States can direct $50B in Centers for Medicare & Medicaid Services funding to rural EMS under new program

Rural Health Transformation Program/Centers for Medicare & Medicaid Services

WASHINGTON — The Centers for Medicare & Medicaid Services (CMS) has issued a new Notice of Funding Opportunity (NOFO) for the Rural Health Transformation (RHT) Program , a $50 billion initiative aimed at transforming rural healthcare delivery.

Applications are due Nov. 5, 2025 (optional letters of intent by Sept. 30). Only states may apply; however, they must consult local providers, including EMS, according to a statement from the American Ambulance Association . States can sub-award or contract RHT funds to EMS agencies and other partners, creating a significant potential federal funding source for rural ambulance services.

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Authorized by the One Big Beautiful Bill Act , the Rural Health Transformation (RHT) Program empowers states to strengthen rural communities by transforming care delivery to improve access, quality and outcomes. It supports system-wide innovations and long-term investments across the rural health ecosystem.

Total RHT funding is $50 billion over five fiscal years (FY2026–FY2030), with $10 billion available each year.

• 50% will be split equally among all approved states.
• 50% will be allocated by CMS based on factors such as each state’s rural population, share of rural health facilities, the status of certain hospitals and other criteria specified in the NOFO.

States must spend RHT funds on at least three approved purposes, including:

• Evidence-based prevention & chronic disease management with measurable outcomes.
• Provider payments for specified health care items and services.
• Consumer-facing, tech-driven tools for preventing/managing chronic disease.
• Training/TA for hospital tech adoption (remote monitoring, robotics, AI, other advanced tech).
• Recruiting and retaining clinicians in rural areas with 5-year service commitments.
• Health IT upgrades (software/hardware) to boost efficiency, cybersecurity, and outcomes.
• Right-sizing local systems across preventive, ambulatory, prehospital/EMS, emergency, inpatient, outpatient, and post-acute care.
• Expanding behavioral health access, including OUD treatment, SUD care, and mental health services.
• Innovative care models (value-based arrangements, alternative payment models).
• Other Administrator-approved uses that sustain access to high-quality rural care.

For EMS, this is one of the largest federal investments in rural health to date. The American Ambulance Association has urged eligibility for ground ambulance providers during FY2025 budget talks, with Sen. Susan Collins proposing a clarifying amendment, and is coordinating state-level outreach to governors, Medicaid officials and health departments to ensure EMS is included.

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