended to provide information about the upcoming transfer of CARA administration to the HCA and to hear directly from community members, partners and individuals with direct experience with the program.
New York launched a public awareness campaign to improve mental health and substance-use disorder care. Governor Kathy Hochul announced the launch of a public awareness campaign to educate New Yorkers on regulations that improve access to mental health and substance-use disorder care. The “Real Care, Real Access to Behavioral Health Services” campaign highlights regulations giving New Yorkers access to initial outpatient appointments for behavioral healthcare within 10 business days. Governor Hochul also announced the release of a new online training for mental health professionals who work with first responders such as 911 dispatchers, law enforcement, emergency medical technicians and firefighters.
North Carolina is connecting people in crisis to care. The North Carolina Department of Health and Human Services announced major updates to the statewide online mental health bed registry. The Behavioral Health Statewide Central Availability Navigator (BH SCAN) is now updated hourly and has been integrated with the 988 Suicide and Crisis Lifeline.
Protecting Vaccine Access
Washington is preserving no-cost preventive services. Governor Bob Ferguson signed legislation signed legislation preserving no-cost preventive services for Washington residents. The bill changes state law to tie the coverage of vaccines to recommendations from the Washington state Department of Health and sets coverage standards for other preventive services based on recommendations from the U.S. Preventive Services Health Task Force.
Reproductive and Women’s Health
New York funded abortion healthcare services. Governor Hochul announced $20 million in state grants available to providers to fund medication abortion healthcare services under the New York State Supplemental Abortion Provider Support Fund.
Wisconsin expanded access to breast cancer screenings. Governor Tony Evers signed “Gail’s Law,” to expand access to to breast cancer screenings. The legislation requires health insurance policies, including Medicaid, to fully cover medically necessary supplemental breast screenings or diagnostic breast examinations for those with dense breasts or who are at an increased risk of breast cancer.
Governors in 19 states urged HHS to fund Title X services. Governors in 19 states (AZ, CA, CO, CT, DE, GU, IL, KY, MA, MD, MI, NC, NM, NY, OR, PA, RI, WA & WI) representing the Reproductive Freedom Alliance sent a letter to HHS Secretary Kennedy urging the immediate renewal of Title X family planning grants, warning that a lapse in funding will cut off access to critical reproductive healthcare for millions.
Rural Health
Arkansas created a RHTP webpage. The state created a webpage highlighting its rural Health Transformation Program which will be updated with information on programming and opportunities.
California hosted an RHTP briefing. The Department of Health Care Access and Information (HCAI) hosted a briefing on the RHTP, including an overview of stakeholder engagement, timelines, Rural Health Policy Council, and next steps. HCAI also published frequently asked questions on the RHTP.
Connecticut received $154 million through the RHTP. Governor Ned Lamont announced that Connecticut is receiving a $154 million federal grant through the RHTP.
Georgia received CMS approval for its amended RHTP budget. The Georgia Department of Community Health announced that the state has received final approval from CMS for its amended first-year budget period to utilize awarded funds through the RHTP.
Indiana is accepting applications for RHTP funding. The state is accepting requests for funding applications fo GROW(Growing Rural Opportunities for Well-being) Regional Grants, an initiative of the Indiana RHTP.
Maine is hosting community webinars on the RHTP. The Department of Health and Human Services will be hosting informational webinars for clinician and community partners on the RHTP. The webinars will include an overview of the program, implementation activity, adjustments to Maine’s budget, and plans for launching RHTP activities.
Maryland is hiring an RHTP administrator and meeting with stakeholders. The Department of Health is seeking a RHTP Administrator to provide administrative and managerial oversight of the implementation of the RHTP. The Department of Health also met with stakeholders to discuss the potential benefits of the RHTP on the state’s agricultural economy, and hosted a rural health workforce roundtable.
Missouri created an RHTP Office. The Missouri Department of Social Services established a Rural Health Transformation Office(RHTO) within the MO HealthNet Division.
Montana hosted an RHTP webinar. The Department of Public Health and Human Services and the Department of Administration hosted a webinar for vendors interested in upcoming requests for proposals for the RHTP.
Nebraska posted a request for applications for RHTP funding. The Nebraska Department of Health and Human Services has posted requests for applications for three grant opportunities under the RHTP. Make Rural Nebraska Healthy Again Through Food as Medicine; the Rural Health Care Workforce Incentive and Sustainability Model; and the Chronic Disease Management Navigation and Education Initiative.
New Hampshire approved four RHTP contracts. The Governor and Executive Council approved four contracts to implement the state’s RHTP plan. These contracts will establish hubs overseen by the Governor’s Office of New Opportunities & Rural Transformational Health (GO-NORTH).
New Mexico is leveraging the RHTP to expand the health workforce. Governor Michelle Lujan Grisham announced that rural healthcare providers can now apply for a share of $50 million in funding as part of the state’s three-year, $146 million investment that has helped recruit more than 800 healthcare workers to underserved communities.
