RHT hub
Rural Health Transformation, explained for program builders
$50 billion across FY2026–2030, distributed to states, spent through subrecipients. If you are standing up or expanding a community paramedicine program, this is the map.
What is the Rural Health Transformation Program?
The Rural Health Transformation Program directs $50 billion over federal fiscal years 2026 through 2030. CMS distributes funds to states; states execute an approved plan; most of the delivery work happens through subrecipients, hospitals, EMS agencies, health centers and other local organizations.
CMS announced first-year state awards on Dec 29, 2025, with per-state amounts ranging from $147 million to $281 million. Every state received an award, and every state's plan is organized around the same five CMS strategic goals described below, even though the specific programs, agencies and dollar allocations differ state to state. Confirm your own state's figure and plan details against the CMS award notice before citing either one.
Vendors like VectorCare are not subrecipients. We are a vendor or subcontractor to the subrecipient. Whether a particular cost is allowable depends on your state's approved plan and on CMS rules, not on a vendor's claim.
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Who receives the money, and who does the work
Three layers, each with a different role and a different set of obligations.
CMS and the state
CMS awards funds directly to each state's designated administering agency, typically a state health department or a Medicaid agency, based on that state's approved rural health transformation plan.
Subrecipients
The state executes subaward agreements with the organizations that do the delivery work: hospitals, EMS agencies, health centers, community-based organizations and, in some states, regional coalitions. The subaward agreement is where budget lines, reporting obligations and allowable uses get specific.
Vendors and subcontractors
A subrecipient may contract with vendors for defined deliverables: software, training, evaluation support. The vendor is not a party to the subaward and does not determine allowability; the subrecipient's grants office and the state program officer do.
This three-layer structure matters because obligations flow downhill and get more specific at each step. CMS sets program-level rules in the award terms and in Uniform Guidance (2 CFR Part 200). The state's plan translates those rules into a strategy and a set of eligible activities. The subaward agreement translates the plan into a specific scope of work, budget and reporting schedule for one organization. If you are a hospital, EMS agency or health center weighing a community paramedicine program, the subaward agreement, not this page or any vendor's materials, is the document that governs what you can spend money on and what you have to report.
Where community paramedicine coordination fits
Community paramedicine and mobile integrated healthcare programs send paramedics or other qualified clinicians into the home on a scheduled, non-emergency basis: post-discharge follow-up, chronic disease checks, falls risk visits, medication reconciliation support. These programs sit outside 911 response, which is why they show up across all five CMS strategic goals rather than under a single one.
The coordination problem that shows up repeatedly in state plans is not clinical, it is logistical: how does a referral get from a hospital chart, a payer's cohort list or a discharge planner's spreadsheet to the right community paramedicine program, how does that program's field status get back to the referrer, and how does the resulting activity get rolled up into the reporting the state owes CMS. That is the layer DispatchCare occupies: referral intake, mission broadcast to the right program by territory and skill, status updates, and the outcome fields a subrecipient needs at reporting time. It does not replace 911 CAD, and it does not replace the ePCR that remains the clinical record of the visit.
What are the five CMS strategic goals?
Every plan narrative is organized around them. Here is how community care coordination maps.
| Goal | Title | Where CP coordination fits |
|---|---|---|
| RHT Goal 1 | Make rural America healthy again | Prevention and chronic disease management delivered where patients live. |
| RHT Goal 2 | Sustainable access | Local capacity that persists when hospital service lines contract. |
| RHT Goal 3 | Workforce | New roles for the paramedic workforce already in the community. |
| RHT Goal 4 | Innovative care | Treat-in-place, remote support and hospital-at-home bridging. |
| RHT Goal 5 | Tech innovation | Shared referral, status and reporting infrastructure across grantees. |
A single community paramedicine program rarely maps to only one goal, and that is by design. A visit that keeps a CHF patient stable at home after discharge is a Goal 1 prevention activity, a Goal 2 access activity because it substitutes for a hospital-based touch that may not otherwise be available, and a Goal 3 workforce activity because it uses paramedics in an expanded role. When you write a plan narrative or a budget justification, it is worth naming more than one goal explicitly rather than picking whichever one seems closest; reviewers are looking for that cross-goal reasoning.
Budget and non-supplantation, in short
Two questions a reviewer will ask about any new spending line: is it a reasonable, allowable cost under your plan, and does it add capacity rather than replace funding that already exists.
Non-supplantation
Why new program infrastructure is not a replacement for billable services.
In practice, community paramedicine budget lines tend to separate cleanly into coordination software, implementation and onboarding, evaluation and reporting, and interoperability with an EHR or ePCR. The non-supplantation question is usually straightforward for a new or newly expanded program: scheduled, preventive home visits are typically not a billable service under existing reimbursement in most states, so the coordination and evaluation infrastructure behind them is a new cost attached to a new activity, not a replacement for one. The budget kit and non-supplantation pages linked above go through both in more detail, including language you can adapt and a checklist for your grants office.
