Contrasting Approaches: What 4 States Can Teach the Rural Health Transformation Program

By James X. Stobinski, Ph.D., RN, CNOR(E), CSSM(E), CNAMB(E)

This month I would like to return to the topic of rural healthcare but with a slightly different approach. There are frequent articles on the large numbers of American rural facilities that are struggling financially. This issue is prominent as the cuts to Medicaid funding loom after the midterm elections and the Rural Health Transformation (RHT) Program continues.¹ I would first like to share some good news on rural healthcare from four states that are doing relatively well and then contrast those efforts with what we know of the progress on the RHT.

In a Becker’s Hospital Review article, Madeline Scheetz informs us that a recent analysis reveals that “…700 rural hospitals are at risk of closing across the U.S. In almost every state, at least some rural hospitals are at risk of closing, with the exception of four.”² Those four states — Delaware, Maryland, New Jersey and Utah — do not have a single facility “at risk of closing” or “at immediate risk.”² The reasons for this relative success lie in “…geography, a mix of specific state payment policy and long-standing regional partnerships.”² In the Scheetz article, state-level officials were open and forthcoming on the factors that aid their financial standing. This openness stands in marked contrast to the information we have regarding the larger picture of RHT implementation.

Each of the four states cited by Scheetz has successful partnerships among health systems that assist facilities to increase access to care and enhance their services beyond their respective physical plant in rural settings. Utah also benefits from increased Medicaid spending at the state level and a low percentage of residents enrolled in Medicaid. Utah also leverages partnerships with large systems — Intermountain Health and the University of Utah — and telehealth specialty services in its rural hospitals. Rural facilities in Maryland are aided by a unique state-level global budget model that facilitates a predictable revenue structure. These successes are well documented and could serve as examples from which other states could build their proposals in the RHT program.

Unfortunately, not every state is making good use of the evidence that exists from states such as Maryland and Utah. Arielle Zionts informs us that the RHT program, which aims to improve rural healthcare, lacks transparency, which makes it difficult to “… protect against fraud, identify successful projects, and ensure the program delivers on its promise to transform the system.”³ She tells us that the Centers for Medicare & Medicaid Services (CMS), which administers the RHT program, is not “…proactively sharing information about where the funding is going and how it will be used”³ and promises only retrospective annual reports at some future date. Some states have also been very selective in sharing the details of their plans for the RHT funds. The lack of information for the expensive, high-stakes RHT program is concerning.

There are lessons to be learned from both the Scheetz and Zionts articles. The four states that have enjoyed some success in rural healthcare are sharing their stories. If the goal of the CMS RHT program is to rapidly transform American rural healthcare on a wider scale, then sharing information on the success of the diverse statewide efforts is essential. More importantly, the funding agencies should mandate program effectiveness studies with public disclosure as a condition of funding. Stakeholders, such as perioperative nurse leaders, would be well served to become informed on the progress of the RHT and the wider implications for American healthcare. In the References section, I provide a link to a reliable source of information on this topic — the Bipartisan Policy Center.⁴

James X. Stobinski, Ph.D., RN, CNOR(E), CSSM(E), CNAMB(E), is a faculty member at Central Michigan University and director of hospital and ASC surgical education relationships with National Institute of First Assisting (NIFA).

References

1. Centers for Medicare & Medicaid Services. (n.d.). Rural Health Transformation. https://www.medicaid.gov/resources-for-states/rural-health
2. Scheetz, M. (2026). 4 states where no rural hospitals are at risk of closing — and why? https://www.beckershospitalreview.com/finance/4-states-where-no-rural-hospitals-are-at-risk-of-closing-and-why/
3. Zionts, A. (August 27, 2026). $50B Rural Health Transformation Program Needs More Transparency, Groups Say. https://kffhealthnews.org/rural-health/rural-health-transformation-program-transparency-50-billion-dollars-state-tracking/
4. Bipartisan Policy Center (August 2, 2026). Federal Policy Priorities To Strengthen Rural Health and Maximize Rural Health Transformation Program Investments. https://bipartisanpolicy.org/report/federal-policy-priorities-to-strengthen-rural-health-and-maximize-rural-health-transformation-program-investments/