Rural Health Transformation Program

The Rural Health Transformation Program, created under the One Big Beautiful Bill Act (OBBBA), is a landmark federal initiative to strengthen rural Americans' health care access and outcomes through sustainability and innovation. Beginning in 2026, the program provides $50 billion over five years, divided equally between state-distributed funds and competitive grants to states awarded by the Centers for Medicare & Medicaid Services (CMS). Missouri's state-led initiative, known as Transformation of Rural Community Health (ToRCH) Care and coordinated by the MO HealthNet Division within the Missouri Department of Social Services, received a $216 million award from CMS for the first year of the program. ToRCH Care is expected to build local partnerships, expand care coordination and build capacity through a “community hub” model. Rural hospitals, clinics and provider networks are expected to be the primary recipients of these funds. These investments are especially critical as hospitals face future reductions in Medicaid state-directed payments and provider tax matching rates, which disproportionately impact rural hospitals.