Today, the Centers for Medicare and Medicaid Services (CMS) announced that applications for the Rural Health Transformation Program (RHTP) are now open for states to apply. Enacted as part of the One Big Beautiful Bill Act, the RHTP is a $50 billion program. Funding is to be allocated to approved states over five years, with $10 billion available each year beginning in federal FY26 (Oct. 1 – Sept. 30, 2026).

Half of the funding will be evenly distributed to all states with an approved application. The remainder will be awarded to approved states based on individual state metrics and applications that reflect the greatest potential for and scale of impact on the health of rural communities. Applications must come from a state government agency or office and include a letter of endorsement signed by the governor.

There are several key considerations to keep in mind regarding the RHTP:

Application deadline: States have until Nov. 5 to apply, and this will be a one-time application. CMS will announce approved states by Dec. 31 and begin disbursing funds in 2026.

Program goals: The RHTP outlines five strategic goals rooted in the statutorily approved uses of funds:

• Make rural America healthy again: Support rural health innovations and new access points to promote preventive health and address root causes of diseases.
• Sustainable access: Help rural providers become long-term access points for care by improving efficiency and sustainability.
• Workforce development: Attract and retain a highly skilled health care workforce by strengthening recruitment and retention of health care providers in rural communities.
• Innovative care: Spark the growth of innovative care models to improve health outcomes, coordinate care and promote flexible care arrangements.
• Tech innovation: Foster use of innovative technologies that promote efficient care delivery, data security and access to digital health tools by rural facilities, providers and patients.

States will receive and manage funds: Unlike previous federal relief programs, the RHTP does not provide direct payments to rural providers and clinics. Instead, states must apply for and manage the funds, with CMS approval.

CCBHC-specific considerations: The RHTP specifically directs applying states to provide a current list of Certified Community Behavioral Health Clinic (CCBHC) entities within their state as of Sept. 1, 2025, every active site of care associated with each CCBHC entity, and the address of every active site of care. For applications without this information, CMS will estimate the number of CCBHCs in the state using the most recent list of CCBHCs as maintained by the Substance Abuse and Mental Health Services Administration (SAMHSA), the list of CCBHCs supported through the Section 223 CCBHC Medicaid Demonstration and through SAMHSA-administered CCBHC Expansion (CCBHC-E) Grants, and State-certified CCBHCs listed on state government websites for states that use other Medicaid authority to designate CCBHCs (such as Medicaid State Plan rehabilitation authority). The addresses of these CCBHCs sites, as available, will be compared to rural area designations using the current HRSA definition of rurality to determine whether a CCBHC is in a rural area.

The Senate’s top Republican leader said on Monday he wants the chamber to vote on a stopgap funding bill before lawmakers leave town for a scheduled weeklong recess.

“I’d like to get it — if we can get it from the House — get it done this week before we leave,” Majority Leader John Thune told reporters. However, getting the measure quickly from the House is in fact a big “if.” House Appropriations Chair Tom Cole (R-Okla.) told reporters Monday that his chamber might not pass the expected continuing resolution, which is expected to keep the government open through Nov. 20, until Thursday or Friday.

House leaders continued to discuss Monday how much new member security funding to add to the stopgap in light of the assassination last week of conservative activist Charlie Kirk, which has contributed to the delay. It could take days for the Senate to get to an initial vote after House passage if all 100 senators can’t agree to move faster. Republicans will need help from Democrats there to advance the funding bill, and senators are already bracing for the possibility of weekend work.

Both chambers are scheduled to be out of Washington next week for the observance of Rosh Hashanah. If the stopgap funding bill gets delayed in the House, Senate Republicans have left the door open to returning after the holiday next week, when they will only be days from the end-of-month shutdown deadline.Senate Minority Leader Chuck Schumer has warned that Democrats will oppose the stopgap bill unless Republicans negotiate with them, including on Affordable Care Act subsidies that are set to expire at the end of the year. Schumer hasn’t drawn a red line on what specific policy concessions Democrats would need, saying only that there needs to be a “bipartisan negotiation.”

“We want to keep the government open by engaging in bipartisan negotiation,” Schumer said on Monday, adding of Republicans: “If one side refuses to negotiate they are the ones causing the shutdown.”Republicans continued to insist Monday that the stopgap would be “clean,” without divisive policy provisions, leaving Democrats no reason to oppose it. “Nothing in there is going to cause anybody to vote ‘no’ that would otherwise vote ‘yes,’” Cole said.Thune left the door open Monday to include new funding for member security after Speaker Mike Johnson separately told reporters that he’s still working to “build consensus” with members on a security funding plan.

Thune also suggested that legislation from Sens. Lindsey Graham (R-S.C.) and Richard Blumenthal (D-Conn.) related to Russia is unlikely to be attached to the stopgap. The legislation would impose tariffs on countries that import Russian energy and implement secondary sanctions on foreign firms that support Russian energy productionGraham and Rep. Brian Fitzpatrick (R-Pa.) issued a joint statement over the weekend, first reported by POLITICO, urging colleagues to link their bill to government funding.Thune said he hoped the legislation is “ripe here soon” but said Republicans are continuing to wait on President Donald Trump to lay the groundwork with U.S. allies first.“I think this needs to be everybody taking the same tack when it comes to addressing the situation,” he said.