Featured states
Fifty state pages, each with the agency landscape and where community paramedicine fits.
Check figures before you cite them
Where DispatchCare fits
Reporting cadence and record retention
States report to CMS on a recurring cycle and pass those obligations down to subrecipients through the subaward agreement. Plan for quarterly progress reporting, annual reporting, and record retention of at least three years after the final report; confirm exact dates and fields in your own subaward.
Underneath the reporting cadence sits Uniform Guidance, 2 CFR Part 200, which sets the baseline for allowability, internal controls, procurement standards and subrecipient monitoring across the whole program, plus a single-audit requirement for organizations that expend federal awards above the applicable threshold. Subawards above the relevant dollar threshold are also reported publicly through FFATA's subaward reporting system (FSRS). None of this is specific to community paramedicine; it is the same Uniform Guidance framework that applies to any federal subaward, and it is worth having your grants office walk through it once at the start of the program rather than discovering a gap at reporting time. The full detail, including a field-by-field list of what is worth capturing from day one, is on the reporting requirements page.
Sources
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A practical sequence for standing up a program
The order that avoids the most rework, whether you are a hospital, an EMS agency or a health center holding the subaward.
- Read the subaward, not just the plan summary. The subaward agreement, not the state's public plan document, is what defines your eligible costs, reporting schedule and record retention obligation.
- Confirm clinical scope with your medical director. Which visit types, protocols and escalation paths the program will run should be settled before budget lines are finalized, since evaluation measures and staffing follow from scope.
- Decide the evaluation measures before you pick tools.Cohort definition, the measures you will report on and the data sources behind them should be fixed first; software and workflow choices should serve that plan, not the reverse.
- Procure any vendor deliverables properly. 2 CFR Part 200 procurement standards and your own organization's procurement policy generally apply to any vendor contract funded from the subaward; confirm the required method with your grants office.
- Run a pilot cohort before full rollout. A small, defined cohort surfaces referral, staffing and data-capture problems while they are still cheap to fix.
- Build the first quarterly report from real data, early.Producing a dry-run report before the first live due date usually finds a missing field or an undefined measure while there is still time to correct it.
Common pitfalls
Treating the vendor's word as the allowability answer
No vendor, including DispatchCare, determines whether a cost is allowable. That determination belongs to your grants office and your state program officer, reading your specific subaward.
Deciding measures after the program is already running
A program that runs for two quarters before its reporting fields are defined usually ends up trying to reconstruct numbers it never captured cleanly.
Blurring new program spend with existing billable services
Moving already-funded ambulance, staffing or ePCR costs into the subaward is the fastest way to raise a non-supplantation question during review.
Skipping procurement documentation
Selecting a vendor without following your organization's procurement policy, or without documenting why a particular method was used, is a common finding in subrecipient monitoring reviews.
How states differ, and what stays constant
Every state received an RHT award and organized its plan around the same five CMS strategic goals, but the specifics vary widely: which agency administers the funds, which activities are prioritized, how much of the award is earmarked for workforce versus infrastructure versus direct services, and how subaward competitions are structured. Two neighboring states can both fund community paramedicine and still run very different application processes, timelines and reporting templates.
What stays constant across states is the underlying federal framework: Uniform Guidance governs allowability and monitoring regardless of which state administers the award, the three-layer structure of CMS, state, and subrecipient does not change, and the reporting obligation to demonstrate progress against the five goals applies everywhere. That is why a state-by-state page is useful for the specifics, while the structural questions, non-supplantation, procurement, record retention, have the same answer nationwide.
Questions to bring to your first planning conversation
Which goal or goals does this activity map to, and can we defend that mapping in a narrative? A program that can articulate its fit against more than one CMS goal is usually easier to justify at renewal than one that was written to satisfy a single line item.
What would we have to show a reviewer six months from now? If the answer requires reconstructing data that was not being captured from day one, that is the clearest sign the evaluation measures were decided too late.
Who in our organization owns the subaward's compliance obligations? Reporting cadence, record retention and procurement documentation usually sit with a grants office rather than a clinical or operations team, and naming that owner early avoids obligations falling through the cracks between departments.
Questions buyers ask
Software, onboarding and evaluation for new or expanded CP programs are commonly budgeted as subaward lines under a state's RHT plan. DispatchCare is a vendor or subcontractor to the subrecipient; eligibility is determined by your state's plan and CMS rules.
Talk through your state's plan with us.
A 30-minute walkthrough with a coordinator view, a CP program view and the dashboard your sponsor will read.