(C) Daily Yonder - Keep it Rural This story was originally published by Daily Yonder - Keep it Rural and is unaltered. . . . . . . . . . . Addressing Workforce Challenges through the Rural Health Transformation Program [1] ['Daisy Kim', 'Maya Sandalow'] Date: 2026-07 To sustain these investments beyond RHTP, states should focus on integrating with existing federal and state resources. States plan to implement three main workforce strategies: 1) recruiting and training providers; 2) upskilling the existing workforce and building infrastructure; and 3) expanding licensure compacts and scope of practice. All 50 states have proposed using Rural Health Transformation Program funds for workforce development, though finalized state-level funding details are not yet available for all states. The $50 billion Rural Health Transformation Program (RHTP) provides states with five years of funding to address longstanding rural health challenges, and every state proposes to use at least some of their funding for workforce priorities. Nearly all rural counties are federally designated as Health Professional Shortage Areas (HPSAs). Rural areas account for more than 60% of all HPSAs across primary care, dental, and behavioral health. BPC’s review of all 50 state plans found three common workforce strategies that states are pursuing: 1) recruiting and training providers; 2) upskilling the existing workforce and building infrastructure; and 3) expanding licensure compacts and scope of practice. Recruiting and Training Providers Building a rural health workforce starts with the pipeline. Early, sustained exposure to health care careers is key to getting and keeping providers in rural communities, yet these opportunities remain scarce in many rural areas. Residency programs have traditionally been funded through Medicare and Medicaid, with Medicare serving as the largest funding source. The Health Resources and Services Administration (HRSA) also administers two grant programs that support rural residencies: The Teaching Health Center Graduate Medical Education program supports training physicians and dentists in community-based settings, and Rural Residency Planning and Development Grants provide start-up funding for rural residencies. States plan to invest RHTP funds in early career pathways and graduate medical education. Awards that are specific to an individual and lead to credentialing or a degree, such as salaries or stipends for residents and fellows during training, are subject to CMS’s five-year rural service commitment, requiring recipients to practice in a rural area within the same state for five years or risk repayment. For example, Maine, West Virginia, and Mississippi propose to fund health career training and certification programs for high school students. Delaware intends to use RHTP dollars to establish the state’s first ever four-year medical school, with the goal of providing educational awards to approximately 140 physicians who commit to practicing for a minimum of five years in Delaware’s rural communities. Several states propose creating new residency programs. For example, Hawaii intends to start a community-engaged process to establish a new rural residency program for doctors studying primary care, internal medicine, or family medicine. Beyond clinicians, states propose to invest RHTP dollars to grow and sustain the community health worker (CHW) and peer support specialist (PSS) workforce, which provides valuable nonclinical services like advocacy, system navigation, and health education. For example, Illinois will launch a new training and certification program for CHWs and PSSs, while Indiana will expand certified PSS trainings. To retain providers in rural areas, states also plan to provide financial incentives, such as child care and housing subsidies. For example, Kansas proposes short-term housing in rural communities for up to 100 medical students, while Nevada proposes financial assistance for housing, relocation costs, signing bonuses, and continuing medical education stipends. For more information on federal policy recommendations to strengthen the health care workforce, see BPC’s reports, Strengthening the Integrated Care Workforce and Addressing the Direct Care Workforce Shortage. Upskilling the Existing Workforce and Building Infrastructure States also propose to use RHTP funds to train and upskill existing health care workers, build data systems, and reimburse services provided by nonclinicians. Infrastructure for workforce development and training in rural areas that does not result in a certificate, degree, or job opportunity are not subject to the CMS five-year rural service commitment. States plan to invest in ongoing training for clinicians to ensure that they can practice at the top of their license. For example, Montana plans to invest in advanced clinical training programs, such as the expansion of surgical technology training (e.g. robotics). Nebraska will invest in a statewide, telehealth-enabled simulation network to bridge gaps in education and training (e.g. obstetrics drills, EMS scenarios, dental safety modules). Hawaii and Arkansas will train providers to help them increase their use of telehealth. States also propose using RHTP funding to better track their health workforce, including by collecting and analyzing data to understand where shortages exist, what programs are working, and