The RFI includes two distinct response tracks:

• Track 1: Remote Patient Monitoring for Maternal Care
  DSS is seeking information on solutions that can help rural providers monitor patients throughout pregnancy and the postpartum period, identify emerging risks earlier and strengthen continuity of care between appointments. Priority use cases include hypertensive disorders of pregnancy, gestational diabetes, high-risk pregnancy monitoring and postpartum care.
• Track 2: Telehealth Specialist Access for Rural Hospitals and Providers
  DSS is seeking information on telehealth solutions and service models that connect rural hospitals and providers with specialists for timely consultation, clinical guidance and decision support. The state is particularly interested in approaches that can help rural hospitals expand access to specialty expertise, strengthen local clinical decision-making and reduce avoidable transfers.

DSS also is seeking information about implementation support, electronic health records integration and interoperability, patient and provider training, connectivity challenges, privacy and security, reporting, technical support, and pricing models appropriate for rural providers.

The RFI is for planning purposes only and will not result directly in an award. Vendors may respond to either track. Those interested in both tracks must submit separate responses.

The RFI is available through MissouriBUYS under bid number 0000000012SL. Interested vendors should submit responses by email to Steven Hoffman, procurement specialist, at Steven.Hoffman@dss.mo.gov.

Among the changes noted in the IFB amendment is the return bid due date has been extended to 2 p.m. Tuesday, Sept. 1, rather than the original Aug. 28 deadline.

Organizations interested in submitting a proposal should download and carefully review the amended IFB from DSS' bid opportunities webpage, as Amendment #01 replaces the original IFB document.

Those preparing a bid should remember that vendors must complete and sign the signature page from the original IFB as well as any applicable amendment documents. Review Section 6 of the IFB for complete submission requirements.

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.

Supported by approximately $6.5 million in funding through July 31, 2027, the initiative aims to improve access to care in underserved communities by integrating EMS providers more closely with hospitals, primary care providers, behavioral health organizations and other community partners.

MIH-CP programs extend the role of paramedics beyond emergency response to provide preventive and coordinated care in community settings. Services may include chronic disease management, care coordination, post-discharge follow-up and connections to social services, helping reduce avoidable emergency department visits and improve patient outcomes.

Currently, more than 30% of Missouri's rural communities have access to MIH-CP services. The partnership is expected to expand that reach and significantly strengthen rural health care delivery networks.

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.

The funding — administered on behalf of the Centers for Medicare & Medicaid Services — supports a new partnership between MDA and the Missouri Department of Health and Senior Services' Office on Women's Health, aimed at expanding the rural maternal health workforce.

For hospital and health system leaders, this initiative addresses rural maternal health workforce shortages. MDA will build recruitment pipelines, formal credentialing systems, and integration pathways for community-based doulas and perinatal community health workers, who provide support throughout pregnancy, childbirth and postpartum recovery.

As these professionals become integrated into rural health care teams, hospitals may see expanded care team capacity, new opportunities to partner with a growing credentialed workforce and stronger community ties around maternal health service lines.

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.

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.

This grant program allows applicants to receive up to $115,000 per contract, with the opportunity for two contract renewals. To qualify, organizations must either establish a new medical school clerkship commitment serving at least three students annually or expand an existing clerkship program by two additional students each year. Any new partnership with a medical school must be established and operational no later than August 2027.

At least half of the clerkship rotation time must take place in Missouri’s Rural Health Transformation Program’s ToRCH Care counties, which include all Missouri counties except Boone, Cass, Clay, Greene, Jackson, Jefferson, Platte, St. Charles and St. Louis as well as St. Louis City.

Additional assistance can be acquired through the Missouri Graduate Medical Education Technical Assistance Center at motac@missourigme.org.

The Missouri Department of Social Services’ MO HealthNet Division is investing $588,000 annually to support evidence-based nurse home visiting programs. Administered by the Missouri Children’s Trust Fund, the funding will help improve maternal and child health outcomes.

Up to $100,000 will support training and model fees for new nurse home visitors, while up to $488,000 will expand existing services. Eligible applicants must operate or be implementing a Home Visiting Evidence of Effectiveness (HomVEE)-approved nurse-led model.

