This blog series takes a closer look at targeted health priorities being advanced by states in their Rural Health Transformation program (RHTP) applications. As authorized under the One Big Beautiful Bill Act (OBBBA), the Centers for Medicare and Medicaid Services (CMS) will provide states with $50 billion over 5 years to strengthen and modernize health care in rural communities. Each state developed a plan in their applications to expand health care access, strengthen workforces, build infrastructure and technology, and support care delivery innovation within rural communities. CMS has awarded RHTP funds to states for the first year, ranging from $147 to $281 million.
Rural Health Resources
Rural health is inherently connected to aging because people living and using health care in rural areas are disproportionately older than those in urban and suburban areas. The rural population is also aging faster than the rest of the country, while the rural workforce to care for the aging population is declining. Older adults require more health care and account for the largest share of health spending by age group. Increased health needs result in transportation, access, and affordability challenges in rural areas that tend to have fewer resources.
State Trends
NASHP policy experts reviewed Rural Health Transformation Program (RHTP) applications from the 47 states with public applications to identify aging-related initiatives. Here are key areas in which states proposed to address rural health and aging:
- 33 states proposed initiatives to increase the health care workforce that cares for the aging population. This includes enhancing the direct care workforce, such as aides who can provide help in the home.
- 32 states proposed initiatives to build upon the long-term care system for older adults, including home care, nursing home care, and related services and supports. Out of these states, 19 focused on nursing homes specifically in their proposals.
- 25 states proposed initiatives related to improving care and coordination for dually eligible individuals who have both Medicaid and Medicare coverage.
- 24 states proposed initiatives focused on technology and telehealth to improve access, health monitoring, and communication for older adults.
- 17 states proposed initiatives related to healthy aging, aging in place, and care coordination for the aging population.
- 11 states proposed initiatives to support family caregivers, who fill in workforce gaps created by shortages and provide essential care to family and friends.
- 10 states proposed initiatives to create or expand Program of All-Inclusive Care for the Elderly (PACE) Programs that provide care to older adults living in home and community settings.
- 8 states proposed initiatives to address the rising number of individuals diagnosed with Alzheimer’s disease and related dementias and their caregivers.
- 6 states proposed initiatives to reduce the risk of falls and increase fall prevention programs for older adults, given that more than one out of four older people falls each year.
- 6 states proposed initiatives related to palliative care and care for individuals with serious illness to focus on pain and symptom management and improve quality of life.
- 5 states proposed initiatives to improve transportation for the aging population to access health care and accessibility in the community and healthcare settings.
- 3 states proposed initiatives to expand or enhance senior centers and Area Agencies on Aging (AAAs).
The RHTP call for applications from CMS did not specify aging as a priority area, so these highlights of aging initiatives in applications are significant. The above themes reflect state challenges and opportunities to improve life for older adults who disproportionately live in rural communities.
Note: The examples highlighted here are taken from publicly available state RHTP applications prior to December 29, 2025. These strategies may continue to evolve, as states finalize plans and begin implementation of activities in the coming months.
Other blog posts in this series:
Acknowledgments
This blog was developed with generous funding from The John A. Hartford Foundation and West Health. NASHP is grateful to these organizations for their continued support and partnership.