where investments are needed. Maryland and New York propose to collect comprehensive rural health workforce data, and Maine plans to build a statewide centralized workforce data platform. These efforts are meant to align with national initiatives, such as the Cross-Profession Minimum Data Set, to improve the consistency, quality, and comparability of health workforce data. To strengthen the health care support workforce, states are investing in reimbursement pathways for services provided by nonclinicians, such as community health workers and peer support specialists. A clear reimbursement pathway for these valuable, nonclinical services can better ensure access to care. In the 2024 Physician Fee Schedule, Medicare introduced the first billing codes for CHW and PSS services, and most state Medicaid agencies now cover their services, especially PSS services. However, reimbursement rates remain low and vary widely from state to state. Nebraska and Wisconsin—which currently do not reimburse CHW services through Medicaid—plan to use RHTP funding to collect data and take steps toward a Medicaid State Plan amendment that would establish reimbursement. While states can use RHTP funds to pay for CHW and PSS services, they cannot do so under the provider payments funding category, which CMS caps at 15% of the annual award. For more information on bolstering the behavioral health workforce with CHWs and PSSs, see BPC’s report, Filling the Gaps in the Behavioral Health Workforce. Licensure Compacts and Scope of Practice Expansions In determining funding allocations, states earn the most points for existing, enacted policies, but they can also earn points for policies that they have formally introduced or that they commit to establishing by the end of 2027. Two of these state policy actions are workforce-related: licensure compacts and scope of practice expansions. CMS incentivizes these policy actions by linking them to state award scores, and if states fail to pass the policy, CMS will recover funds in later years of the program. States propose various approaches to addressing scope of practice and licensure compacts. For example, Vermont proposes to expand pharmacists’ scope of practice to include test-to-treat scenarios, such as COVID-19, flu, and strep. Connecticut proposes to support the implementation of various interstate licensure compacts, including additional outreach efforts to increase rural participation in these licensure compacts. Licensure compacts allow providers licensed in one state to practice in others through a streamlined process and can improve patient access. There are several types of licensure compacts: Interstate Medical Licensure Compact, Nurse Licensure Compact, EMS Services Compact, Psychology Interjurisdictional Compact (PSYPACT), and Physician Assistants (PA) Compact. Scope of practice refers to the activities that a licensed provider is permitted to perform, as defined by state licensing boards. There is ongoing debate about the potential impact of expanding the scope of practice, with some indicating that it can help address physician shortages in areas where access to care is limited by allowing nurse practitioners and physician associates to provide care that is currently limited to physicians. Others have raised concerns about patient safety and health care costs. A few states that have committed to new policy actions have already passed legislation. In February 2026, Maine passed legislation to expand scope of practice for PAs, and New Mexico passed legislation to join several interstate licensure compacts, including PSYPACT. For additional information on licensure and patient access to care via telehealth, see BPC’s report, What Eliminating Barriers to Interstate Telehealth Taught Us During the Pandemic. To learn more about the role of licensure in strengthening the behavioral health workforce, see BPC’s report, Redesigning the Health Care Delivery System to Better Meet the Needs of Youth. What’s Next for Rural Health Workforce Initiatives? States are moving fast. With a deadline to obligate first-year RHTP funds by October 2026, many states have already released requests for proposals to identify subrecipients. States must also begin progress reporting in August, which will inform next year’s funding decisions. RHTP’s long-term success will depend in part on whether CMS allows states flexibility to adjust their plans based on early implementation experience. As states enter their second year of funding, the ability to revise activities without significant administrative burden will be critical. Funding from RHTP is an opportunity, but five years of federal funding is not a long-term solution. With the program set to end in 2030, states should be thinking now about sustainability—including how to sustain initiatives once RHTP ends. One approach is to integrate RHTP investments with existing federal and state resources, such as HRSA’s rural health workforce programs, to ensure these efforts outlast a one-time burst in funding. [END] --- [1] Url: https://bipartisanpolicy.org/explainer/addressing-workforce-challenges-through-the-rural-health-transformation-program/ Published and (C) by Daily Yonder - Keep it Rural Content appears here under this condition or license: Creative Commons CC BY-ND 4.0 International. via Magical.Fish Gopher News Feeds: gopher://magical.fish/1/feeds/news/dailyyonder/