The massachusetts rural health transformation program will catalyze transformative investmentsthat strengthen rural MA communities, enabling them to thrive and sustain improved health andwell-being. -…

The Centers for Medicare and Medicaid Services awarded a Cooperative Agreement totaling $486,015,714.39 to the Commonwealth of Massachusetts Executive Office of Health and Human Services on December 29, 2025, under the Rural Health Transformation Program (CFDA 93.798).

The award funds transformation of healthcare delivery systems across Massachusetts's 160 rural jurisdictions, which represent 57 percent of the state's land mass and are home to 700,000 rural residents—approximately 10 percent of the state's population. The program addresses persistent gaps in access to essential health and social services, including workforce shortages, infrastructure deficiencies, and limited primary and specialty care access points. Rural Massachusetts experiences higher uninsurance rates, greater reliance on public insurance, elevated chronic disease and behavioral health burdens, and worse health outcomes than non-rural areas—for example, hypertension prevalence of 32.4 percent in rural versus 28.8 percent in non-rural communities, and mental health emergency department visits of 1,016 per 100,000 in rural versus 756 per 100,000 in non-rural areas. Rural hospital capacity has declined from 11 hospitals in 2014 to 6 in 2025, with corresponding reductions in clinics, behavioral health services, pharmacies, and long-term care options. The Commonwealth will deploy these funds toward targeted investments in rural workforce development, infrastructure, and access to primary and specialty care, including maternal and pediatric services.

Performance extends through October 30, 2030, with place of performance in Massachusetts.

The massachusetts rural health transformation program will catalyze transformative investmentsthat strengthen rural MA communities, enabling them to thrive and sustain improved health andwell-being. - of MA's 351 jurisdictions, 160 are designated rural. Representing 57% of the state's land mass, sparsely populated rural towns have a density of 198 people per square mile, compared to non-rural communities (2,256 people per square mile). The target population of this project includes MA's 700,000 rural residents representing 10% of the state's population who experience persistent gaps in access to essential health and social services. MA's rural communities face significant barriers to healthcare including higher uninsurance rates, greater reliance on public insurance, rising chronic disease, behavioral health, and substance use disorder burdens. Care is often distant, with fewer primary and specialty care access points, fragile EMS, and healthcare systems strained by aging infrastructure. Shrinking access points reflect broader system decline such as rural hospital reductions (11 in 2014 to 6 in 2025), with limited clinics, behavioral health, pharmacies, and long-term care options. Technology and transportation gaps further restrict access. Key health challenges include maternal and pediatric service shortages, long specialty care wait times, workforce shortages (PCP ratio 79/100,000 VS. 102 non-rural), and financial fragility of rural providers. These factors lead to worse outcomes: chronic disease prevalence and ED visit rates are consistently higher in rural communities (e.g., hypertension 32.4% VS. 28.5% non-rural; mental health ED visits 1,016 VS. 756 per 100,000). Addressing these differences requires targeted investments in rural workforce, infrastructure, and access to primary and specialty care. Through the rural health transformation program, we will catalyze transformative investments that strengthen rural MA communities, enabling them to thrive and sustain improved health and well-being for generations. To actualize this vision to transform rural health, we have three overarching goals: (1) ensure rural residents can readily access healthcare services, (2) generate opportunities to improve the health and well-being of rural residents, and (3) scale systems, policies, and investments to meet unique needs of rural communities. The MA rhtp is structured around seven broad initiatives to transform rural healthcare in MA, and within each initiative, multiple activities to achieve the initiative goals. Initiative i. Population health advancement: improving clinical infrastructure, increasing coordination, and expanding payment methodologies to advance rural providers' value-based care and efforts to lower cost and increase quality of care. Initiative II. Innovation in rural care models: facilitating the introduction and redesign of models in rural MA to increase access, broaden service availability, and improve efficiency in the delivery of health care. Initiative III. Training healthcare for retention. Innovation, & excellence (thrive): strengthen the full continuum of the healthcare workforce in rural communities with targeted activities focused on workforce development, recruitment, and retention. Initiative IV. Healthy rural communities: supporting community-informed and led prevention activities to increase opportunities and empower communities to address gaps related to the root causes of health. Initiative v. EMS service integration: investments and programs to increase viability, integration, and expanded role of EMS in rural communities. Initiative VI. Enhancing technology interoperability and connectivity: improving technological infrastructure of rural health providers to increase connectivity, create efficiencies, and support better outcomes. Initiative VII. Facility modernization & RE-use: support minor renovations of rural facilities to optimize space and expand access. The total budget is $1,000,000,000 across five years. Together, MA is confident these initiatives can truly transform and improve the health of our rural communities.