Program Overview
The Texas Rural Health Transformation Program, administered by the Health and Human Services Commission (HHSC) as Rural Texas Strong, supports rural hospitals and providers through workforce development, infrastructure investment, and recruitment initiatives. The program provides funding via ongoing competitive grant rounds and targeted solicitations, supporting key areas such as healthcare team development, workforce shortages, facility and equipment upgrades, health technology, telehealth expansion, and rural health infrastructure. Structured plans currently track multiple initiatives and strategic goals, with active event schedules and public forums outlining current and upcoming activities. Major focus areas include provider training, collaborative partnerships, and technology-enabled access to care. Current structured plan tracks 15 key initiatives and 12 strategic goals.
Updated
County-level estimates averaged across Texas — % of adults 18+ unless noted. Delta vs US county average shown in red/green.
pp = percentage points vs US county average
County Drilldown (254)
| County | Pop | Poverty | Uninsured |
|---|---|---|---|
| Harris County | 4,838,303 | 16.3% | 13.1% |
| Dallas County | 2,621,179 | 13.9% | 10.8% |
| Tarrant County | 2,167,390 | 11.1% | 8.2% |
| Bexar County | 2,067,341 | 14.6% | 11.2% |
| Travis County | 1,330,015 | 10.9% | 7.1% |
| Collin County | 1,163,337 | 6.2% | 4.7% |
| Denton County | 979,561 | 7.1% | 4.4% |
| Fort Bend County | 893,767 | 7.6% | 6.5% |
| Hidalgo County | 891,977 | 26.7% | 23.3% |
| El Paso County | 870,779 | 18.7% | 16.3% |
| Montgomery County | 684,432 | 9.4% | 7.3% |
| Williamson County | 672,688 | 6.4% | 4.4% |
AI source: TX - 2026 - © Copyright 2018-2026. Texas Health and Human Services Commission. All rights reserved.
AI auto-updated Jun 10, 2026
API refreshed May 7, 2026
Key signals are summarized here. Open the source for the supporting detail.
Due Nov 5, 2025
6 related documents
TX - 2026 - Rural Texas Strong (RHTP)
Guidance / reference (not standalone opportunity)
2,895,576 rural residents
Texas received its first-year CMS award and finalized revised narratives for Budget Period 1 as of April 2026. The state is in the active planning phase, with HHSC preparing procurements and the first Rural Health Transformation Program RFAs scheduled for release in July 2026. No open subrecipient grant applications were available as of August 2026. Full program implementation is anticipated to begin following the advertised 2026 RFA release timeline. State opportunities: 1 active (1 open, 14 past/closed), $97.8M listed funding. Key opportunities: Rural Texas Strong Program – Initiative 4 (Round 2): The Next Generation of the Small Town Doctor and Team; TX - 2025 - HHS0015344 BCCS RFA - Breast and Cervical Cancer Services; Family Support Services (FSS) Community Services Grant. Strategy alignment: supports workforce, prevention, care access priorities.
Texas advances the Rural Texas Strong strategy for the Rural Health Transformation Program (RHTP) by targeting chronic disease, workforce shortages, behavioral health, and infrastructure needs through HHSC-administered grants. Implementation is organized around six major initiatives, using competitive grant cycles and procurements for evidence-based, trauma-informed, and culturally competent interventions; with strong fiscal, indirect cost, and data controls. Grantees must demonstrate compliance readiness, leverage advanced technology, and create sustainability plans, with phased rollouts and annual funding through FY2030.
Model
Multi-initiative, Texas HHSC-administered model, allocating RHTP funding through coordinated initiatives—chronic disease prevention, wellness and nutrition, patient engagement technology, advanced telehealth/AI, rural workforce strengthening and training, infrastructure and cybersecurity modernization, capital improvements to rural health facilities, and behavioral health/trauma-informed care—all under robust fiscal and data protections.
Key Initiatives
Timeline: Application submitted to CMS (November 3, 2025); CMS Notice of Award (December 29, 2025); Budget Period 1 approved (April 7, 2026); Initiative launches begin September 2026 (grant deadlines May–December 2026); funding and initiatives continue annually through FY2030.