A virtual informational meeting will be held from 9 to 10 a.m. Wednesday, July 8, and interested organizations can register here. Applications are due Sunday, Aug. 23, and must be submitted via email to Melinda.Kirsch@oa.mo.gov.

RHTP also is investing in Missouri’s rural health care future through the development of a Digital Backbone — a technology and data infrastructure designed to better connect rural providers, health systems and community services.

To help stakeholders better understand this work, RHTP will host Digital Backbone Roadshow events that will provide an overview of electronic health record modernization and interoperability, social-care referral systems, data and AI governance, advanced technologies, and the findings from Missouri’s Digital Readiness Survey.

• Monday, July 13, 3:30-5:30 p.m., Osage Beach, Mo.
• Tuesday, July 14, 2-4 p.m. Union, Mo.

Participants may attend in person or virtually and are encouraged to register and bring questions or concerns they would like addressed. Organizations also are encouraged to share the Digital Backbone Roadshow flyer within their networks to help spread awareness of this opportunity.

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.

HRSA expects to award 15 grants of up to $750,000 each over a three-year project period through two pathways: General Primary Care and High-Need Specialty or Maternal Health and Obstetrics. Applications are due by Wednesday, July 8.

Applicants should follow updated program timelines, use the term “medically vulnerable” rather than “underserved” throughout their submission and consult ACGME rural track standards to ensure accreditation compliance. Organizations also must notify their state office early of their intent to apply.

Missouri hospitals seeking a letter of support from the Missouri Department of Health and Senior Services’ Office of Rural Health and Primary Care should email GME@health.mo.gov as soon as possible. Hospitals planning to apply or considering an application also are encouraged to notify the Missouri GME Technical Assistance Center by emailing motac@missourigme.org.

• establishes a 10-year federal funding program to support rural hospital emergency departments
• provides eligible rural hospitals with at least $1 million annually, with additional funding based on local needs and circumstances
• includes emergency assistance of up to $250,000 for rural hospitals facing imminent closure
• preserves hospitals’ eligibility for other federal health care programs, grants and funding sources 

Joining Hawley at his press conference announcing this legislation were Jon D. Doolittle, Missouri Hospital Association’s president and CEO; Laura Smith, R.N., CEO of Ellett Memorial Hospital & Clinic in Appleton City, Mo.; Aaron Neisen, D.O., a board-certified family physician and emergency department doctor at Scotland County Hospital in Memphis, Mo.; and Mike Poore, CEO of Mosaic Life Care in St. Joseph, Mo. 

Proposals are due by 2 p.m. Tuesday, July 7.

Applicants may receive up to $115,000 per contract, with the opportunity for two contract renewals. To qualify, organizations must either establish a new medical school clerkship commitment serving at least three students annually or expand an existing clerkship program by two additional students each year. Any new partnership with a medical school must be established and operational no later than August 2027.

At least half of the clerkship rotation time must take place in Missouri’s Rural Health Transformation Program’s ToRCH Care counties, which include all Missouri counties except Boone, Cass, Clay, Greene, Jackson, Jefferson, Platte, St. Charles and St. Louis as well as St. Louis City.

A pre-proposal teleconference regarding the RFP will take place at 11 a.m. Thursday, June 25. For questions about the RFP or to obtain dial-in instructions for the teleconference, contact Amy Raymo at Amy.Raymo@oa.mo.gov.

The survey is open through Friday, June 19, to hospitals, federally qualified health centers, primary care and specialty practices, and other providers with APM experience. Topics include prior experience with APMs, challenges and benefits of APMs, and the capacity to implement these models. 

The survey should be filled out once per organization or practice, not per individual provider. Materials to support providers in filling out the survey are available.

Provider responses may help inform future MO HealthNet APM efforts and opportunities for ongoing engagement. The survey is being funded through the Rural Health Transformation Program. Questions may be directed to DSS.RHTP@dss.mo.gov.

This funding opportunity supports the design, modernization and strategic renovation of existing rural hospital facilities as part of Missouri’s state-led initiative of the Rural Health Transformation Program, known as Transformation of Rural Community Health (ToRCH) Care. Bids are due to Dirk Elrod, with DSS, by 2 p.m. Thursday, June 11.

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.

This funding opportunity supports the design, modernization and strategic renovation of existing rural hospital facilities as part of Missouri’s state-led initiative of the Rural Health Transformation Program, known as Transformation of Rural Community Health (ToRCH) Care.

