As states move from plan approval to implementation of the Rural Health Transformation Program (RHTP), the choices made now will determine whether this investment leads to lasting system change or short-term, fragmented efforts.

To achieve meaningful, sustainable impact, states must fully leverage one of the most effective and proven assets in rural health: community health centers (CHCs).

CHCs serve nearly one in three rural patients nationwide, making them essential partners in advancing RHTP priorities such as workforce recruitment and retention, sustainable access to care, innovative care models, chronic disease prevention and management, and technology-enabled service delivery. As states transition from plan approval to implementation, this phase presents a critical opportunity to intentionally align transformation investments with the primary care infrastructure already embedded in rural communities.

Why CHCs Should Be Central to RHTP State Implementation Strategies

Community health centers already deliver on the core priorities RHTP aims to advance:

• Access and Trust: Deeply rooted in their communities, CHCs meet patients where they are, through services like mobile units, telehealth, and food pantries. For example, Yakima Valley Farm Worker Clinic’s mobile fleet of 15 vehicles provides rural Washington state with mobile mammography, dental care, and primary health services. 
• Expertise with High-Need Populations: CHCs routinely serve Medicaid enrollees, the uninsured, and other traditionally medically complex populations, often with better outcomes than in other types of care settings. This positions CHCs well to expand their high-quality care for chronic disease, behavioral health services, and other RHTP priorities. HRSA reports that in 2024, health centers ensured over 3.6 million patients had controlled hypertension, helped more than 2.2 million patients control their diabetes, and screened 4.6 million pediatric patients for weight assessment and nutrition counseling.
• Workforce Pipelines: Through residency programs, teaching health centers, and local recruitment efforts, CHCs are rural workforce hubs. For example, Mountain Comprehensive Health Corporation’s RAISE program, serving rural Kentucky, supports the upward mobility of existing employees to increase their skills and meet workforce needs without utilizing other methods such as temporary staffing.  
• Value-Based Care Readiness: Many CHCs already participate in alternative payment models and track quality metrics, making them natural partners for RHTP payment reform initiatives. CHCs have an existing safe harbor protection that enables strong referral networks.
• Technology and Data Infrastructure: CHCs operate certified electronic health record (EHR) systems, manage quality reporting, and increasingly deploy telehealth and remote monitoring tools that can scale state priorities. Many are on the frontlines of deploying AI in health care settings as well. Their mission-driven providers, engagement tools and expertise, and strong patient relationships make them ideal sites for pilot testing new models with high needs/rural populations.
• Leveraging Telehealth to Extend Specialty Care: CHCs can serve as rural access hubs for specialty consultations and virtual care initiatives, expanding patient access without duplicating costly infrastructure. Through e-consults, remote patient monitoring (RPM), tele-psychiatry, and specialty partnerships, CHCs help connect rural patients to timely specialty services.
• Behavioral Health/SUD: CHCs integrate primary care, behavioral health, and substance use disorder (SUD) services to improve access and care coordination for rural patients. Through co-located behavioral health providers, medication-assisted treatment (MAT) programs, care coordination models, and programs such as Programs of All-Inclusive Care for the Elderly (PACE) and other team-based approaches, CHCs are well-positioned to advance behavioral health access and whole-person care.

Why CHCs Make Strong Implementation Partners for States

• Reach in Rural Populations: Because CHCs already serve nearly one in three rural patients, they offer states a trusted, community-based pathway to engage high-need populations. Their longstanding relationships, care models, and deep community ties will ensure that RHTP initiatives are delivered through providers that patients know and trust, strengthening overall participation and impact.
• Ability to Blend and Align Funding Streams: CHCs have extensive experience blending federal, state, local, and grant funding to operate. This flexibility positions them to align RHTP investments with existing programs and sustain initiatives beyond short-term funding cycles.
• Built-In Accountability and Reporting: CHCs operate under rigorous federal reporting requirements, including Uniform Data System (UDS) quality and outcome measures. Their existing data infrastructure and performance tracking capabilities can support state-level RHTP evaluation, benchmarking, and accountability efforts while minimizing duplicative reporting burdens.

A High-Value Strategy for States

As states steward significant federal RHTP funding, partnering with CHCs offers a clear return on investment. Health centers reduce avoidable emergency department use, improve chronic disease outcomes, and deliver cost-effective care while helping states meet both fiscal and quality goals. Health centers generate an estimated $13 return for every $1 invested by reducing unnecessary emergency department visits, preventing avoidable hospitalizations, and delivering lower-acuity, preventive care. Partnering with CHCs will allow states to advance RHTP goals while maximizing the fiscal impact of federal dollars.

What States Should Do Now

To maximize the impact of RHTP, ACH urges states to take the following actions:

1. Include CHCs Early in Implementation Planning: Early engagement ensures that health centers can inform RHTP initiatives that align with existing care delivery realities and community needs; this partnership can be achieved through advisory committees, formal partnership agreements, and coordination with the state’s Primary Care Association (PCA).
2. Establish Provider Engagement and Accountability Mechanisms: If they haven’t already, states should create opportunities for direct feedback from rural providers and clinics. This could include advisory groups, provider roundtables, or formal feedback channels that allow CHCs and other rural providers to provide real time feedback on program design, implementation, and barriers. 
3. Convene Rural Provider Learning Networks: States should consider convening learning collaboratives, affinity groups, and/or peer networks to allow rural providers to share best practices. CHCs, RHCs, and other safety net providers should be intentionally included in these forums to share practical insights and “on the ground” experiences to inform care delivery mechanisms and program implementation that can benefit the entire ecosystem.  
4. Direct Implementation Resources Toward Rural Safety Net Providers: States should consider dedicating a portion of RHTP resources to directly support CHCs, RHCs, and other rural safety net provider participation. Targeted funding for technical assistance, model implementation, workforce development, and infrastructure improvements will ensure that rural safety net providers have the capacity to fully participate in the RHTP – reinforcing the entire rural health care infrastructure and statewide delivery system.
5. Support Sustainable Infrastructure, Not Just Time-Limited Projects: States should prioritize investments that strengthen long-term workforce capacity, IT systems, and care teams to support durable system improvements beyond the grant period (e.g., workforce retention incentives, EHR modernization, care team expansion).
6. Use CHC Data to Inform Strategy and Evaluation: States should leverage CHC patient data and quality reporting systems to identify high-need populations, target interventions, and measure meaningful transformation outcomes (e.g., UDS data, chronic disease control metrics, telehealth utilization trends).

The Opportunity for States 

As RHTP implementation unfolds, states have an opportunity to strengthen rural health systems by fully leveraging community health centers as long-term partners in workforce development, innovation, and primary care delivery. 

Through intentional collaboration and a shared focus on sustainability with CHC partners, states can ensure that RHTP investments deliver lasting improvements and maximize the impact of federal funding in rural communities.