Can FQHCs Get Rural Health Transformation Funding?

Yes, federally qualified community health centers (FQHCs) can get Rural Health Transformation Program (RHTP) funding, but not by applying to Center for Medicaid and Medicare Services (CMS). The $50 billion program awards money to states, and states pass it to providers through subgrants and contracts under their approved plans. So for a federally qualified health center, the path runs through your state: get your health center's project named in, or aligned with, the state's plan, then compete for the subgrant when the state opens it. This post walks through what that means in practice and what to prepare now.

Many health centers already have the pieces reviewers want: a rural footprint, an existing patient panel, established referral relationships, and the ability to stand up a new access point quickly. The work is translating that into a project a state office can fund under its plan.

Are FQHCs eligible for RHT funding?

Health centers are strong candidates. Many state applications named community health center investments, and CMS has framed the program around exactly the work FQHCs do: primary care, chronic disease management, behavioral health, and prenatal care in underserved areas. The National Association of Community Health Centers found that a large share of state plans include health center initiatives, and that nearly two-thirds of applications propose expanding behavioral and maternal health services (see NACHC's summary of health center investments in state plans).

Eligibility is not automatic, though. Because states decide who gets funded, a health center's eligibility is really about fit: does your project match a category your state committed to in its plan?

The money goes to states, not providers. What does that mean for a health center?

It means your funder is your state, not CMS. CMS awarded first-year sums averaging about $200 million per state, with all 50 states approved, and each state now administers its own plan (details on the CMS RHT overview page). States will move that money to providers through mechanisms they control: competitive subgrants, directed contracts, or funding tied to named partners in the application.

For a grantwriter, that changes the target. You are not writing to a federal NOFO. You are positioning your health center to win a state subgrant, which means knowing your state's plan, its funded categories, its timeline, and the office running it. The centers that get funded first will be the ones already visible to that office.

How do I get my health center into my state's RHT plan?

Work the state process directly. A practical sequence:

1. Find your state's approved RHT plan and the agency administering it, usually the state office of rural health or the Medicaid agency.
2. Read the funded project categories and identify the two or three that match what your center can deliver.
3. Contact the program office before any funding opportunity opens. Ask how they intend to distribute funds and whether they are identifying provider partners.
4. Frame your project in the plan's language, tied to a named category and a measurable outcome.
5. Line up partners now: a hospital, a school system, a Tribal health program, or another FQHC. Plans favor coordination across rural providers.

CMS has said it wants rural providers working together and functioning as long-term access points, so a project that connects your center to other rural organizations reads better than a standalone ask.

What have states already proposed for health centers?

Enough to signal where the money is going. States are funding satellite and mobile clinics, behavioral and maternal health expansion, and workforce pipelines, often with health centers as the delivery partner. Georgetown's CHIR found that at least 42 states referenced mobile health in their plans, frequently positioning mobile units as extensions of FQHCs embedded in existing referral networks and delivered at community sites like schools and churches (see the CHIR analysis).

That framing is an opening for health centers. If your state named mobile or satellite access points, a proposal to run one as an extension of your existing scope, with your clinicians and your referral network, fits the plan and plays to what an FQHC already does well. Getting the operating model right, from planning and staffing to workflows, is what separates a fundable proposal from a wish.

What documentation should an FQHC prepare now?

Prepare the material a state reviewer will ask for before the window opens:

• Your service area's need data: shortage designations, travel distances, uninsured and Medicaid rates, gaps in behavioral, maternal, or dental care.
• Your center's capacity: current panel, sites, clinical staff, and what you could add.
• A project concept tied to a named plan category, with a measurable outcome and a budget.
• Letters or memoranda from partners (hospitals, schools, Tribal programs, other centers).
• A sustainment plan for after FY2030, since RHT funding ends then and reviewers weigh longevity.

Having this ready turns a short application window into a fast, credible submission. If grant development is where your team runs thin, grant and funding support can carry the proposal while your clinical staff keeps the doors open.

Frequently asked questions

Can an FQHC apply to CMS for RHT funds directly?

No. CMS awarded RHT funds to states. Health centers access the money through their state's plan, typically as a subgrant or contract. Your first contact is your state's RHT lead agency, not CMS.

Are health centers named in state RHT plans?

Many are. A large share of state applications include community health center investments, and nearly two-thirds propose expanding behavioral and maternal health services, work that health centers commonly deliver.

What is the best project for an FQHC to propose?

One that matches a category your state already funded and plays to your center's strengths. Satellite and mobile access points run as extensions of your existing scope are a common fit, especially where the state named mobile health.

When should we start talking to our state?

Now. States control distribution and timelines, and early, visible partners have an advantage. Contact the program office before any funding opportunity opens.

Does RHT funding replace our HRSA grant?

No. RHT is a separate, state-administered fund with its own project focus and a five-year clock through FY2030. Treat it as additional project funding, not a substitute for base HRSA support, and plan for what happens when it ends.

If your health center is weighing an RHT project, talk with our team. We help program leaders position for state subgrants and build access points that keep running after the grant ends.