Iowa's rural health transformation program

The Centers for Medicare and Medicaid Services awarded the Iowa Department of Health and Human Services a $1.045 billion cooperative agreement on December 29, 2025, to implement Iowa's Rural Health Transformation Program under CFDA 93.798, running through October 30, 2030.

The award funds three interconnected initiatives under the Healthy Hometowns program. Hometown Connections builds formal partnerships to restructure rural healthcare delivery, including expansion of the governor's Centers of Excellence program and development of hub-and-spoke networks with investments in telehealth, specialized medical equipment, provider recruitment and retention, efficient space utilization, and limited support for uninsured Iowan care. Health hubs may include school-based service provision. Best and Brightest recruits and retains rural healthcare workforce. Combat Cancer—Prevent and Treat increases access to cancer screening, forms cancer-specific health hubs, upgrades equipment for cancer screening and treatment, and delivers supportive care for cancer-impacted families. Within five years, Iowa anticipates reductions in avoidable emergency department visits, increases in rural residents receiving locally delivered care through new or expanded service lines, improvements in rural provider-to-population ratios, and increases in telehealth consultations to rural residents, with downstream reductions in chronic disease and cancer incidence.

Performance occurs across rural Iowa. The assistance type is a cooperative agreement.

Sub-recipients include over 80 rural hospitals, health centers, and provider networks across Iowa receiving funds for acquisition and installation of advanced medical technologies including robotic surgical systems, low-dose CT scans, radiotherapy units, CT/PET scanners, and cardiac catheterization equipment to expand service lines, enhance screening capabilities, and reduce rural bypass. Named sub-recipients include Floyd Valley Healthcare, Avera Holy Family, Veterans Memorial Hospital City of Waukon, Mitchell County Memorial Hospital, Mercy Medical Center—Clinton, and dozens of additional rural facilities. The University of Iowa serves as technical assistance sub-recipient, providing advisory expertise and capacity-building support on evidence-based hub-and-spoke models for health hubs and cancer-focused projects. The Iowa Primary Care Association provides technical assistance on Communities of Care projects. Marion County Sheriff's Office receives funds for colorectal and skin cancer screening test kit distribution, consumer-facing telehealth equipment, radon test kit distribution and mitigation reimbursement, and media outreach on cancer risk factors and prevention.

Supports rural hospitals and partners, build collaborations, recruit providers, prevent and treat chronic disease, combat cancer, rural technology upgrades. - this package outlines iowa's application for healthy hometowns, iowa's rural health transformation program. Healthy hometowns consists of initiatives that work together to support rural hospitals and their partners, build collaborations for long term systemic sustainability of rural healthcare, prevent and treat chronic disease, combat cancer, and invest in equipment and technology upgrades. Within five years, iowans can expect a reduction in avoidable emergency department visits, an increase in rural residents receiving care locally through new or expanded service lines, an increase in the provider to population ratios in rural iowa, and an increase in the number of telehealth consultations delivered to rural residents. Iowa anticipates this will lead to future reductions in chronic disease and cancer. Iowa's application includes the following: hometown connections: an initiative that builds formal partnerships to restructure healthcare delivery options for rural communities. This includes an expansion of iowa governor KIM reynold's centers of excellence program and a rare opportunity to develop enhanced health hubs, or hub-and-spoke networks of care, with investments in telehealth, specialized medical equipment, provider recruitment and retention, efficient space utilization, and limited funds to support care for uninsured iowans. Health hubs may include school-based service provision. Best and brightest: a sub-initiative to recruit and retain an excellent rural healthcare workforce. Combat cancer-prevent and treat: an initiative to comprehensively tackle cancer throughout the state via increasing access to cancer screening, forming cancer-specific health hubs, upgrading equipment for cancer screening and treatment, delivering supportive care for families impacted by cancer, and supporting studies and analyses by academic partners. Iowa will address lung cancer prevention through radon testing and mitigation, breast cancer by paying for mammograms and follow-up breast mris, colorectal cancer through fit tests and follow-up colonoscopies, skin cancer through telehealth and new equipment, and prostate cancer through routine screening methods. Communities of care: an initiative that supports CO-location of different rural provider types for convenient patient access and improved coordination, hires community health workers as system navigators, and invests heavily in chronic disease prevention and management techniques. Health information exchange: an initiative that allows records to be accessible across the state as patients travel throughout new health hubs and seek care in new ways. EMS community care mobile: an initiative that invests in new telehealth technology for high-risk transport of moms and their new babies to higher levels of care throughout the state and a mobile integrated healthcare program that brings prenatal, postpartum, post-surgery discharge, chronic disease management, and other types of care to rural residents in their homes or to easily accessible sites in their communities. Iowa requests $200 million per project year period (total $1 billion over the 5-year grant).