Texas rural communities face shortages in medical staff, particularly primary care providers, prompting targeted recruitment and training efforts.
Rural hospitals require capital investment to modernize facilities and resources, addressing healthcare access gaps in underserved areas.
Texas HHSC will host a public forum on August 19 in Big Spring to discuss the Rural Texas Strong plan, a statewide strategy for rural health transformation. The plan is funded by CMS with an initial award of over $281 million. Key initiatives include wellness and nutrition, health technology, telehealth, workforce strengthening, cybersecurity, and equipme...
TX - 2026 - The Rural Texas Strong Program – Initiative 1 (Part 2): Make Rural Texas Healthy Again
Auto-linked process guidance fallback (1%)
TX - 2025 - Notice of Award Dec. 29, 2025
Migrated from duplicate federal row
TX - 2025 - One Big Beautiful Bill Act (OBBBA) RHTP – Rural Texas Strong
Auto-grouped context match (38%)
TX - 2026 - Budget Period 1 Notice of Award
Auto-grouped context match (37%)
TX - 2026 - Rural Texas Strong Program (RHTP)
Texas award recipients
Texas Health and Human Services Commission (HHSC) — Office of Rural Hospital Finance
Due Aug 26, 2026
5 related documents
TX - 2026 - Request for Application: HHS0017618
Primary source
TX - 2026 - Exhibit G, Federal Funding Accountability and Transparency Act (FFATA) Certification (RFA No. HHS0017618)
Exhibit G, Federal Funding Accountability and Transparency Act (FFATA) Certification
TX - 2026 - Exhibit I, Grants Management System (GMS) External Portal Information (RFA No. HHS0017618)
Exhibit I, Grants Management System (GMS) External Portal Information
TX - 2026 - Exhibit J, Texas Uniform General Conditions for Construction Contracts and 2025 Supplemental General Conditions (RFA No. HHS0017618)
Exhibit J, Texas Uniform General Conditions for Construction Contracts and 2025 Supplemental General Conditions
TX - 2026 - Exhibit L, Solicitation Form - Questions and Requests for Clarification (RFA No. HHS0017618)
Exhibit L, Solicitation Form - Questions and Requests for Clarification
Texas Health and Human Services Commission
Due Aug 3, 2026
47 related documents
Texas Nutrition Incentive Program Project RHTP Application
Texas Health and Human Services Commission (HHSC)
Due Jul 13, 2026
16 related documents
TX - 2026 - HHS0017228 Exhibits and Forms
Supporting source — Attachment extracted from Exhibits and Forms ZIP
| FY↓ | Awardee↕ | Amount↕ | Activity↕ | Source |
|---|---|---|---|---|
| 2026 | 80 Rural Hospital Districts with a publicly owned and operated hospital Estimated 80 direct awards averaging $3,125,000 each to rural hospital districts for Initiative 1: implementation for rural health improvement. | $250.0M | Flex Fund | |
| 2026 | Department of State Health Services (DSHS) AMBUS IAC Interagency agreement for mobile medical units (AMBUS) to strengthen rural emergency medical services. | $20.0M | EMS Development | |
| 2026 | DSHS AMBUS IAC Acquisition of 10 Advanced Medical Buses (AMBUS) for rural EMS emergency and disaster response; AMBUS units to be hosted and maintained by local EMS/Fire Departments. | $20.0M | EMS Development | |
| 2026 | Unspecified Rural Healthcare Providers (Initiative 6 Subawards) Subawards for rural healthcare providers for infrastructure and capital investments under Initiative 6. Award amounts will vary depending on the application process. | $4.4M | Flex Fund | |
| 2026 | External Monitoring Contract (TBD Vendor) External contractor will conduct audit readiness assessment to proactively identify and address compliance issues for subrecipients. | $1.9M | Quality Improvement | |
| 2026 | Deloitte LLP (Grants Management System Support) Provides technical and operational support for GMS tracking RHTP awards/activities. | $1.8M | Health IT | |
| 2026 | Electra Memorial Hospital Grant award to support rural hospital operations and transformation initiatives in Texas. | $250K | Other | |
