Washington State Advances Planning for Rural Health Transformation Program
Olympia, WA — Washington state agencies are working with partners, providers, and community members to develop an application for the Rural Health Transformation Program (RHTP), a $50 billion federal initiative created under the One Big Beautiful Bill Act (OBBBA). The program seeks to stabilize and strengthen rural health care systems at a time when new federal policy changes threaten coverage and funding for hundreds of thousands of Washington residents.
The OBBBA, signed into law in July 2025, significantly reduces federal funding for Medicaid (Apple Health) and Affordable Care Act marketplace plans. An estimated 200,000–320,000 Apple Health enrollees and 100,000–150,000 Washington Healthplanfinder participants could lose coverage. This loss, combined with reduced payments to providers, is expected to put additional financial strain on hospitals, clinics, and other health facilities—especially in rural areas.
The RHTP provides $10 billion annually from 2026 to 2030 to approved states, with half distributed equally and half allocated based on rural population, facility numbers, and other factors.
Priorities for Washington’s Transformation Plan
As part of the application, the state will outline how funds will:
Preserve access to hospitals, clinics, behavioral health, and other essential providers.
Improve rural health outcomes, with a focus on prevention and chronic disease management.
Leverage technology, including AI-enabled tools, to support care delivery.
Strengthen the rural health workforce through targeted recruitment, training, and retention efforts.
Support long-term financial stability for rural hospitals and clinics.
The state must also choose at least three specific funding activities, which may include supporting behavioral health treatment, expanding value-based care models, improving telehealth capacity, and providing technology and technical assistance to rural providers.
Collaborative Planning and Public Engagement
The Washington State Department of Health (DOH), Health Care Authority (HCA), and Department of Social and Health Services (DSHS), in coordination with the Governor’s Office, are leading the planning process. Engagement opportunities include:
Tribal consultation through the Office of Tribal Affairs.
A public webinar in mid-September to review plan components and collect feedback.
Timeline (Tentative)
August–October 2025 – Stakeholder engagement, drafting transformation plan.
Nov–Dec 2025 – Final plan submission to the Centers for Medicare & Medicaid Services (CMS).
July–Sept 2026 – CMS approval and funding notification.
Oct 1, 2026 – First round of funds distributed (must be used by Sept 30, 2028).
How to Provide Input
Washington is seeking input from rural stakeholders to help shape its RHTP transformation plan.
We welcome:
Ideas, insights, considerations, project concepts, and other information that align with RHTP goals. Written responses should be 10 pages or fewer; slides and other formats are also accepted.
Your response should include:
A brief overview of your organization’s mission (if applicable), rural health experience, and the challenges your idea addresses.
A high-level summary of your idea, how it aligns with one or more of the 10 required RHTP activities, its expected impact on rural communities, and sustainability plans beyond the program.
Key partners and roles, community readiness, general timeline, and success measures.
Major risks and how you plan to address them.
Submission details:
Email: HCA Paying for Value, payingforvalue@hca.wa.gov
Mail/Drop-off:
Washington State Health Care Authority
Attention: Keah Hardy
626 8th Avenue SE
Olympia, WA 98501
If dropping off, please leave materials at the front desk/reception.
Deadline: All input must be received by 5 p.m. (Pacific), Friday, August 29, 2025. Early submissions are encouraged, and responses will be reviewed on a first-come, first-served basis.
Contacts for More Information
DOH – Maria Courogen, Executive Director, Center for Access to Whole Person Care – maria.courogen@doh.wa.gov
HCA – Kahlie Dufresne, Deputy Policy Director – kahlie.dufresne@hca.wa.gov
SWACH - Nichole Peppers, Executive Director - nichole.peppers@southwestach.org
DSHS – Grace Kiboneka, Planning & Development Manager – grace.kiboneka1@dshs.wa.gov