A $50 Billion Opportunity: How RHTP could shape care for Tribal Nations & Alaska Native communities

Tribal communities must act now to secure their portion of state-distributed RHTP funds

The Rural Health Transformation Program is a once-in-a-generation federal investment: $50 billion over five years dedicated to strengthening rural health systems across every state in the country. For American Indian and Alaska Native communities, this moment carries both opportunity and complexity. 

Over half of all American Indian and Alaska Native people live in rural communities. Tribal health programs are some of the most essential providers in rural America. But the way this funding flows to Tribes, through states rather than directly, means that advocacy and strategy will determine whether this money reaches your community or passes it by. 

There are also long-term considerations. To access these funds, Tribes need to effectively demonstrate how they would use them and design programs that sustain care well beyond the RHTP’s five-year window. Securing funding is one step. Building something that outlasts the grant is the real work. 

We’ll walk through what the RHTP actually funds, how much each state received, what themes are emerging from all 50 state plans, and where the strategic openings are for Tribal Nations right now. We’ll also share how our Government Affairs, Tribal Health Advisory, Tribal Care, and teams can help you navigate this moment. 

What Tribal Leaders Need to Know Now 

H.R. 1, the “One Big Beautiful Bill” Act, created the Rural Health Transformation Program: a 5-year, $50 billion investment intended to strengthen rural health systems, expand access to care, modernize facilities and technology, and support innovative care models in communities that have historically struggled to meet the healthcare needs of their residents. 

CMS announced awards on December 29, 2025, confirming that all 50 states will receive first-year funding. That announcement marked the shift from planning to implementation. 

Here’s what the numbers look like: 

• Total Funding: $50 billion over 5 years (FY2026–2030) 

• Annual Funding: $10 billion per year 

• Distribution: 50% distributed equally across all states; 50% weighted by rural need, state policy actions, and impact potential 

• FY26 Awards: Range from $147M (New Jersey) to $281M (Texas), averaging roughly $200M per state 

• Timeline: Implementation is underway. CMS has assigned project officers to each state and will host an annual Rural Health Summit beginning in 2026 

States are already standing up governance structures, selecting partners, and moving toward implementation. This is happening now, and keeping track of your state’s deadlines is critical. 

What the Program Funds: A National Breakdown 

Based on the state application abstracts submitted to CMS, several major investment categories are taking shape. Many of them align with work that Tribal communities have been leading for years. 

That’s the framing worth holding onto throughout this post. The RHTP can support and expand care that Tribes created, rather than replace it. Tribal-led behavioral health programs, community health worker models, virtual care infrastructure, workforce training pipelines: these are not ideas that need to be imported. They need to be funded, scaled, and sustained. The RHTP can be the vehicle if Tribes are positioned to show how those funds connect to their needs. 

States With Explicit Tribal Partnerships 

A number of states explicitly named Tribal Nations, Tribal health organizations, or Tribal communities in their applications as a result of tireless advocacy work across Indian Country. Their plans create clear openings for partnership during implementation. If your Tribe is in one of these states, the door is already open to draft plans for funds to flow into your community. 

State	Tribal-Relevant Initiatives	FY26 Award
Alaska	Tribal Health Organizations as direct subrecipients; community-led, regionally designed systems	$272M
Arizona	Collaboration with Tribal Nations; priority on maternal health, chronic disease, behavioral health	$167M
Michigan	Tribal governments as potential subrecipients; focus on regional partnerships	$173M
Minnesota	Rural Tribal Nations as eligible subrecipients; technology-enabled care delivery	$193M
Montana	Tribal health organizations as likely partners; workforce and sustainability focus	$233M
New Mexico	$243M for rural and Tribal Workforce; Tribal communities explicitly named in plan	$211M
Oklahoma	Tribal Nations as key stakeholders in planning; 6 integrated initiatives	$223M
Oregon	$200M/year with a set-aside for Nine Federally Recognized Tribes of Oregon	$197M
Washington	Investments in Native families; training capacity for Tribal providers	$181M
Wisconsin	Local and Tribal governments as partners; flexible regional grants	$203M
Alaska	Tribal Health Organizations as direct subrecipients; community-led, regionally designed systems	$272M
Arizona	Collaboration with Tribal Nations; priority on maternal health, chronic disease, behavioral health	$167M

If your state isn’t on this list, the opportunity still exists. It just means the advocacy work matters even more. Ashley Hesse, Vice President of Tribal and State Government Affairs, is actively monitoring state plans and engaging with CMS on behalf of Tribal Nations. Whether your state named Tribes explicitly or not, we can help you understand your state’s specific RHTP initiatives, draft consultation requests, and connect with state project officers. 