| 2026 | Electra Memorial Hospital Texas Rural Hospital Improvement Grant (HHS0015677) awardee list | $350K | Rural hospital improvement award | |
| 2026 | Baylor Scott & White Medical Center – Brenham Texas Rural Hospital Improvement Grant (HHS0015677) awardee list | $350K | Rural hospital improvement award | |
| 2026 | Comanche County Consolidated Hospital District dba Comanche County EMS Texas Rural Hospital Improvement Grant (HHS0015677) awardee list | $350K | Rural hospital improvement award |
Texas HHSC will host a public forum on August 19 in Big Spring to discuss the Rural Texas Strong plan, a statewide strategy for rural health transformation. The plan is funded by CMS with an initial award of over $281 million. Key initiatives include wellness and nutrition, health technology, telehealth, workforce strengthening, cybersecurity, and equipment upgrades. Key contacts: Rural Texas Strong ruraltexasstrong@hhs.texas.gov Event schedule: - Public Forum - 08/19/2024 - 3:00 PM - 7:00 PM CT - Big Spring City Hall council chambers, 307 E. Fourth St. - Formal Presentation - 08/19/2024 - 3:30 PM CT - Big Spring City Hall council chambers - Formal Presentation - 08/19/2024 - 6:30 PM CT - Big Spring City Hall council chambers
Event Schedule
Contacts
Core Initiatives
This resource provides standard forms and instructions for entities applying to the Texas RHTP. It supports applicants in supplying required organizational information, eligibility details, and contact information as part of a broader state application package.
This is a required form for applicants to list service sites and hours under the Thriving Texas Families program RFA. It collects information on site location, hours of operation, and service coverage for contract incorporation.
This Indirect Cost Rate Questionnaire (ICRQ) is required for applicants seeking Texas RHTP funding. It allows organizations to disclose or request their relevant indirect cost rate or to opt for a de minimis rate. Completion and submission of this form is necessary for the indirect cost rate process and compliance with RHTP solicitations. Event schedule: - Revision Date - 01/17/2025
Event Schedule
Core Initiatives
This TX RHTP supporting guidance file provides applicants instructions on preparing their proposals, including fiscal year requests, targeted counties by population size, and narrative prompts for project innovativeness, scaling, evidence-based practices, and service types. It is used for submitting new, innovative, or expanded rural health projects under the Texas Medicaid RHTP transformation plan. The document is part of the state's official bundle for application preparation.
This document provides the required narrative template for applicants to the Texas RHTP, focusing on identifying local gaps, developing evidence-based project strategies, and forming collaborative partnerships to address behavioral health and unmet needs in rural communities. Applicants must describe their community demographics, partnership structures, experience, and monitoring plans. The template guides applicants to develop strong, data-driven proposals integrating both health and social support initiatives.
This document provides a required template for respondents to indicate and explain any exceptions to the terms and conditions outlined in the main TX RHTP solicitation. Completion of this form is not required if no exceptions are being taken.
This supporting document guides applicants in accessing and using the HHS Online Bid Room to submit responses for the Texas Rural Health Transformation Program RFA. Instructions cover creating a new user account, organizational registration steps, and important submission deadlines. Applicants are reminded to allow several days for registration and must adhere to solicitation package requirements to avoid disqualification.
