Rural Health Transformation Program - Building a Resilient Rural Workforce, Training Healthcare Support Workers

The Rural Health Transformation (RHT) Program was designed to empower states to strengthen rural communities by improving healthcare access, quality, and outcomes through transforming the healthcare delivery ecosystem. Illinois’ Rural Health Transformation Program will support rural communities across the State of Illinois in improving healthcare access, quality, and outcomes by transforming healthcare delivery. This program will strengthen rural healthcare by expanding and establishing new training and certification programs tailored to local needs. The focus will be on developing a larger workforce for roles such as CHWs, doulas, lactation consultants, and peer support professionals and offering training opportunities that can keep rural learners in their communities. All RHT applicants must complete the Euna application. Once the completed application is received and approved, the Illinois Department of Healthcare and Family Services will collaborate with each subaward to complete the grant award process. Note: Stevens Amendment Acknowledgment This funding opportunity is supported by the Centers for Medicare; Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $193,418,216.21 with 100 percent funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS, or the U.S. Government. Illinois is the sixth most populous state in the nation and is home to 12.7 million residents, based on 2024 data. Outside of the Chicago metro area, Illinois is largely rural. Eighty-five of 102 counties are classified as rural as defined by the Health Resources and Services Administration (HRSA). Unfortunately, individuals living in rural parts of the state tend to face structural barriers in access to critical healthcare services resulting in poor health outcomes. The intent of Illinois’ Rural Health Transformation (RHT) Program is to direct resources to reshape the way healthcare is delivered across rural Illinois. The RHT Program is focused on interventions targeting individuals who reside in rural census tracts (two-thirds of counties in IL) as defined by HRSA. HRSA defines rural using the following criteria: 1) Non-metropolitan counties, 2) Outlying metropolitan counties with no population from an urban area of 50,000 or more people, 3) Census tracts with Rural-Urban Commuting Area (RUCA) codes 4-10 in metropolitan counties, 4) Census tracts of at least 400 square miles in areas with population density of 35 or fewer people per square mile with RUCA codes 2-3 in metropolitan counties, 5) Census tracts with Research Report Series (RRS) 5 and RUCA codes 2-3 that are at least 20 square miles in area in metropolitan counties. Illinois responded to the federal RHT Program authorized and administered by the Centers for Medicare and Medicaid Services (CMS) in July 2025, under H.R.1. Illinois submitted their application in November 2025 and received approval in December 2025. The funding will empower states to strengthen rural communities through improved access to care, quality of care, and health outcomes by transforming the healthcare delivery ecosystem.

This grant program utilizes federal CMS Rural Health Transformation (RHT) Program funds.2 Total amount of funding expected to be awarded through this NDFI is up to $11 million in year 1 and up to $55 million in total across years 1-5, subject to continued funding and program approval. Funding in future years is subject to CMS’s continuation, review, and award of future Rural Health Transformation grant funding. The release of this NDFI does not obligate the Department to make an award.

In order to charge indirect costs to a grant, the applicant organization must have an annually negotiated indirect cost rate agreement (NICRA). There are three types of NICRAs: a) Federally Negotiated Rate. Organizations that receive direct federal funding, may have an indirect cost rate that was negotiated with the Federal Cognizant Agency. Illinois will accept the federally negotiated rate. The organization must provide a copy of the federally NICRA. b) State Negotiated Rate. The organization may negotiate an indirect cost rate with the State of Illinois if they do not have a Federally Negotiated Rate. If an organization has not previously established in indirect cost rate, an indirect cost rate proposal must be submitted through the GATA Grantee Portal no later than three months after receipt of a Notice of State Award (NOSA). If an organization previously established an indirect cost rate, the organization must annually submit a new indirect cost proposal through the GATA Grantee Portal within six months after the close of the grantee’s fiscal year. c) De Minimis Rate. An organization that has never negotiated an indirect cost rate with the Federal Government of the State of Illinois is eligible to elect a de minimis rate of 10% of modified total direct cost (MTDC). Once established, the De Minimis Rate may be used indefinitely. The State of Illinois must verify the calculation of the MTDC annually in order to accept the De Minimis Rate. All grantees must complete an indirect cost rate negotiation or elect the De Minimis Rate to claim indirect costs. Indirect costs claimed without a negotiated rate or a De Minimis Rate election on record in the GATA Grantee Portal indirect cost rate system may be subject to disallowance.

