State Opens Applications For $40 Million Rural Health Infrastructure Program

The Missouri Department of Social Services issued an Invitation for Bid (IFB #DSS26015) for the Smart Growth and Service Line Modification (Horizon 2) program through the state’s Rural Health Transformation Program known as Transformation of Rural Community Health (ToRCH) Care.  

This funding opportunity offers individual grants of up to $5 million for one-time infrastructure investments in maternal health, behavioral health or diagnostics/outpatient care, with nearly $40 million available overall during program years 1 and 2, pending budget approval by the Centers for Medicare & Medicaid Services. Funding cannot be used for new construction, demolition, major facility expansions, cosmetic upgrades or routine operating expenses.

A pre-proposal teleconference for the Horizon 2 IFB will be held at 2:30 p.m. Tuesday, Aug. 11. Hospital staff interested in attending should email Dirk.Elrod@dss.mo.gov for a meeting invitation. Bids are due by 2 p.m. Friday, Aug. 28, to DSS via Dirk Elrod. Organizations must register on the MissouriBuys portal to apply.

This new opportunity is different from the Strategic Minor Renovations (Horizon 1) program, which is still pending award. The Missouri Hospital Association anticipates that Horizon 1 award information will be released well in advance of the Horizon 2 due date and has asked the state to share additional context as quickly as possible when available.

For more information, visit Missouri’s Rural Health Transformation Program website.

About the 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. Members can stay up to date on ToRCH Care and other Rural Health Transformation Program news, funding opportunities and resources on MHA’s Rural Health Transformation Program webpage.