The Rural Texas Strong Program includes initiatives like The Next Generation of the Small Town Doctor and Team to address rural healthcare workforce needs. Current active funding opportunities with explicit deadlines support rural hospital stability and transformation. Event schedule: - Release of Procurement - 7/15/2026 - Submission Deadline - 8/26/2026
Event Schedule
TX - 2024 - HHSC Hosting Rural Texas Strong Public Forum Aug. 19 in Big Spring
Aug 4, 2026 15:11
·EmailTX - 2024 - Timeline for Rural Texas Strong Grant Recipient Negotiations
Jul 28, 2026 20:27
·EmailTX RHTP site updated — 1 new doc(s)
TX - 2024 - Rural Texas Strong Initiative 4, Round 2 Posting
Jul 15, 2026 21:24
·EmailTX RHTP site updated — 5 new doc(s)
Spreadsheets, data exports, and reference documents — available for download but excluded from the main activity feed. Showing the 40 most recent of 776.
how-apply-enrollment
HTML
TX - 2026 - HHS0016961 Form O HOPWA Requested Budget Template
XLSX
TX - 2026 - HHS0016961 Form I Requested Budget
XLSX
Texas Nutrition Incentive Program Project RHTP Meeting Minutes
Texas Health And Human Services Data Use Agreement RHTP Guidance
Texas Nutrition Incentive Program Project RHTP Guidance
Texas Nutrition Incentive Program Project RHTP Annual Report
TX - 2026 - HHS0014534 Exhibit L Certification Regarding Lobbying
Texas Attachment 2- Security And Privacy Initial Inquiry [Attach Completed SPI Here] RHTP Guidance
Texas Attachment 2- Security And Privacy Initial Inquiry [Attach Completed SPI Here] RHTP Guidance
TX - 2026 - HHS0014534 Exhibit M Evaluation Tool
HHS0014534 Exhibit J - HHS Additional Provisions Grant Funding Version 1.0.pdf
Texas FORM B-1 Authorized Officials - Governmental Entity RHTP Document
Texas Cecile Young, Executive Commissioner Request For Applications (RFA) RHTP Document
Texas Form E: Project Work Plan Legal Business Name Of Applicant: RHTP Application
Texas Form A Face Page – Applicant Information RHTP Application
Texas Form B Administrative Information RHTP Application
Texas Form C: Financial Management And Administrative Questionnaire RHTP Document
TX - 2026 - HHS0014534 Form F Tx HHS System Indirect Costs Rate (ICR) Questionnaire
TX - 2026 - HHS0014534 Exhibit O HHS FFATA Certification Form
Texas Nutrition Incentive Program Project RHTP Guidance
Texas FORM B-2 RHTP Document
Texas FORM D: NARRATIVE PROPOSAL Legal Business Name RHTP Application
TX - 2026 - HHS0014534 Exhibit K Assurances Non Construction Programs
TX - 2026 - HHS0015874 Deaf and Hard of Hearing Access Services RFA
Primary RFA document (HHS0015874)
TX - 2026 - HHS0015874 Attachments
HHS0015874 package: Attachment A -Contract Standards for Deaf and Hard of Hearing Access Services Grants .pdf
TX - 2026 - HHS0015874 Attachments
HHS0015874 package: Attachment A-1 - Sample DHHS Direct Communication Services Confidentiality and Professional Condu.pdf
TX - 2026 - HHS0015874 Attachments
HHS0015874 package: Attachment A-2-Sample DHHS Resource Specialist Services Advocacy Referral Form.pdf
TX - 2026 - HHS0015874 Attachments
HHS0015874 package: Exhibit A - HHS Solicitation Affirmations v.2.10.pdf
TX - 2026 - HHS0015874 Attachments
HHS0015874 package: Exhibit B - HHS Uniform Terms and Conditions - Grant, version 3.5.pdf
TX - 2026 - HHS0015874 Attachments
HHS0015874 package: Exhibit C - HHS Data Use Agreement.pdf
TX - 2026 - HHS0015874 Attachments
HHS0015874 package: Exhibit C-1 - Governmental Entity Version HHS Data Use Agreement v8.5.pdf
TX - 2026 - HHS0015874 Attachments
HHS0015874 package: Exhibit D- Additional Provisions and Grant Funding version 1.0.pdf