The Big Investment Categories 

Across all 50 state plans, these themes appear most frequently. Each connects to work that Tribal Nations know well. 

Workforce Development 

Nearly every state prioritized recruiting, retaining, and training rural health workers. Delaware is creating its first medical school with a rural health track. North Dakota committed $162M to residencies and “grow-your-own” pipelines. New Mexico dedicated $243M to rural and Tribal workforce pathways, clinical training, and housing support. 

For Tribal communities, workforce has always been the bottleneck. The providers who stay are the ones who understand the community. Building that pipeline takes investment in local people, culturally grounded training, and provider networks designed to serve the whole community, not just fill slots. Our Tribal Care team and the Guardiant Health provider network were designed around this exact challenge: expanding access by growing and coordinating the workforce your community actually needs. 

Technology and Telehealth Infrastructure 

States are investing heavily in EHR modernization, interoperability, cybersecurity, telehealth expansion, remote monitoring, and AI-enabled care. Virginia committed $282M to health tech initiatives and EHR modernization. Texas launched programs around advanced AI, telehealth, and rural cyber protection. Alabama is building regional IT hubs for EHR integration. 

For Tribal Nations, technology-enabled care has already proven its value. Think about what it means when a community member can see a cardiologist or a psychiatrist without a six-hour round trip. OneRoom Health’s digital exam room and CareWall™ technology make that possible today in Tribal health facilities across the country. The RHTP’s technology investments are built to support and scale exactly this kind of work. 

Maternal and Child Health 

Maternity care deserts, perinatal outcomes, and pediatric access are major priorities across many state plans. Alabama is piloting digital obstetric regionalization and telerobotic ultrasound. Kentucky launched a maternal and infant health initiative with telehealth-enabled community teams. Ohio is pursuing legislative reforms to allow low-risk birthing centers in rural hospitals. 

Many Tribal communities sit in some of the most severe maternity care deserts in the country. A mother shouldn’t have to drive two hours for a prenatal visit or deliver her baby in a hospital far from her family and her community. Virtual care technology can bring OB/GYNs, perinatologists, and lactation consultants into a Tribal health facility so mothers receive safe, supported care without leaving home. 

Chronic Disease Prevention and Management 

Nutrition programs, “Food is Medicine” initiatives, fitness programs, and chronic disease reversal efforts are emerging across multiple states. Nebraska is transforming rural school kitchens and building regional food hubs. Iowa launched a statewide cancer screening and treatment initiative. Kansas created a statewide “Food Is Medicine” program with community health workers. 

Tribal communities have led culturally grounded approaches to wellness and prevention for generations. Traditional food systems, community-based prevention programs, ceremonies, and holistic approaches to health have always been part of how Tribal Nations care for their people. The RHTP creates a pathway to formalize and fund these efforts on Tribal terms, not import external models that miss the cultural context entirely. 

Behavioral Health and Substance Use Disorder 

States are expanding Certified Community Behavioral Health Clinics (CCBHCs), crisis services, integration into primary care, and telehealth-based behavioral health. Kentucky is implementing EmPATH units and mobile crisis teams. South Dakota is rolling out CCBHCs statewide. North Carolina is expanding non-traditional workforce models for behavioral health. 

Behavioral health is one of the most urgent needs in Indian Country. And Tribal-led models have shown that when care is designed by and for the community, people engage with it. Our Opioid Treatment Program (OTP) clinics and integrated behavioral health programs are built on this principle. RHTP funding can help Tribes expand these programs, add crisis response capacity, and weave behavioral health into every level of the care system. 

EMS and Emergency Care Transformation 

Treat-in-place models, mobile integrated health, community paramedicine, and regional EMS coordination are gaining traction. Ohio is scaling treat-in-place programs to reduce emergency department visits. Iowa launched mobile care for high-risk maternal transport. Wyoming is consolidating small ambulance services into sustainable regional systems. 

For rural Tribal communities where the nearest emergency department may be an hour or more away, these models carry real weight. They can mean the difference between someone receiving care in their community or not receiving it at all. 

Regional Partnerships and Care Coordination 

Hub-and-spoke models, clinically integrated networks, shared services, and data-sharing platforms are becoming structural priorities. California is anchoring regional networks around rural hospitals. Pennsylvania established eight “Rural Care Collaboratives.” Missouri is building regional coordinating networks. 

Tribal Nations already operate as care coordination hubs in their regions. The RHTP creates an opportunity to formalize and fund that role, ensuring that Tribal-led care models are at the center of regional partnerships rather than on the margins. 

Facility Modernization and Capital Investments 

Renovations, equipment purchases, mobile health units, and facility upgrades are funded across many states. Idaho is investing in facility renovations, clinical equipment, and mobile health units. Mississippi’s “BRIDGE” initiative targets capital investments and innovative pilots. 

