Rural Health Transformation for Tribal Nations
Where Tribes stand in each state, what’s open now, and how to get ready for the four funding years ahead.
RHTP at a Glance
$50 billion over five years
About $10 billion a year to states, fiscal 2026 through 2030.
Tribes reach it through their states
Usually as subawards, a share of the state’s grant. Each state includes Tribes differently, from set-asides to competitive rounds.
Year 2 runs from October 31, 2026
States had to commit Year 1 funds by October 30, 2026, and must spend them by September 30, 2027. There are no extensions.
Amounts can change each year
Half of each state’s award is the same every year. The other half is recalculated each year based on the state’s progress, so totals can go up or down. The Centers for Medicare & Medicaid Services (CMS) announces amounts each fall.
As of October 2026.
How Tribes reach RHTP in each state
The basics of how funding reaches Tribes, state by state. Decisions about your share always belong to your Nation.
California
At least 5% of Year 1 funds are reserved for federally recognized Tribes and the rural Tribal health system. Tribal clinics and Tribal entities can apply for subawards. The state hasn’t yet published how Tribes will access the pool.
Idaho
3.5% of the state award is set aside for the five Tribes in Idaho. Each Tribe’s share follows its own workplan and budget. The state is committing Year 1 shares now.
Washington
10% of the state award, shared equally among the 29 federally recognized Tribes through each Tribe’s agreement with the state. Payments went out in August and September 2026. Tribes can also apply for other state funding.
Oregon
Direct awards for the nine federally recognized Tribes in Oregon, each for its own projects. Agreements were signed and first payments sent by September 2026.
Nevada
A 4.5% set-aside, awarded by application and open only to the 28 Tribal Nations, Bands and Councils in Nevada. Year 1 funded six projects. The Year 2 round is planned for January 2027.
Wisconsin
An equal yearly amount for each of the 11 Tribal Nations in Wisconsin. Tribes can also apply to all three state initiatives. Tribal work begins in early 2027.
Arizona
Direct government-to-government agreements and competitive grants. Proposals that show Tribal engagement can earn up to a 5% scoring bonus. There’s no set-aside. Consultation continues all five years.
Don’t see your state? Sign up for alerts and choose Other. We’re adding state guides as plans develop.
Latest RHTP updates for Tribes
Analysis from our team, plus the state and federal news that matters to Tribes.
Where the program stands
Four funding years remain.
Where does your Tribe stand?
Most Tribes fit one or more of these situations.
Allocated
Your state has set aside RHTP funding for Tribes. The work now is using it well and on time.
Competing
Your Tribe or organization can apply for state RHTP funding. The focus now is being ready before the window opens.
Preparing
Your Tribe is still getting ready, or Year 1 came and went. The work you do now shapes what you can reach in Years 3 to 5.
Not sure
You’re in good company. Many states haven’t explained their Tribal pathways clearly, and a status check can help you find out.
The Year 2 Playbook walks through each situation with a 90-day plan and a readiness checklist. Get the Playbook
RHTP Year 2 Playbook for Tribal Nations and Tribal Health Organizations
A free guide from Indigenous Pact's Government Affairs and Tribal Health Advisory teams.
- Find your situation in three quick questions
- A 90-day plan for each situation
- A readiness checklist built to share with your council or board
- A one-page project brief and a state-by-state guide
Send me the Playbook
We’ll email it to you right away, along with a way to reach our team if you have questions.
How we can help
Tribal Nations cared for their people long before RHTP, and will long after it ends. Indigenous Pact partners with Tribes and Tribal health organizations to build, sustain and expand stronger systems of care, with Government Affairs alongside you at every step. It’s how we work toward our mission: health equity for American Indians and Alaska Natives in one generation. Every decision stays with your Nation.
At every step
Government Affairs
Know what your state is doing for Tribes.
We’re with you from your first questions through Year 5. We follow RHTP in your state as it changes and explain it in plain terms for your leadership. We also support your advocacy priorities and help bring the right people together.
Build
Tribal Health Advisory
Decide what to build, and be ready to act.
We help you assess where you stand and turn your priorities into a plan your council can act on, from feasibility and facility planning to governance, budgets and financial readiness.
Sustain
Tribal Health Operations
Launch and run what you build.
We open and manage programs on your Tribe’s behalf, from staffing and billing to day-to-day administration, while your Tribe makes the decisions. That includes opioid treatment programs. We run clinics and mobile medication units with Tribes today, and RHTP can help fund new substance use treatment services.
Expand
Tribal Care
More specialty care in your community.
Tribal Care expands the care your community can access, starting with specialists your people would otherwise travel far to see. Patients stay at your own clinic, and the specialist joins live through a video exam room, with a medical assistant by their side. RHTP can help fund the technology and training to start, and visits are billed through your clinic, so the service can continue after RHTP ends.
Find your Tribe's next step on RHTP
Talk with our team about where your Tribe fits in your state’s plan and what it would take to be ready.
Guided by Tribal health policy expertise
Ashley Hesse
Vice President, Tribal & State Government Affairs, Indigenous Pact
Ashley leads Indigenous Pact’s Tribal and state government affairs work, helping Tribal Nations understand what RHTP and related federal and state policy mean for their programs.
Get RHTP updates for your state
We’ll email you when your state opens a funding window or changes its plan, plus a short monthly RHTP briefing.
Questions Tribal leaders ask
What is the Rural Health Transformation Program?
A five-year, $50 billion federal program that funds states to strengthen rural health care, fiscal 2026 through 2030. CMS runs it, and each state decides how to spend its award.
Can Tribes apply to CMS directly?
No. Tribes reach RHTP through their states, usually as subawards: set-asides, dedicated Tribal pathways or competitive state funding.
Does my state set aside money for Tribes?
Several do. Check your state above, or request a status check and we’ll walk through it with you.
Can urban Indian organizations take part?
In some states. Eligibility depends on the state's plan.
What can RHTP pay for?
Workforce, technology and telehealth, behavioral health, prevention and chronic disease care, upgrades to existing facilities and equipment, and regional partnerships. It can’t pay for new construction, major renovations, land, or care that insurance already covers. Each state also sets its own limits.
What happens when the funding ends?
Year 5 starts October 31, 2029, and all funds must be spent by September 30, 2031. Plan now for how you’ll staff and pay for new services after that.
Who decides how our share is used?
Your Nation does, through your council. We can help you weigh the options.
Does the RHTP status check cost anything?
No. It’s a free, no-commitment conversation about where your Tribe stands. Request one here.
Sources
- CMS: Rural Health Transformation Program
- KFF: A Closer Look at the $50 Billion Rural Health Transformation Program
- Hobbs, Straus, Dean & Walker, LLP: General Memorandum 26-001 (January 2026)
- California HCAI: CalRHT program
- California HCAI: CalRHT FAQ (July 1, 2026)
- Idaho Department of Health and Welfare: Rural Health Transformation Program
- Washington Health Care Authority: Rural Health Transformation Program
- Oregon Health Authority: Rural Health Transformation awards (April 10, 2026)
- Nevada Health Authority: Rural Health Transformation Program
- Wisconsin DHS: Rural Health Transformation Program
- Arizona AHCCCS: Rural Health Transformation Program
- Native Nations Institute
- CMS: Rural Health Transformation Program webinar (February 25, 2026)
