The Rural Health Transformation Program: What’s all the buzz about?

July 9, 2026

Dr. Caruso is senior nurse practitioner at Penn Medicine and Adjunct Assistant Professor at the University of Pennsylvania School of Nursing

Rural Health Transformation

Across the U.S., access to healthcare remains one of the system’s greatest challenges—especially in rural communities. As Nurse Practitioners continue to play a critical role in providing healthcare across the U.S., new federal investments are putting a spotlight on how policy, funding, and scope of practice can either accelerate or hinder progress.

So, what is all the buzz about the Rural Health Transformation (RHT) Program? How does this federal program relate to Nurse Practitioner (NP) practice in Pennsylvania and other states?

The RHT Initiative is a $50 billion federal program designed to strengthen healthcare access, quality, and outcomes in rural communities across the United States.

The RHT Program, authorized under the One Big Beautiful Bill Act (Public Law 119-21), is a five-year initiative slated to invest $50 billion from 2026 to 2030 to modernize rural health care delivery, improve workforce capacity, and expand access to care in rural areas. Each year, $10 billion is allocated to states, with half distributed equally and the other half based on rural population, proposed initiatives, and projected impact.

The Centers for Medicare & Medicaid Service (CMS) outlines several key objectives for the program. These are healthcare access and innovation, workforce development, innovation and technology, care model innovation, and sustainability. The states have some discretion regarding logistics, but the main aim is to design transformative plans to reflect local priorities.

Execution of the RHT Program Varies from State to State

Let’s look at Pennsylvania. Approximately 3.4 million Pennsylvanians live in rural areas as of 2026. This represents between 20% and 26 % of the state’s total population, depending on whether federal health designations or county level metrics are applied and measured by the 48 designated rural counties in Pennsylvania, (Centers for Rural Pennsylvania; Pennsylvania Office of Rural Health.).

According to the data by the Centers for Rural Health, rural communities comprise 75% of Pennsylvania’s total land area. Out of Pennsylvania’s 67 counties, 48 are classified as rural, except for Philadelphia and Delaware counties which contain zero rural population.

What is the issue as it relates to NPs?

While there are many components to the RHT program, one key element is the state practice environment for NPs. State Practice Environment across the United States, according to the American Association of Nurse Practitioners (AANP), is classified as restricted practice, reduced practice or full practice authority (FPA). In Pennsylvania, reduced practice means NPs must have a business agreement with a physician to practice. This circumstance has been proven time and time again as a barrier to NP practice, an impediment to patient access to healthcare, as well as adding unnecessary cost to care. Pennsylvania is currently a reduced practice environment state.

FPA in Pennsylvania would translate to modernization of the nursing law and retirement of outdated barriers. There is a plethora of evidence to support states with FPA for NPs, having higher overall improved health. This is inclusive of 29 states, Washington D.C. and the federal Veterans Administration Medical Center (VAMC). Proposed FPA Legislation introduced by Pennsylvanian NPs for more than thirteen years has been considered but not enacted.

RHT Program Awards

The RHT program allocates more money to states with FPA for NPs, and therefore Pennsylvania is at a disadvantage when compared to our neighboring states of Delaware, Maryland, New York and West Virginia. Pennsylvania received less funding than neighboring states that granted all or most NPs Full Practice Authority.

Some RHT Program estimates show FPA states receiving $497 dollars per rural resident in contrast to Pennsylvania who was awarded $67 per resident during the first year of the program. Pennsylvania is losing out on federal funds. Pennsylvania has the third-largest rural population in the nation yet ranked just 34th on RHT Program funding.

The Solution

Pennsylvanians are waiting in shortage areas while qualified NPs are already providing care across hospitals, urgent care, primary care, rural health and specialty settings. Statistics show that NPs are more likely to live and practice in the communities they serve. If Pennsylvania’s goal is to strengthen rural healthcare access and compete for future federal dollars, our outdated laws need modernization which translates to granting NPs in Pennsylvania, FPA.

Pennsylvania has an opportunity to reassess the NP state practice environment and submit an updated CMS report by August 30th with changes to the RHT program application. Pennsylvania has the potential to receive millions more federal dollars through this program in the upcoming four years.

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