Rural Health Transformation Program funding in Ohio

On Dec. 29, 2025, the Centers for Medicare and Medicaid Services announced first-year Rural Health Transformation (RHT) Program awards. Ohio will receive a total of $202,030,262, the 25th highest total amount. However, according to HPIO’s analysis, Ohio was awarded the 46th-most funding per rural resident.

The RHT program was created as part of the federal reconciliation bill HR 1, sometimes referred to as the One Big Beautiful Bill Act, which was signed into law in July 2025. RHT will allocate $50 billion to states over five years, with $10 billion allocated in the first year.

Half of the first-year funding was awarded evenly among all 50 states ($100 million per state) and the other half was awarded based on state-submitted applications. The federal government scored proposals based on “factors including rural population, the proportion of rural health facilities in the state (and) the situation of certain hospitals in the state,” according to CMS, as well as the adoption of certain policy priorities such as restricting the purchase of unhealthy foods and drinks with SNAP benefits, scope of practice expansions, and loosening certificate of need laws.

Even after subtracting the portion of funding allocated equally to states (which inherently disadvantages larger states like Ohio), the state received the fifth-lowest amount of funding per rural resident from the application-based portion of the award. The only states to receive less funding per rural resident were Michigan, Pennsylvania, North Carolina and Texas.

While Ohio will receive more than $202 million in federal dollars this year through the RHT Program, the amount is one of the lowest in the nation based on rural population size. In addition, the funding will not replace all of the losses to rural health funding expected due to other provisions in HR 1 ($5.6 billion for Ohio over the next 10 years, according to KFF estimates).