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.

The updates expand and clarify eligibility criteria by evaluating financial need at the system level. The amendment also broadens the definition of qualifying “contractor facilities” and allows bundled projects under a single proposal per location. In addition, guidance is offered on eligible medical equipment, furniture, fixtures, buildings and infrastructure. Partial awards will be allowed, too.

This funding opportunity supports the design, modernization and strategic renovation of existing rural hospital facilities as part of Missouri’s state-led initiative of the Rural Health Transformation Program, known as Transformation of Rural Community Health (ToRCH) Care. Bids are due by 2 p.m. Thursday, June 4.

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.

From Thursday, May 21, through Thursday, June 4, DSS will host 10 in-person events and five virtual sessions. In-person attendance is limited to two representatives per organization, while virtual events are open to unlimited participants. Registration is required for all sessions.

The ToRCH Care Roadshows provide an opportunity for hospital leaders, providers and community partners to connect with the Missouri Rural Health Transformation Office and learn more about ToRCH Care and its impact on rural health care. Additional regional meetings will take place later this summer.

For questions or additional information, email DSS.RHTP@dss.mo.gov.

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. 

The Missouri Department of Social Services on May 15 released the county groupings that will define the community “Hubs” under the state’s Rural Health Transformation Program, known as ToRCH Care, which is part of a $50 billion federal initiative established in July 2025.

The 27 Hub groupings — each consisting of about two to six counties — reflect extensive stakeholder input and are intended to align with how care is already delivered in local markets. A map of the Hub groupings is available on the DSS website.

In addition to the boundary announcement, DSS opened a Request for Applications (RFA) for organizations to serve as Hub Anchors. Applications are due by 11:59 p.m. Thursday, June 18, and must be submitted to DSS.RHTP@dss.mo.gov.

Interested applicants are encouraged to register for a webinar about the Hub Anchor application process, scheduled from 11 a.m. to 12:30 p.m. Tuesday, May 19.

These community Hubs are central to the state’s effort to redesign rural health care by organizing providers and community partners into coordinated, multicounty regions that can better align services and address local health needs. Each Hub will bring together hospitals, clinics, EMS, pharmacies and community-based organizations to improve access, strengthen care coordination and address local population health needs.

A designated Hub Anchor will serve as the neutral convener, responsible for coordinating partners, supporting governance, and ensuring effective clinical and social service integration across the region.

For hospitals, this represents a key strategic opportunity to shape regional care delivery. DSS is encouraging collaborative, consortium-based approaches. Early engagement will be critical as organizations determine whether to pursue an Anchor role or participate as a key partner.

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. 

A virtual preproposal conference, with a question-and-answer session, will be held at 2 p.m. Tuesday, May 19. Hospital staff wishing to attend must email Dirk Elrod, with DSS, to receive the meeting invitation. Hospital teams with questions regarding the bid also may email Elrod in advance of the preproposal conference. Bids are due by 2 p.m. Thursday, June 4.

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. 

The four webinars will take place from 1-3 p.m. Wednesdays from April 22 through May 13. Topics covered will include an overview of the RHTP, the Transformation of Rural Community Health (ToRCH) Care model and the Hub Anchor role.

These informational sessions are timely, as Missouri begins implementing RHTP following recent approval from the Centers for Medicare & Medicaid Services of $216 million in Year 1 funding, covering the period through Sept. 30, 2027. This approval allows the state to move from planning to full implementation of ToRCH Care, the statewide strategy designed to improve access to health care in rural communities.

The funding will be spread across the following five pillars.

• Activating Regional Networks and Local Hubs ($52 million)
• Advancing Sustainability Through Payment Reform ($9 million)
• Laying the Digital Foundation for Long-Term Transformation ($56 million)
• Expanding and Retaining Rural Health Workforce ($18 million)
• Strengthening Rural Providers and Modernizing Service Delivery ($57 million)

An additional $24 million will provide strategic and operational support to coordinate and execute the RHTP statewide.

Learn more and view the detailed funding breakdowns of the Year 1 award.

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. 

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. 

The Missouri Department of Social Services announced Tuesday that Joseph (Joe) Miller will serve as director of the newly created Rural Health Transformation Office within MO HealthNet, effective Monday, March 30. 