TX - 2026 - HHS0015874 Attachments
HHS0015874 package: Exhibit E - Evaluation Tool.pdf
TX - 2026 - HHS0015874 Attachments
HHS0015874 package: Exhibit F Online Bid Room Information.pdf
TX - 2026 - HHS0015874 Attachments
HHS0015874 package: Exhibit G - Exceptions.docx
TX - 2026 - HHS0015874 Attachments
HHS0015874 package: Form A - Face Page .docx
TX - 2026 - HHS0015874 Attachments
HHS0015874 package: Form B - Administrative Information.docx
TX - 2026 - HHS0015874 Attachments
HHS0015874 package: Form B-1 Governmental Entity - Authorized Officials .docx
TX - 2026 - HHS0015874 Attachments
HHS0015874 package: Form B-2 Non-Profit or For-Profit Entity - Authorized Officials .docx
TX - 2026 - HHS0015874 Attachments
HHS0015874 package: Form C - Executive Summary .docx
TX - 2026 - HHS0015874 Attachments
HHS0015874 package: Form D - Narrative Proposal Form - Resource Specialist Services.docx
TX - 2026 - HHS0015874 Attachments
HHS0015874 package: Form D-1 - Narrative Proposal Form - Senior Citizen Services.docx
TX - 2026 - HHS0015874 Attachments
HHS0015874 package: Form D-2 - Narrative Proposal Form - Direct Communication Services .docx
TX - 2026 - HHS0015874 Attachments
HHS0015874 package: Form E - Requested Budget Template.xlsx
TX - 2026 - HHS0015874 Attachments
HHS0015874 package: Form F Internal Controls Questionnaire.pdf
TX - 2026 - HHS0014534 - Exhibits and Forms (ZIP)
HHS0015874 package: Exhibit C-2 Tx HHS System -Data Use Agreement ‐Attachment 2 SECURITY AND PRIVACY INQUIRY (SPI).pdf
TX - 2026 - HHS0014534 Exhibit C Expenditure Proposal (Project Budget)
Texas Nutrition Incentive Program Project (HHS0014534) RHTP 2023 Reference
TX - 2026 - HHS0017228 Exhibits and Forms
Supporting source — Attachment extracted from Exhibits and Forms ZIP
TX - 2026 - HHS0017228 Exhibits and Forms
Supporting source — Attachment extracted from Exhibits and Forms ZIP
TX - 2026 - HHS0017228 Exhibits and Forms
Supporting source — Attachment extracted from Exhibits and Forms ZIP
TX - 2026 - Exhibit H Grants Management System (GMS) External Portal Information
Supporting source — Exhibit H (GMS External Portal Information)
TX - 2026 - Request for Application: HHS0017228
Primary source
TX - 2026 - Request for Applications (RFA) - Pediatric Tele-Connectivity Resource Program for Rural Texas Grant Program
Supporting source — HHS0017228 RFA
TX - 2026 - HHS0017228 Exhibits and Forms
Supporting source — Exhibits and Forms (ZIP container)
TX - 2026 - HHS0017228 Exhibits and Forms
Supporting source — Attachment extracted from Exhibits and Forms ZIP
TX - 2026 - Exhibit G, Insurance Requirements
TX - 2026 - Exhibit F, Pedi-Tele Evaluation Tool
TX - 2026 - Exhibit B-1, HHS Additional Provisions Grant Funding
TX - 2026 - Exhibit C, Texas Uniform General Conditions for Construction Contracts and 2025 Supplemental General Conditions
TX - 2026 - Exhibit E, Budget Template
TX - 2024 - Exhibit B, HHS Uniform Terms and Conditions – Grant
TX - 2026 - HHS0017228 Exhibits and Forms
Supporting source — Attachment extracted from Exhibits and Forms ZIP
Form D collects entity identification, nonprofit status, conflict of interest disclosures, prior contract and litigation history, and applicant relationships with the Texas Health and Human Services Commission. It ensures applicants meet eligibility, transparency, and compliance requirements for participation in the RHTP procurement. Event schedule: - Does this proposal include financial participation by a person or entity that has been convicted of violating federal law, or been assessed a penalty in a federal civil administrative enforcement action, in connection...
