Missouri transformation of rural community health care (torch care)

The Centers for Medicare and Medicaid Services awarded the Missouri Department of Social Services a cooperative agreement totaling $865,107,270.64 on December 29, 2025, under the Rural Health Transformation Program (CFDA 93.798) to lead the Missouri Transformation of Rural Community Health Care (TORCH CARE) initiative.

The award funds a comprehensive statewide effort to transform rural healthcare delivery and sustainability through five coordinated initiatives: regional coordinating networks and hub activation to coordinate local care delivery and expand entry points for physical health, behavioral health, and social services; alternative payment models designed to support rural provider sustainability; and targeted investments in infrastructure, innovative technologies, and evidence-based practices. The project aims to expand access to primary and behavioral health providers, community-based maternity options, and specialist care enabled by telehealth and provider interoperability; improve health outcomes through integrated care coordination and aligned incentives; and reinforce long-term rural provider sustainability through payment models reflecting the realities of rural care delivery.

Performance spans Missouri statewide, with an ultimate completion date of October 30, 2030. The cooperative agreement is structured as a one-time application and award with no renewals or extensions under the Rural Health Transformation Program statute.

Abstract

Organization: missouri department of social services (DSS) project title: missouri transformation of rural community health care (TORCH care) total budget amount: $1 billion over five years of rhtp (as requested by CMS) purpose and overview: missouri department of social services (DSS) will lead a comprehensive, statewide effort through transformation of rural community health care (TORCH care) to transform how rural healthcare is delivered and sustained. Building on the proven success of missouri's transformation of rural community health (TORCH) program, TORCH care will create a connected system of local community hubs to ensure every rural missourian has access to the high-quality care they need through a delivery system that is well aligned, community anchored, and built to last. Goals: • expanding access to care: ensure rural missourians can access primary and behavioral health providers close to home, community-based maternity options, with connections to specialists and complex care enabled by telehealth and provider interoperability • improving health outcomes: strengthen healthcare quality through integrated care coordination, aligned incentives, and evidence-based practices - so that rural missourians consistently experience seamless, high-value care • strengthening provider sustainability: reinforce the long-term sustainability of rural providers through targeted investments in infrastructure, adoption of innovative technologies, and payment models that reflect the realities of rural care delivery use of funds: missouri will deploy rhtp funding across five coordinated initiatives: 1. Regional coordinating networks and hub activation: building the foundation of regional coordinating networks and local community hubs to coordinate local care delivery and expand entry points for physical health, behavioral health, and social services 2. Alternative payment models: designing and launching alternative payment models to sustain TORCH care through rewarding collaboration that leads to high quality and high value outcomes 3. Digital backbone: establishing the foundational layers of technology that enable TORCH care to function, including platform interoperability and data modernization 4. Rural health workforce programs: creating a talent pipeline that encompasses the cultivation, recruitment, training, and retention of rural clinicians and a broad array of healthcare professionals 5. Provider transformation: invest in operational innovations that modernize and increase the sustainability of rural providers while preserving access with strategic renovations