The RHTO will guide the implementation of ToRCH Care — Missouri’s five-year, federally funded Rural Health Transformation Program, designed to strengthen and modernize health care delivery in rural communities.

“I’m really excited to be in a position that lets me work directly with hospitals across Missouri and learn from you. It will be a priority for me to spend time in communities across the state, meeting with hospitals to hear directly about what’s working, what’s not and what’s needed locally,” Miller said. “Every rural community is different, and a one-size-fits-all approach won’t work, especially in areas already stretched thin. Local hospitals play a critical role in the health of their communities, and I look forward to working together to ensure individuals and families have access to the care they need.”

The new office will serve as the central hub for strategy, governance and technical support for rural hospitals, clinics and behavioral health providers participating in Missouri’s RHTP initiatives.

Miller’s leadership will focus on developing innovative payment models, improving alignment across state agencies, coordinating work with provider and education partners, and ensuring accountability across all RHTP initiatives. 

His previous experience includes helping lead a community-based health care (including behavioral health) organization with locations in four states and directing data-driven strategies to improve quality outcomes and increase efficiencies in health care IT for a clinically integrated network of independent Federally Qualified Health Centers.

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. 

Missouri is implementing ToRCH Care — the state’s model for improving rural health through the federal Rural Health Transformation Program. ToRCH Care’s design is based on the state’s Medicaid demonstration at six rural hospitals, known as Transformation of Rural Community Health (ToRCH).

The system incentivizes care and management of Medicaid patients, emphasizing strong connections with local partners that can assist patients with the nonclinical components of health that often drive poor health.

In this episode of the Missouri Hospital Association’s PolicyHuddle podcast, we hear from the following leaders at the six participating hospitals about their insights on ToRCH implementation and what challenges and opportunities may lay ahead with ToRCH Care.

• Marvin Smoot, vice president of clinic operations at Bothwell Regional Health Center in Sedalia, Mo.
• Michael Calhoun, CEO/executive director of Citizens Memorial Hospital in Bolivar, Mo.
• Craig Thompson, CEO of Golden Valley Memorial Healthcare in Clinton, Mo.
• Jana Cook, senior vice president/CFO at Phelps Health in Rolla, Mo.
• Tim Braun, executive director of population health at Ray County Hospital and Health Care in Richmond, Mo.
• Brooke Bollman, CEO of Salem Memorial District Hospital

This edition of PolicyHuddle is less than 20 minutes in length and available online or on your favorite podcast platform.

The Missouri Department of Social Services, through MO HealthNet, is requesting input from hospitals and other rural health partners to inform the Transformation of Rural Community Health Care (ToRCH Care) program. Regional Hubs, which will comprise of about three to five counties each, will coordinate clinical and nonclinical services among hospitals, clinics, pharmacies, EMS and community-based organizations.

To ensure these Hubs align with how communities naturally collaborate across county lines, DSS is gathering perspectives through the short survey. Responses are due by Thursday, March 12.

Hospital leaders are encouraged to share the survey with staff across clinical locations in the identified rural counties. Your insight is essential to shaping Missouri’s rural health future. 

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. 

Missouri Hospital Association and Missouri Perinatal Quality Collaborative staff attended Rural Health Advocacy Day held Feb. 24 at the Missouri State Capitol. The event brought together advocates, health care providers and community members to meet with lawmakers and their staff to discuss priorities for rural health.

Discussion topics included implementation of Missouri’s recently approved budget for its $216 million initial Rural Health Transformation Program award, proposed bills that would impact rural health care, state budget priorities, rural hospital sustainability, health care workforce shortages and access to care in Missouri’s rural communities.

“Rural Health Advocacy Day brought Missouri’s most pressing rural challenges into sharp focus, and MHA is leading the push for real solutions by elevating key issues and amplifying the unified voice of rural hospitals,” said Stephen Njenga, MHA’s director of quality measurement and population health improvement. “These hospitals anchor their communities, and MHA is ensuring they have the support needed to keep vital care local.”

Also in attendance, MO PQC highlighted its ongoing work to support rural obstetrics and postpartum efforts in Missouri. With more than half of Missouri counties classified as maternal care deserts, MO PQC is bridging gaps by hosting rural convenings statewide and creating a pool of OB emergency trainers. In 2025, the MO PQC provided $16,000 in rural stipends to support rural maternal health care. Rural teams are leveraging their emergency departments, EMS, community-based organizations and connections to higher levels of care, ensuring they are prepared to stabilize and save the lives of mothers and babies.