Event Schedule
Core Initiatives
This document provides detailed quarterly performance and outcome measures for behavioral health grant programs under Texas’s RHTP initiative, specifying output and outcome indicators for participants served, program completion, symptom improvement, bed utilization, training, housing, employment, and justice involvement. The guidance includes standardized tools and definitions, promoting data-driven quality improvement and accountability for rural behavioral health transformation. No sub-award or fiscal data is present; this is a technical appendix for applicant and grantee use. Event schedule: - Quarter 1 Data Due - 12/30/2025 - CT - Quarter 2 Data Due - 03/30/2026 - CT - Quarter 3 Data Due - 06/30/2026 - CT - Quarter 4 Data Due - 09/30/2026 - CT - FY26 Version 3 release - 2025-07-01
Event Schedule
Core Initiatives
HHS0016961 Appendix G DSHS TBHIVSTD Local Responsible Party (LRP) Handbook V.2-2019.pdf
HHS0016961 Appendix F Clinical Quality Management Policy Clarification Notice.pdf
HHS0016961 Exhibit C HHS_Additional_Provisions_Grant_Funding - final 6.1.26.pdf
TX - 2026 - HHS0015357 - Grant Awarded
XLSX
TX - 2026 - HHS0015344 EXHIBIT K Certfication Lobbying
HHS0016961 Appendix E HRSA Trafficking in Persons Award Terms and Conditions.pdf
SB00030F.pdf
TX - 2026 - HHS0014956_Attachment 2 to Addendum 5_HRSA (excel)
XLSX
TX - 2026 - Form G, Tx Health and Human Services System Indirect Costs Rate (ICR) Questionnaire
TX - 2026 - Attachment to ADDENDUM 6 - Exhibit H FY2026 BCCS Budget Workbook (revised)
XLSX
Exhibit D-1, Governmental Entity Version HHS Data Use Agreement v.8.5.pdf
TX - 2026 - HHS0014610 - Grant Awarded
XLSX
TX - 2026 - HHS0014534 Exhibit K Assurances Non Construction Programs
Attachment A Statement of Work.pdf
Attachment A-3, Example SBHCC Report.pdf
Exhibit K, HHS Additional Provisions Grant Funding Version 1.0.pdf
2015-2020_Dietary_Guidelines.pdf
TX - 2026 - Exhibit H, Assurances Non Construction Programs
TX - 2026 - HHS0014956_Attachment 1 to Addendum 5_Facilities Licensed Psychiatric Beds (excel)
XLSX
Exhibit C, HHS Additional Provisions Grant Funding V1.0.pdf
TX - 2026 - Attachment B 1 Additional Documentation
DOCX
Exhibit D, HHS Data Use Agreement v.8.5.pdf
TX - 2026 - HHS0014534 Form F Tx HHS System Indirect Costs Rate (ICR) Questionnaire
TX - 2026 - Exhibit E, Budget Template
XLSX
TX - 2022 - HHS0015344 Exhibit I HHS Ffata Certification Form August 2022
TX - 2026 - Form G, Performance Measures
XLSX
TX - 2026 - HHS0014609 - HHS Award Notice
XLSX
Exhibit G Evaluation Tool V1.6mr CQC7.18 - 09.02.pdf
TX - 2026 - Attachment A 4 Example MatchReimCertForm
XLSX
TX - 2026 - Exhibit D 2, Data Use Agreement Attachment 2, Security and Privacy Inquiry (SPI)
TX - 2026 - Exhibit H FY24 Estimated Budget Workbook
XLSX
TX - 2026 - Exhibit C, Requested Budget Template
XLSX
TX - 2026 - HHS0014956_Attachment to Addendum 8 Revised Facilities Licensed Psychiatric Beds and HRSA (excel)
XLSX
TX - 2026 - Attachment A 2, Project Expenditure Report
XLSX
TX - 2026 - Form L, Psychiatric Emergency Flowchart
DOCX
TX - 2026 - Exhibit Q, ADRC Staff and Allocation Workbook
XLSX
TX - 2026 - HHS0014211 - Grant Awarded
XLSX