For Tribes with aging infrastructure or plans for new facilities, the RHTP provides a pathway to fund feasibility studies, equipment purchases, and improvements that would otherwise take years to finance. If you’ve been waiting for the right funding vehicle to modernize your health facility, this may be it. 

The Tribal Challenge: Access as Pass-Throughs 

Tribal leaders are already familiar with this dynamic: the RHTP sends funding to states, and Tribes access it as subrecipients or partners. The pass-through model has a long and complicated history. States have not always engaged Tribes in meaningful consultation, and funding has not always reached the communities with the greatest need or with the planning needed to make a significant impact. 

Consider what this looks like in practice. A state receives $200 million in RHTP funds and begins distributing them through an RFA process. If Tribal Nations weren’t named in the original application, there may be no set-aside, no dedicated engagement pathway, and no mechanism ensuring Tribal priorities are reflected in how those dollars get spent. The programs get funded, the reports get filed, and the communities that needed the investment most are left to compete for whatever remains through piecemeal grant applications and rushed planning. 

But there’s a structural feature of the RHTP that changes the equation. States must submit annual non-competing continuation applications to CMS and demonstrate satisfactory progress. Technical scores are recalculated each year and directly affect future funding levels. CMS project officers are assigned to each state and will be tracking implementation closely. 

That means there are multiple leverage points for Tribal advocacy across the full five years, not just during the initial application. The Tribes that engage early, put their priorities in writing, and position themselves as essential implementation partners will be best positioned to benefit. 

What Tribal Leaders Can Do Right Now 

As states move from planning to implementation, the window for shaping how these funds reach your community is open. These are the actions that carry the most weight right now. 

Identify and map your Tribal health priorities across facilities, workforce, behavioral health, and technology to your state’s RHTP plan and submit them in writing. States are required to demonstrate stakeholder engagement and measurable outcomes. Written priorities from Tribal governments carry real weight, especially when they connect to initiatives the state has already committed to. A specific, well-documented ask that aligns with the state’s priorities is far more likely to get funded than a broad request submitted late. Our Tribal Health Advisory team can even work with your Tribe to build a financial model or outline a program plan that demonstrates long-term sustainability to your state. 

Engage with your state officials and any state initiatives connected to RHTP funds. Don’t wait for an invitation. Consult with officials on your community’s priorities, ensure you have a representative at state-sponsored information sessions, advisory councils, or one-to-one conversations with state representatives. Our Government Affairs team can work with you to draft conversation points and questions that can better inform your application messaging. 

Assert Tribal data sovereignty in every data-sharing discussion. As states build data infrastructure and analytics platforms, Tribal Nations need to ensure that Tribal health data stays governed by the Tribe. Data sharing agreements should protect sovereignty. 

Build partnerships with federal agencies, Tribal organizations, and regional partners. The RHTP encourages regional collaboration. Tribes that show up as partners in shaping implementation have more influence over how the money gets spent.  

How Partnerships Support Tribes Navigating RHTP 

There are 575 federally recognized Tribal Nations across the country, each with their own governance and health priorities that support their vision for their community. Our mission is to reach health equity for American Indians and Alaska Natives in one generation. That may sound ambitious, but it simply means supporting Native communities in whatever ways they need. Partners that recognize this are a critical component of accessing and allocating these funds.  

When you lead the way, you can build the kind of care that supports your people now and for generations to come, so our work focuses on three pillars that reinforce each other particularly when it comes to RHTP. 

Government Affairs—Our team navigates state engagement, asserts Tribal sovereignty, and ensures your priorities are reflected in your state’s implementation plan. Ashley Hesse, Vice President of Tribal and State Government Affairs, is actively monitoring RHTP implementation and engaging with federal agencies. We support Native communities with: 

• Policy Translation & Intelligence: Monitoring RHTP implementation—CMS guidance, state plan approvals, funding formula decisions, and annual reporting cycles — and translating them into clear implications for tribal leadership, operations, and governance. Because RHTP funds flow through states rather than directly to tribes, we track where tribal health is included in each state’s approved plan and where it’s missing. 

• Legislative & Regulatory Analysis: Structured analysis of the RHTP within the broader One Big Beautiful Bill Act—including the $911 billion in Medicaid spending reductions, restrictions on provider tax authority, AI/AN-specific exemptions, and how the program’s allowable funding categories align with tribal health priorities. 

• Medicaid, Funding & Program Readiness: Support at the intersection of new RHTP dollars and long-term Medicaid exposure helping tribes assess revenue risk, engage state agencies on plan inclusion, navigate interactions with existing 638 compacts and IHS reimbursement, and plan beyond the program’s 2032 spending deadline. 

