Rural hospitals have been running the same calculation for years. A vacant surgical tech position carries significant costs in traveler premiums and lost case revenue — closed surgical bays mean surgeries that simply don't happen. A CNA opening posted three times in one year is not a recruiting problem — it is the absence of a career pipeline. The staff who could fill those roles are often already in the building. They just have no funded, structured path forward.
For the first time in decades, there is federal money specifically designed to fix that.
Your State Already Has the Funding
On December 29, 2025, the Centers for Medicare & Medicaid Services announced that all 50 states received awards under the Rural Health Transformation Program — a $50 billion federal initiative signed into law under the One Big Beautiful Bill Act, H.R. 1 (Public Law 119-21). First-year awards average $200 million per state, with individual state allocations ranging from $147 million to $281 million. Funds are available at $10 billion per year through FY2030.
This is not a competitive grant that most organizations will miss. Every state received an award. The question is how your organization gets access to what your state already has.
What the Workforce Pillar Funds
RHTP is organized around five priorities: expanding access to care, strengthening the rural clinical workforce, modernizing facilities and technology, driving structural efficiency in care delivery, and advancing innovative care models.
For rural hospitals, SNFs, FQHCs, and behavioral health providers, the workforce pillar is the most direct entry point. Under it, states are funding clinical workforce training and residency programs, recruitment and retention incentives, new career pathways that help community members begin healthcare careers without leaving home, and programs that upskill and retain the existing clinical workforce.
That last item matters most for rural employers. RHTP is not designed to help you recruit from outside your region. It is designed to help you build career ladders for the people already working for you — a patient care tech trained into a sterile processing role, a CNA moving into an LPN position, a medical assistant who stays because there is a next step. That is what work-based learning and apprenticeship-based pathways are built to do. A Bipartisan Policy Center review of all 50 state workforce plans found every state proposing to use at least some of their funding for workforce priorities — with upskilling and building career infrastructure as a consistent theme.
How the Money Reaches Your Organization
CMS distributes RHTP funds to states. From there, each state runs its own implementation through its designated lead agency — typically a state Medicaid office, health department, or rural health office.
Organizations access those funds through sub-awards, competitive grants, RFPs, and state procurement processes. The path varies significantly by state. Many states have already released their first RFP cycles in 2026 — you can track current state-by-state solicitations on the NRHA's RHTP state tracker. Others are still finalizing their distribution models. A few require vendor registration before an organization can respond to an opportunity.
There is no single national application. What matters is whether your state has released an RFP, what eligibility it requires, and whether your organization needs to complete any preliminary steps — vendor registration, MOUs with local partners, or eligibility verification — before you can participate.
Which Workforce Programs Are Most Likely to Qualify
Based on what states are prioritizing under the workforce pillar, programs with the clearest fit include:
- Incumbent worker upskilling — structured training that moves existing employees into credentialed allied health roles, including surgical tech, sterile processing tech, phlebotomy, medical assistant, and CNA-to-LPN pathways
- Earn-and-learn and apprenticeship-based programs — work-based learning pathways where learners stay employed and receive wages during training while completing related technical instruction through a credentialed provider
- Career ladder programs — multi-step credential pathways tied to measurable wage progression and retention outcomes
- Community health worker and behavioral health pathways — where state plans specifically include community-based or behavioral care workforce development
Roles with national certification standards tend to be the most straightforward to build. They travel across states without requiring a different training provider in each one, and the credential is recognized wherever the worker ends up.
What You Need Before You Engage Your State
You do not need a fully built program before you contact your state agency. You do need enough clarity for a productive first conversation:
- A specific role and the vacancy or turnover data behind it
- A workforce narrative — your HPSA designation, regional shortage figures, or the documented cost of your current staffing gap
- A training model — whether you're thinking internal OJT, a community college partner, or a national RTI provider
- A documentation plan for how you will track learner progress, clinical hours, competency milestones, and credential attainment — funders want outcomes data, not program descriptions
Organizations moving fastest right now have a workforce narrative and a named training approach already in hand. The ones stalling are waiting until everything is figured out before making the first call.
There is also a reason not to wait: first-year RHTP funds need to be obligated — committed through a contract or sub-award — by October 30, 2026. You can review each state's current RFP timeline and funding priorities in the CMS Rural Health Transformation Program State Project Abstracts. Many states have already opened their first cycles, and the window to participate in year-one funding is narrowing.
Ready to Build?
If RHTP funding is moving in your state and you want to connect it to a running work-based learning program, the hardest part for most rural teams is the operational build: finding a credentialed RTI partner, navigating registered apprenticeship infrastructure, braiding RHTP with WIOA and other funding sources, and setting up a documentation system that holds up to funder review.
At Craft, we bring what we call Apprenticeship in a Box — a turnkey model that packages the RTI partner (Pangea Learning for allied health), registered apprenticeship infrastructure, braided funding navigation, and data tracking for competency progression and funder-ready reporting. Your team brings the clinical placement and the people. We handle the rest.
If your state has released RFPs and you're ready to move, book a call — we'll show you what a program looks like for your organization.
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