Applicants must first be registered and pre-qualified through the Grant Accountability and Transparency Act (GATA) Grantee Portal at www.grants.illinois.gov/portal. The application must be completed using Euna system. Any applicant that does not submit a complete and timely grant application may not be considered.

Applicants must upload all required documents in the designated sections of this opportunity. HFS will not accept documents sent by email, mail, or any method outside of the Euna system. Grant proposals submitted under this opportunity will be reviewed solely on a competitive/noncompetitive basis. Application materials must address all components of this opportunity and demonstrate both a need for the program and an ability to successfully implement the program. HFS will review and award applications based on completeness, budget requirements, clear and detailed responses to the program narrative questions, and inclusion of all mandatory program elements

Please use this link for any questions: https://officeofmedicaidinnovation.jotform.com/form/rural-health-transformation-program

Eligible applicant(s) include (must also be registered and in good standing with the State): Illinois Community College Board University of Illinois College of Medicine - National Center for Rural Health Professions

The beneficiaries of the Building a Resilient Rural Workforce initiative will be residents of rural communities where access to essential health services is limited by geographic isolation, workforce shortages and resource constraints. This initiative will help to ensure all residents of the State of Illinois will have access to high-quality, sustainable care.

Registration and pre-qualification through the Grant Accountability and Transparency Act (GATA) Grantee Portal is required, www.grants.illinois.gov/portal.

Applicants are required (unless the applicant is an individual or Federal or State awarding agency that is exempt from those requirements under 2 CFR § 25.110(b) or (c), or has an exception approved by the Federal or State awarding agency under 2 CFR § 25.110(d)) to: a) Be registered in SAM before submitting its application with a UEI assigned. To establish a SAM registration, go to www.SAM.gov. b) Always continue to maintain an active SAM registration with current information during an active award, application or plan under consideration by HFS. HFS may not issue a grant award until the applicant has complied with all applicable SAM requirements, if an applicant has not fully complied with the requirements by the time HFS is ready to make an award, HFS may determine that the applicant is not qualified to receive a grant award.

Upon successful application submission via Euna Grants, ICCB and UIC Rockford will receive a Notice of State Award (NOSA) to initiate the grant agreement phase. During this phase, the awardee will be contacted by the Department of Healthcare and Family Services to develop a Uniform Grant Agreement, which can be months long process depending on complexity, cooperation and conformity with all applicable federal and state laws. The Department reserves the right to issue a reduced award, or not to issue any award if it is in the Department’s best interest to do so. The NOSA is not an authorization to begin performance or incur costs.

In addition to implementing the funded project consistent with the approved project proposal and budget, the grantee must comply with applicable grant terms and conditions and other legal requirements, including the CMS Rural Health Transformation Program funds, and GATA. Additional programmatic and administrative special conditions may be required.

All recipients must submit periodic financial reports, periodic performance reports, final financial and performance reports, and, if applicable, an annual audit report in accordance with the 2 CFR 200 Uniform Guidelines. Future awards and fund drawdowns may be withheld if reports are delinquent.

Illinois Department of Healthcare and Family Services Dani Mendez Please use this link for questions: https://officeofmedicaidinnovation.jotform.com/form/rural-health-transformation-program

All applications will be screened for completeness including GATA pre-qualification and ICQ submission for the current state fiscal year.   HFS reserves the right to reject incomplete proposals, proposals that include unswallowable activities, proposals that do not meet eligibility or program requirements, and proposals that are otherwise unsatisfactory. The HFS may invite applicants to answer clarifying questions and modify budgets that include unallowable or unreasonable costs. The application budgets will be reviewed for allowability, completeness, and cost-effectiveness. During the budget review HFS may require budget modifications that do not materially change the nature of the program.  This application is subject to the Illinois Freedom of Information Act (FOIA). Any information that the applicant believes should be exempt under FOIA should clearly highlight the information that is exempt, and the basis of the exemption.