Rural hospitals face unique challenges — from workforce shortages to financial and infrastructure barriers — and MHA supports the state’s rural hospitals through advocacy, resources and ongoing evaluation to strengthen the health of rural communities.

MHA also is the convener of the Rural Hospital Council, which guides MHA’s policy, advocacy and services for rural and critical access hospitals.

MHA will release additional details once published by UHC.

Missouri secured a $216 million initial award — one of the nation’s top 10 — through the RHTP, which will benefit rural Missourians’ access to care and health outcomes through a range of health care and community services organizations, including Missouri’s hospitals. 

Missouri secured a $216 million initial award — one of the nation’s top 10 — through the federal program, which will benefit rural Missourians’ access to care and health outcomes through a range of health care and community services organizations, including Missouri’s hospitals.

Learn more about the ORHT and RHTP.

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. 

Additional details will be shared once the official Notice of Funding Opportunity is released for each program. Prospective applicants may click the Subscribe button on each listing to get real-time updates.

Rural Residency Planning and Development Program

Rural Communities Opioid Response Program-Planning

Rural Communities Opioid Response Program-Impact

“This award reflects a shared commitment to improving health care access and outcomes for rural Missourians. From the start, the state engaged primary care providers, behavioral health organizations and hospitals, among others, as key partners in shaping a plan that works for the communities we jointly serve. That collaboration is Missouri’s strength — and it’s why our state's ToRCH CARE proposal stood out nationally.”

The leaders said this funding will help stabilize rural hospitals, expand primary and behavioral health services, and build a workforce pipeline to meet local needs. It also invests in technology and data tools that connect care across settings — ensuring patients experience seamless, coordinated services.

In addition to Gov. Kehoe, they also commended the state's Department of Social Services, including Director Jess Bax, for Missouri's uniquely collaborative approach. Missouri’s Transformation of Rural Community Health (ToRCH) CARE model brings together a wide variety of stakeholders, including clinics, behavioral health providers, federally qualified health centers, EMS, hospitals, physicians, other providers, public health and social-service organizations through regional networks and community hubs. This structure fosters shared accountability and innovation, making care more accessible and sustainable.

The state is expected to finalize its cooperative agreement with CMS and launch implementation of the ToRCH CARE model features in early 2026.

“We congratulate Gov. Kehoe’s administration on a visionary and successful application that earned Missouri one of the nation’s top‑10 awards,” Jon Doolittle, MHA President and CEO, said. “We’re grateful the state included MHA and our member hospitals as key stakeholders throughout the process. This investment will help rural Missourians receive high‑quality care in strong, connected local systems — the kind of care that improves lives and sustains communities.”

What this means for rural Missourians
This cooperative agreement gives the robust network of providers in Missouri's health care system additional tools to extend care where people live — primary, maternal and behavioral health services; workforce pipelines; and the digital backbone that ties it all together.

How Missouri will put the funding to work
Missouri’s plan — built around Transformation of Rural Community Health (ToRCH Care) — advances five practical priorities hospitals will recognize:

• Regional networks and community hubs. Seven coordinating networks and dozens of multi-county hubs will align local partners — hospitals, behavioral health providers, clinics, EMS, public health and social‑service organizations, physicians and other providers, among more — to close gaps and keep people healthier.
• Payment models that reward collaboration. Alternative payment approaches will support care coordination and prevention, not just volume, strengthening hospital sustainability.
• Digital backbone. Interoperable tech and data tools — including referral platforms — will simplify handoffs, track outcomes and reduce friction for patients and providers.
• Workforce pathways. Targeted rural workforce programs will recruit, train and retain clinicians and caregivers to meet local needs.
• Provider transformation support. Hospitals can receive financial and technical assistance to stabilize and modernize operations and care delivery — with measurable improvements in access, quality and cost.

What’s next
Missouri’s Department of Social Services will finalize cooperative agreement terms with CMS, then sequence funding for hub activation, workforce initiatives and tech procurement. The state will continue formal engagement with hospitals and partners with MHA actively facilitating hospital input so implementation reflects real‑world needs.