• Leadership & Consultation Preparation: Briefing materials and talking points tailored to each tribe’s state allocation, approved plan priorities, and governance structure— supporting leadership conversations with state health departments, CMS, legislators, and funding partners. Indigenous Pact supports tribal-led engagement. We do not lobby or speak on behalf of tribes. Our role is to equip leadership with clarity, confidence, and the information needed to engage on RHTP on their own terms. 

Tribal Health Advisory—We help Tribes build sustainable health systems. That means turning RHTP funding into lasting infrastructure—not just grant-period programs that disappear when the money does. Our advisory work aligns directly with RHTP’s allowable funding categories, so the systems you build today are positioned for both immediate impact and long-term viability: 

• Revenue Cycle & Financial Sustainability: Making sure the programs you launch with RHTP funding generate the Medicaid, MCO, and additional third-party revenue to sustain themselves long after the 2032 spending deadline—including PRC savings optimization and billing infrastructure that outlasts the grant period and lasts far beyond RHTP to roll into future health system improvements. 

• Health System Feasibility & Rightsizing: Assessing which service lines your community needs most and whether the operational model can support them—from behavioral health programs to primary care expansion—so RHTP investments target real gaps, not assumptions. 

• Workforce & Organizational Development: Building the staffing models, credentialing pipelines, and organizational structures that RHTP workforce funding requires—including the program’s five-year rural service commitments for recruited clinicians. 

• 638 Self-Determination & Program Readiness: Helping Tribes structure new programs under Title I or V authority so RHTP-funded services strengthen sovereign health delivery capacity rather than creating dependency on state-administered funding channels. 

Tribal Care—We design and support care that reaches your citizens where they are. RHTP specifically funds technology-driven care models, specialty care access, chronic disease management, and innovative delivery—that’s what we build every day. When your state plan includes these priorities, we help you deliver on them:  

• Virtual & Immersive Care Through OneRoom Health: Deploying telehealth and immersive specialty care that directly aligns with RHTP’s technology innovation and remote care priorities that bring specialists into communities that have never had local access. 

• Recovery Services: Standing up Opioid Treatment Programs (OTPs) and Office-Based Opioid Treatment (OBOT), outpatient, and residential recovery programs that match RHTP’s explicit funding category for opioid use disorder, substance use, and mental health services—with culturally grounded clinical models designed for Tribal communities. 

• Chronic Disease Prevention & Management: Evidence-based programs for diabetes, cardiovascular disease, and other conditions driving health disparities in Indian Country—directly aligned with RHTP’s primary funding category of measurable chronic disease interventions. 

• Mobile & Community-Based Care Delivery: Mobile health units, community outreach, and flexible care models that bring services into rural and reservation communities—meeting RHTP’s goal of expanding access points beyond traditional facility walls. 

What This Looks Like in Practice 

Picture a Tribe in a state that included Tribal partnerships in its RHTP application. Your leadership engages our Government Affairs team early. Together, you submit written priorities, request government-to-government consultation with the state agency, and document your facility and workforce needs so they’re on record before subrecipient selections begin. 

While that advocacy work is underway, our Tribal Health Advisory team is already working with your finance and operations leaders to map out how new services will generate sustainable revenue. They’re modeling Medicaid reimbursement scenarios and MCO payment structures that ensure the programs you build don’t collapse when federal dollars sunset. 

With that financial foundation in place, you launch a mobile health unit or bring virtual specialty care into your clinic through OneRoom. A community member who used to drive three hours to see a specialist now walks into their Tribal health center down the road, and meets their primary care provider in front of the CareWall™ to talk to the specialist directly. 

All three pillars are working at the same time, reinforcing each other. The advocacy secures funding. The advisory work ensures sustainability. The care delivery puts real services in front of real people. 

Now, picture a different situation: your state didn’t name Tribal partnerships in its RHTP application at all. Our Government Affairs team helps you draft language that states are looking for in applications. We position your existing health programs as models that align with the state’s stated priorities (because many of them already do). Our advisory team builds the financial case showing that RHTP investment today creates a self-sustaining care system that outlasts the grant. Our care operations team provides the clinical framework.  

So, what was once pass-through funding becomes true Tribal-led, transformative healthcare systems. 

The Implementation Clock Is Ticking 

States are standing up advisory councils, releasing applications, and selecting partners right now. Alaska’s first letter of interest period has already opened and closed. Montana has finalized its initiatives. New Jersey has released its RFA. Every week that passes is a week where decisions are being made about how these funds will be distributed. Find your state’s award amount and read your state’s application abstract on the CMS RHTP page. 

Talk to us about what comes next. We’ll be here with you every step of the way.