The Rural Health Transformation (RHT) Program was authorized by the One Big Beautiful Act in the summer of 2025. Following this, every state submitted an application to the Centers for Medicare & Medicaid Services (CMS) detailing its vision for using the funds. Wyoming’s plan, submitted on November 5th, 2025, focused on several key priorities:
- Chronic disease prevention and behavioral health.
- Sustaining access to care in rural communities.
- Innovative care delivery and payment models.
- Workforce development and training.
- Technological and consumer health solutions.
- IT advances and technical assistance.
CMS announced Wyoming’s award in late December 2025, which totaled $205 million for the first year—an amount that exceeded state expectations, with the full funding award totaling as much as $800m over the five years. Funding ends in October 2030.
The state legislature must now pass a separate authorizing vehicle, whether as part of the larger state budget or a standalone bill, to appropriate the federal funds before the state can use them. The Joint Appropriations Committee (JAC) opted to draft a standalone RHTP bill (linked HERE) to function as the authorizing mechanism and guide the specifics of the fund’s structure and operation. This bill was heavily amended in committee, notably deleting pages 25 through the top of page 44, which aimed to remove state licensure requirements for telehealth providers located outside the state of Wyoming, with the only remaining requirement being that they hold an active license to practice medicine, or their health profession, elsewhere in the United States.
The bill is structured in two main sections:
Section 1: Perpetuity Fund (Long-term Investment)
This section establishes a permanent endowment fund where a portion of the federal money will be invested. The goal is for the generated interest to sustain rural health transformation initiatives after the federal funding ends in 2030. It sets up an advisory committee and dictates the annual distribution of the interest funds as follows:
- 40.7% for the Critical Access Hospital Basic Incentive Program (CAHB).
- 26.9% for emergency medical services.
- 21.6% for workforce education and individual support (tuition, fees, stipends). This includes nursing, EMS, clinical behavioral health, and physicians (including undergraduate medical students). Recipients must commit to practicing in Wyoming for a minimum of five years.
- 10.8% for physician post-graduate medical education (GME) individual support, prioritizing family medicine physicians providing obstetrical care or other high-demand specialties identified by the Wyoming Department of Health (WDH).
Section 2: Time-Limited Funds (Immediate Use)
This part addresses the funds not allocated to the perpetuity fund, specifying how they must be spent and establishing a sunset date. These funds will be distributed through a competitive Request for Proposal (RFP) or Request for Application (RFA) process managed by the WDH. The allocations are:
- 36.4% for time-limited initiatives focusing on integrated primary care, specifically involving Federally Qualified Health Centers (FQHCs). This includes integrating primary medical care with behavioral health, obstetric/gynecological care, dental, and preventive health services.
- 15.1% to support the technology adoption program.
- 8.2% for initiatives related to a statewide tele-specialist platform, intended to establish and operate a centralized platform for physician-level specialty consultations statewide.
- 8.2% for workforce education startup costs, supporting training programs operated by in-state educational institutions.
- 8.2% for care coordination. These funds will be distributed through competitive grants to providers and facilities to propose clinically integrated care coordination models across one or more counties. The aim is to improve chronic disease management for high-risk individuals who are dually eligible for Medicare and Medicaid, potentially using capitated models that mirror managed care.
- 4.9% for centralized billing capacity, primarily for EMS, but expandable to other providers.
- 4.6% for any initiative that meets federal requirements but is not otherwise authorized.
- 3% for initiatives supporting exercise and diet programs.
- 2.6% for general administration of the funds and programming by the WDH.
- 2% for establishing and operating a non-emergency transportation coordination platform.
Practical takeaways for WMS Members
This funding presents immeasurable opportunity for the state of Wyoming. The Wyoming Medical Society’s current primary focus is educating lawmakers to accept the funds and not make efforts to change or add programming that could jeopardize the federal approval of Wyoming’s award. If this bill passes largely as written, the bill will channel part of the funding into ongoing support (CAHs, EMS, workforce, and physician training) and part into near-term infrastructure and care delivery projects (integrated primary care/FQHC expansion, technology, tele-specialty, care coordination, and transportation). WMS will monitor the process closely, keeping members apprised of any changes as well as opportunities to participate in joint applications for funding projects when appropriate.