MHA will continue to issue updates and guidance to members on participating in hubs, data and referral workflows, workforce opportunities and hospital transformation resources.

Background
CMS announced awards on Dec. 29, 2025, to every state under the $50 billion Rural Health Transformation Program, with first‑year awards averaging $200 million.

ToRCH Care envisions establishing seven regional coordinating networks and up to 30 community hubs of two to five counties each to align goals, represent community- and region-specific differences, and empower clinical and nonclinical partners at the local level to leverage the health improvement work they do best.

All RHTP applications have been submitted by the states. CMS’ input on the Missouri application, and the eventual funding award, are expected by Wednesday, Dec. 31. MHA continues to engage with the state and provider partners to create the systems necessary to launch and maintain the program.

• improving health care access for rural Missourians by connecting providers, pharmacies, public health agencies, at-home resources and digital health tools through a unified, regional network
• expanding access to primary care, behavioral health, and maternity services in rural communities while strengthening specialty and complex care through telehealth and patient-focused technology
• enhancing rural provider sustainability by increasing collaboration among local partners to advance technology, operations, and care delivery, and incentivizing better health outcomes through shared savings of avoidable health care costs

CMS will review each state's proposal and notify awardees by Wednesday, Dec. 31.

For more information on Missouri's plan, visit the DSS website or learn more about the RHTP on the CMS website.

The letter also provides guidance on maximizing Missouri’s share of the funds, including how to best calculate the state’s rural factors and conform with the priorities identified by the Centers for Medicare & Medicaid Services. The letter also suggests the state establish performance metrics to evaluate program implementation and ensure that rural health facilities are prioritized for receipt of funding.

The full Notice of Funding Opportunity is available online. MO HealthNet will be responsible for submitting Missouri's application through the portal.

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, coordinated by the MO HealthNet Division, 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. 

Missouri’s estimated share of the fund will be $200 million to $250 million per year for a five-year period. CMS is preparing an application and additional guidance for states to apply for funding.

Comments should be submitted utilizing MO HealthNet’s public comment form by Tuesday, Sept. 30.

Additional information on the One Big Beautiful Bill Act can be found on MHA’s website.

Leaders representing more than a dozen of Missouri's critical access and rural emergency hospitals visited with lawmakers at the Missouri State Capitol in Jefferson City, Mo., on April 10. The full group met with Speaker of the House Jon Patterson, R-Blue Springs, to advocate for legislation to reform insurers’ prior authorization systems. 

The legislation would address delays and denials for providers who have a percentage of high percentage of prior authorization approvals upon appeal. In addition to their visit with Speaker Patterson, the hospital leaders met with their respective lawmakers in the Missouri House and Senate. 

Learn more about our prior authorization advocacy and share your thoughts with lawmakers at MissouriHealthMatters.com.

Attending were leaders from the following hospitals.

• Cedar County Memorial Hospital in El Dorado Springs
• Community Hospital – Fairfax
• Excelsior Springs Hospital
• Harrison County Community Hospital in Bethany
• Hedrick Medical Center in Chillicothe
• Hermann Area District Hospital
• Mercy Hospital Aurora
• Mercy Hospital Cassville
• Mercy St. Francis Hospital in Mountain View
• Missouri Baptist Sullivan Hospital
• Parkland Health Center – Farmington
• Parkland Health Center – Bonne Terre
• Pershing Memorial Hospital in Brookfield
• Pike County Memorial Hospital in Louisiana
• Ray County Hospital in Richmond
• Salem Memorial Hospital
• Samaritan Hospital in Macon
• Scotland County Hospital in Memphis
• Sullivan County Memorial Hospital in Milan
• Wright Memorial Hospital in Trenton

Among the attendees were Bill Bridges, CEO of Texas County Memorial Hospital, and Kristina Grant, D.O., a family medicine physician and obstetrics provider at TCMH.

Dr. Grant shared her concerns about health care deserts with lawmakers. 

“These rural programs are really important to take care of that,” Dr. Grant said. “It increases the health of those communities, which increases the ability of those people to work, which increases the production in the state, and it works out for everybody — it’s that trickle-down effect.”

Family medicine physicians from University Health Lakewood Medical Center also attended the event to share the importance of primary care to rural health. 

In addition to speaking with legislators, attendees had the opportunity to network with health care advocates from across the state.