New York received sign off from CMS on the state’s RHTP budget. The New York State Department of Health (NYS DOH) Office of Rural Health announced at a Rural Health Council meeting that CMS approved the state’s revised RHTP budget of $212 million and the state’s four initiatives with little to no change. NYS DOH expects to make the applications available by late spring/early summer in order to meet CMS requirements that funding must be obligated by October 30, 2026.
North Carolina opened applications for RHTP grants and held a series of listening sessions. The Department of Health and Human Services is seeking applications to serve as designated ROOTS Hub Leads for the RHTP. ROOTS Hubs are regional, locally governed networks that coordinate services and lead implementation of RHTP initiatives. Governor Josh Stein led the second in a series of Rural Listening Sessions, alongside business leaders, local elected officials, and other leaders. The governor and cabinet secretaries are embarking on this listening tour to hear directly from rural North Carolinians about their concerns and priorities to help focus the administration’s rural efforts, including healthcare.
North Dakota is leveraging the RHTP for workforce retention. North Dakota Health and Human Services announced the first RHTP funding opportunity to support the retention of healthcare professionals in 37 critical access hospitals and their owned and operated clinics.
Ohio issued solicitation invitations for RHTP. The Ohio Department of Health posted RHTP solicitation invitations, including for a rural health workforce pipeline, pathways for upskilling and retention and a pharmacy initiative.
Oklahoma opened its first grant application and posted an RHTP reference guide. The Oklahoma RHTP released its first public grant application through a notice of funding opportunity for the Community-Led Wellness Hubs: Microgrants program. The state also released a quick-reference quide on the RHTP, including frequently asked questions on funding distribution, oversight measures, and fund uses.
South Dakota released two rounds of RHTP requests for proposals. The state released its first round of RHTP requests for proposals(RFPs) and a second round of RFP’s, covering digital health modernization, caregiver support, doula workforce advancement, and more.
Tennessee will host an RHTP information session. The Tennessee Department of Health will host an information session on new funding opportuinities in the Tennessee RHTP for health leaders, partners, and stakeholders.
West Virginia’s Legislature took steps to appropriate RHTP funds. Governor Patrick Morrisey called on the West Virginia Legislature to move quickly on legislation to authorize the deployment of $199 million in federal funding to launch the state’s RHTP. The Governor issued a statement on the passage fo the RHTP supplemental.
SHVS is tracking state RHTP implementation; this expert perspective identifies the state agencies leading RHTP work and includes links to state RHTP webpages.
Services for Children and Youth
Michigan is seeking proposals to support substance-use prevention programs for children and youth. The Michigan Department of Health and Human Services is seeking proposals for primary substance-use prevention programs for youth. The funding supports community-based organizations in delivering evidence-informed primary prevention programs aimed at delaying the initiation of alcohol, tobacco and other drug use among youth ages 12 to 17.
North Carolina is piloting a mental healthcare program for young people involved in the justice system. The North Carolina Department of Health and Human Services, the Department of Public Safety, Alliance Health and New Hope Treatment Centers are partnering on a pilot program to improve mental healthcare for young people involved in the justice system. The $3.5 million investment will fund a new mental health program at the Dillon Juvenile Detention Center in Butner.
Services for Individuals with Disabilities
Massachusetts is developing a multi-agency strategy to support adults with autism spectrum disorder. Governor Maura Healey signed an executive order to establish a statewide stategy to better support adults with profound autism. The executive order aims to improve coordination across state agencies, promote innovation and advance outcomes for adults with profound autism and their families.
States React to Federal Policy
Maine released a video statement responding to CMS. Governor Janet Mills issued a video statement on the state’s response to CMS’ request for information about the management of the state’s Medicare program, noting that the state “sent back a comprehensive response” and highlighting its steps to fight fraud.
New York hosted the first in a series of roundtables on H.R.1. The New York Department of Health, NYSOH and the United Hospital Fund hosted the first in a series of roundtables dedicated to addressing the implementation challenges presented by H.R.1.
Waiver and State Plan Amendments, Requests and Approvals
Minnesota’s corrective action plan is approved by CMS. CMS approved Minnesota’s program integrity corrective action plan (CAP), which the state submitted in response to CMS’ proposed compliance action that would have withheld over $500 million in federal Medicaid funding every quarter. In light of the accepted CAP, CMS has proposed to suspend the compliance action.
Missouri to provide coverage to former foster care youth up to age 26. CMS approved an extension of the “Missouri Former Foster Care Youth” section 1115 demonstration. This demonstration provides Medicaid coverage to Missouri residents who were former foster care youth under age 26, were in foster care under the responsibility of another state for at least six months as of the date they turned 18 and were enrolled in Medicaid while they were in foster care.
New York received approval to terminate its section 1332 waiver. CMS approved New York’s request to terminate its section 1332 state innovation waiver and return to Basic Health Program authority. The transition preserves Essential Plan coverage for approximately 1.3 million New Yorkers with incomes below 200% of the federal poverty level. Approximately 450,000 New Yorkers with higher incomes will become ineligible for the Essential Plan due to H.R.1, and will instead be eligible for qualified health plans beginning July 1, 2026.