Rural Health Access for Tennessee's Future

• Competitive Healthcare Resiliency Program grants: expand service lines, co-locate behavioral and specialty care
• Last Mile Teams: more ambulances, community paramedicine, mobile health & maternal care
• Strengthening the Safety Net through dental and primary care in every rural county
• Memory Care Assessment Network and Dementia Navigators to reach older rural adults sooner

• Competitive grants to address preventable poor outcomes, including facility upgrades and standards for rural birthing units
• Postpartum screenings, substance use prevention, behavioral health support
• Mobile apps, remote care, and triage networks 
• Goal: 25% fewer rural maternal deaths; 15% fewer infant deaths 

• “Make Rural Tennessee Healthy Again” initiatives
• Grants to activate parks, trails, farmers markets, and school-based health
• Address nutrition insecurity and diseases of despair

• Statewide Health Information Exchange (first ever)
• Tele-specialty expansion via eConsult
• Secure, interoperable data systems that reduce paperwork burden

• Career pipelines starting in high school
• Rural clinical rotations, fellowships & behavioral health scholarships
• Support for rural health administration leadership

The RHT Program is a new federal initiative authorized by the One Big Beautiful Bill Act that provides up to $50 billion over five federal fiscal years (FFY 2026–2030) to strengthen rural health systems in all 50 states. It aims to improve access, quality, workforce stability, innovation, and technology across rural communities nationwide.

Local hospitals, health systems, non-profits, federally qualified health centers, community groups, and other organizations can participate as recipients of sub-awards under the state plan. The organization must be registered with the state.

Yes — CMS has awarded Tennessee approximately $206.9 million for Budget Period 1 through the RHT Program to support rural health transformation efforts. CMS allows states through the end of the next fiscal year to spend those funds. That means:

• Budget Period 1 funds can be spent through end of FFY 2027 (September 30, 2027)
• Budget Period 2 funds can be spent through end of FFY 2028 (September 30, 2028)
• Budget Period 3 funds can be spent through the end of FFY 2028 (September 30, 2029)
• Budget Period 4 funds can be spent through the end of FFY 2029 (September 30, 2030)
• Budget Period 5 funds can be spent through the end of FFY 2030 (September 30, 2031)

Tennessee is still awaiting final approval from CMS, as of February 25^th, 2026.

CMS does not automatically give the same amount to states every year. Each Budget Period’s funding level depends on:

• Completed annual reports and progress updates to CMS.
• Compliance with proposed use of funds.
• Any redistribution of unspent funds from prior period.
• ·CMS’s review of evolving rural needs (for the discretionary 50%).

Tennessee’s RHT proposal centers around five broad categories:

1. Healthcare IT and Technology: Projects that modernize rural health infrastructure to improve care coordination, quality, and access (e.g. central patient monitoring, eICU) and the use of technology to reduce provider burden and close gaps in rural service delivery.
2. Maternal & Child Health: Targeted interventions to address high maternal and infant morbidity and mortality in rural Tennessee; programs that improve continuity of care before, during, and after pregnancy; targeted interventions to improve adolescent and early relational health.
3. Make Rural Tennessee Healthy Again: Community-driven, prevention-focused initiatives that address chronic disease and social drivers of health; programs that go beyond clinical care and activate local partners to address substance use, active living, school-health, and isolation.
4. Co-Location and Expansion of Services: Efficient service delivery models that reduce fragmentation and patient travel; expansion of services that rural communities lack or are at risk of losing.
5. Transportation: Practical, scalable solutions to one of the largest rural access barriers: getting patients to care; models that support non-emergency health needs.

• Evidence-based interventions to improve prevention and chronic disease management.
• Support for behavioral health, substance use treatment, and mental health services.
• Workforce recruitment and retention strategies with rural commitments.
• Training and technical assistance for emerging care technologies.
• IT improvements like telehealth expansion and cybersecurity.
• Innovative care models and alternative payment approaches.

The RHT funding provides Tennessee with resources to:

• Strengthen rural health infrastructure and prevent hospital closures.
• Expand access to preventive, behavioral, maternal, and chronic disease care.
• Promote workforce training and retention in underserved areas.
• Enhance digital infrastructure and telehealth services in rural settings.

Foster innovative care delivery models that improve outcomes. 

