Possible, and necessary! Here’s How LTC Providers Can Win Rural Health Transformation Grants

The Rural Health Transformation Program (RHTP) is a historic funding opportunity for rural Long-Term Care (LTC) providers. From FY26 through FY31, CMS will distribute $50 billion across all 50 states, and based on our review of 35 state applications and budgets, roughly $10 billion is likely to be directed toward workforce. For rural nursing homes, skilled nursing facilities, assisted living communities, and senior living operators, this level of investment is unprecedented.

You do not need reminding of the staffing crisis facing LTC: CNA and LPN shortages, rising acuity, increasing regulatory pressure, burnout, and intense wage competition from hospitals and travel staffing. RHTP will not undo HR1-related Medicaid reductions, but it represents one of the few pathways to stabilizing rural LTC. Many states are planning to invest over $200 million each into rural workforce pipelines, recruitment, and retention. LTC cannot afford to miss this. Several states, including Iowa, will release RFPs in Q4 2025–Q1 2026. Here is what LTC providers must do now to transform their workforce.

Why LTC Is Perfectly Positioned for the Rural Health Transformation Program

Long-Term Care is indispensable in rural America. Older adults represent a disproportionate share of rural populations, and they often live far from hospitals, specialists, and rehabilitation facilities. In Iowa, for example, more than half of all adults aged 65 and older live in rural counties, and many rely on LTC for essential support.

Across the country:

• Rural nursing homes often serve as the only 24/7 healthcare anchor in a region.

• Skilled nursing facilities manage post-acute recovery for patients discharged earlier than ever.

• Assisted living and senior living communities prevent ED visits and unnecessary hospitalizations.

• LTC fills the gap when home health or HCBS coverage is limited or unavailable, which is common in rural counties.

LTC’s impact on rural health is enormous, yet LTC is barely featured as a core stakeholder in many state applications. This absence is not a disadvantage — it is a call to action. Providers must assume they will not be automatically prioritized unless they assert themselves early.

1) Arm Yourself for the Battle for Funds

RHTP funds will be competitively awarded, and LTC will be competing with:

• Critical Access Hospitals

• FQHCs

• Rural hospitals and clinics

• Home health agencies

• Behavioral health providers

• EMS and mobile care teams

• Tribes and community-based organizations

Remember that states will receive funds in two ways:

• $25B distributed equally across all states

• $25B distributed based on rural population, remoteness, workforce shortages, and chronic disease burden

This second group is where rural LTC stands out — but only if LTC leaders position themselves now.

Across state applications, LTC is rarely named as a priority stakeholder. For example:

• Washington focuses on hospitals, Tribes, and behavioral health.

• Oregon’s $200M model prioritizes hospitals, FQHCs, and regional partnerships.

• Nevada’s workforce strategy is centered on rural hospitals and clinics.

LTC is often referenced only as “post-acute care” or “community-based organizations.”
That means LTC must assume it is not automatically included — and organize to be included.

2) Shape the Plan and Stay Informed

States have been conducting planning sessions since mid-2024. You can see fingerprints of rural employers all over their applications.

To win RHTP grants, LTC providers must join:

• State planning meetings

• Regional rural health coalitions

• Aging and disability stakeholder groups

• Workforce pipeline discussions

• Partnerships led by hospitals or FQHCs

This is where decisions are made about:

• which sectors qualify

• what projects will be funded

• how workforce dollars will be structured

• which partnerships states want to see

For instance:

• Iowa plans to release its first RFP December 2025

• Oregon anticipates major workforce RFPs in February 2026

• Colorado and Washington are moving earlier through network-based planning

If you wait for the RFP to drop, you are too late. Preparing now gives LTC providers:

• pre-established partnerships

• program designs ready to submit

• data and impact metrics

• staffing models aligned to state priorities

3) Build Partnerships to Increase Your Chances of Winning

Every state application emphasizes regional coalitions — especially for workforce funding. Reviewers want solutions that create shared impact, not siloed projects.

This is excellent news for LTC.

Hospitals, FQHCs, and EMS need LTC to address:

• post-acute transitions

• dementia and behavioral health needs

• chronic disease management

• long-term stabilization

• reducing readmissions

• population health outcomes

Examples of RHTP-aligned LTC partnership opportunities:

• Oregon: LTC providers can join Regional Partnerships determining both Phase 1 and Phase 2 workforce allocations.

• Colorado: LTC can participate in Rural Health Networks designing access and workforce solutions.

• South Dakota: Identifies patient transportation and coordination gaps — areas LTC manages every day.

• Montana: Calls for expanded community health services and skillset optimization, directly aligned with LTC.

Across all state plans, RHTP prioritizes:

• prevention

• chronic disease management

• care coordination

• data-sharing

• transitions of care

These are LTC strengths.

Examples of competitive LTC-led proposals:

• A hospital–LTC partnership to reduce readmissions

• A regional CNA/LPN pipeline co-developed with community colleges

• A dementia-care training program supporting rural hospitals

• Shared staffing pools across LTC, assisted living, and hospitals

• Integrated HIE and care coordination with primary care

Partnerships increase credibility, impact, and likelihood of being funded.

How LTC Providers Can Win Rural Health Transformation Grants? Seize the Moment

Do not wait for the RFP to land on your desk with a 30-day deadline.

States did not prominently feature LTC in their applications, but every state described needs that LTC is uniquely suited to solve. LTC providers must put themselves in the room.

Act now by:

• Attending planning sessions

• Joining regional coalitions

• Building partnerships with hospitals, FQHCs, and home health

• Preparing workforce and chronic-care proposals early

• Gathering data demonstrating LTC’s impact

• Aligning with your state’s specific RHTP priorities

These grants will be competitive.
LTC can shape how funding is distributed by showing up early, collaborating, and demonstrating value.

The opportunity is historic.
The need is urgent.
And LTC providers who prepare now will be the ones who win Rural Health Transformation Grants