Applicants are eligible to apply for more than one Healthcare Resiliency Program competitive opportunity. If any of the applications are linked, there will be an ability to track this in the narrative.

No; while there are not currently any budget maximums for the opportunities, we would ask that you consider scale, impact and feasibility of spending when creating your application.

Yes; sub-recipients will pay the cost up front, submit documentation for procurement (if necessary) and proof of payment, and then be reimbursed.

Subawardees are subject to the same cost restrictions as the state. Subawardees are subject to Tennessee’s relevant indirect cost rates, and they are also subject to the 10% limit on program administrative costs.

CMS does not allow the following costs:

• Pre-award costs.
• Meeting matching requirements for any other federal funds or local entities.
• Services, equipment, or supports that are the legal responsibility of another party under federal, State, or tribal law, such as vocational rehabilitation or education services.
• Services, equipment, or supports that are the legal responsibility of another party under any civil rights law, such as modifying a workplace or providing accommodations that are obligations under law.
• Goods or services not allocable to the project.
• Supplanting existing State, local, tribal, or private funding of infrastructure or services, such as staff salaries.
• Construction or building expansion, purchasing or significant retrofitting of buildings, cosmetic upgrades, or any other cost that materially increases the value of the capital or useful life as a direct cost.
• The cost of independent research and development, including their proportionate share of indirect costs. See 2 CFR 300.477.
• Funds related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or executive order.
• Purchase of covered telecommunications and video surveillance equipment (See 2 CFR 200.216) as well as financial assistance to households for installation and monthly broadband internet costs.
• Meals, unless in limited circumstances such as:
• Subjects and patients under study.
• Where specifically approved as part of the project or program activity, such as in programs providing children’s services.
• As part of a per diem or subsistence allowance provided in conjunction with allowable travel.
• Activities prohibited under 2 CFR 200.450 and the HHS Grants Policy Statement, including but not limited to:

Paying the salary or expenses of any grant recipient, or agent acting for such recipient, related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or executive order proposed or pending before the Congress or any State government, State legislature, or local legislature or legislative body.

Lobbying, but awardees can lobby at their own expense if they can segregate federal funds from other financial resources used for lobbying.

For guidance on some types of costs that we restrict or do not allow, see 2 CFR Part 200 Subpart E - General Provisions for Selected Items of Cost.

• New construction is unallowable. Supplanting funding for in-process or planned construction projects or directing funding towards new construction builds is unallowable. Renovations or alterations, as described in category J of the program requirements and expectations use of funds section, are allowed if they are clearly linked to program goals.

Category J funding cannot exceed 20% of the total funding CMS awards States in a given budget period.

• To replace payment for clinical services that could be reimbursed by insurance. We will not accept payments to clinical services if they duplicate billable services and/or attempt to change payment amounts of existing fee schedules. If you plan to fund direct health care services, you must justify why they are not already reimbursable, how the payment will fill a gap in care coverage (such as uncompensated care or services not covered by insurance), and/or how they transform the current care delivery model.

Funding for provider payments, as described in category B of the program requirements and expectations use of funds section, cannot exceed 15% of the total funding CMS awards States in a given budget period.

Funding cannot be used for initiatives that fund certain cosmetic and experimental procedures that fall within the definition of a specified sex-trait modification procedure at 45 CFR 156.400 because that is beyond the scope of this program.

• No more than 5% of total funding CMS awards to a State in a given budget period can support funding the replacement of an EMR system if a previous HITECH certified EMR system is already in place as of September 1, 2025.
• Funding towards initiatives similar to the “Rural Tech Catalyst Fund Initiative” cannot exceed the lesser of (1) 10% of total funding awarded to a State in a given budget period or (2) $20M of total funding awarded to a State in a given budget period, and funding is subject to all restrictions and requirements described in the example initiative.
• Clinician salaries or wage supports for facilities that subject clinicians to non-compete contractual limitations.
• None of the funding shall be used by the State for an expenditure that is attributable to an intergovernmental transfer, certified public expenditure, or any other expenditure to finance the non-Federal share of expenditures required under any provision of law.
• SSA Section 2105(c), paragraphs (1), (7), and (9) apply as funding limitations. These limitations are related to general limitations, limitations on payment for abortions, and citizenship documentation requirements for payments made with respect to an individual.