Program Overview
Washington is actively implementing the Rural Health Transformation Program, launching six major initiatives to advance rural hospital innovation, workforce development, care access, and community health. Current efforts emphasize system transformation with priorities shaped by stakeholder and tribal engagement, and explicit focus on behavioral health and technology. The first performance period begins December 2025, under a long-term strategy rather than short-term grantmaking. Current structured plan tracks 3 key initiatives.
Updated
County-level estimates averaged across Washington — % of adults 18+ unless noted. Delta vs US county average shown in red/green.
pp = percentage points vs US county average
County Drilldown (39)
| County | Pop | Poverty | Uninsured |
|---|---|---|---|
| King County | 2,287,171 | 8.6% | 5.2% |
| Pierce County | 930,319 | 8.8% | 5.9% |
| Snohomish County | 844,430 | 8.0% | 5.5% |
| Spokane County | 549,056 | 11.7% | 7.3% |
| Clark County | 516,959 | 8.0% | 5.5% |
| Thurston County | 299,067 | 9.5% | 6.4% |
| Kitsap County | 277,881 | 8.2% | 5.4% |
| Yakima County | 257,152 | 15.5% | 11.7% |
| Whatcom County | 230,503 | 12.9% | 7.2% |
| Benton County | 212,905 | 11.0% | 8.2% |
| Skagit County | 131,328 | 11.6% | 7.4% |
| Cowlitz County | 112,360 | 12.2% | 8.0% |
AI source: WA - 2018 - Washington Department Of Health And Human Services Section 438.6(c) DRAFT Preprint – 06/24/20 Centers For Medicare & Medicaid Services STATE: CALIFORNIA (3 Of 6 Preprints) ________
AI auto-updated May 22, 2026
API refreshed May 7, 2026
Centers for Medicare & Medicaid Services (CMS)
Due Nov 5, 2025
9 related documents
WA - 2026 - CMS RHTP 50-State Spotlight (FY2026) — Washington
780,653 rural residents
Washington received over $181 million in RHTP federal funds as of December 29, 2025. State agencies are initiating procurement processes, stakeholder engagement, and advisory committee formation for six major initiative areas. Multiple requests for proposals (RFPs) are scheduled in the next several months, marking the official launch of the program, but subgrantees have not yet been selected. Preparations signal the shift from planning into the early launch phase. State opportunities: no active opportunities, $181.0M listed funding.
Washington’s RHTP strategy centers on sustainable, system-wide transformation of rural health care through multi-year initiatives. It focuses on rural hospital innovation, technology adoption, workforce development, tribal health investment, prevention, and behavioral health system expansion, leveraging robust public and stakeholder input and a strong alignment with federal and state priorities.
Model
Multi-sector, integrated delivery system transformation driven by infrastructure modernization, value-based models, tribal set-asides, and technology-enabled care, coordinated across state agencies and stakeholders.
Key Initiatives
Timeline: Application submitted in fall 2025; funding is allocated annually from 2026–2030, with each year’s funds available for two years. Implementation begins late 2025, progresses through distinct initiative phases, and includes annual performance reporting.
Washington State Health Care Authority invites carceral facilities to participate in a voluntary Medicaid-supported Reentry Demonstration Initiative, aiming to provide pre-release health services to incarcerated individuals. Initial funding is available starting July 1, 2024, with the first cohort launching July 1, 2025. Event schedule: - Q&A webinar - 04/29/2024 - 11:00 AM PT - virtual - Virtual office hours - 05/13/2024 - 11:00 AM PT - virtual - Virtual office hours - 05/23/2024 - 11:00 AM PT - virtual - Deadline for Intent to Participate - 06/01/2024 - PT - submission to HCAReentryDemonstrationProject@hca.wa.gov - First cohort launch - 07/01/2025 - PT - participating Washington State carceral facilities
The Reentry Demonstration Initiative will invest up to $303 million in federal Medicaid transformation funding to help WA prisons, jails, and youth carceral facilities deliver pre-release healthcare services for Medicaid-eligible individuals. The program features staged milestones, direct technical and IT infrastructure support, and the requirement for an intent to participate and implementation plan per facility. Engagement will roll out across three cohorts from 2024 through 2027. No individual facility/recipient awards yet announced. Key contacts: HCAReentryDemonstrationProject@hca.wa.gov Event schedule: - Cohort 1: Intent to Participate Due - 06/01/2024 - Cohort 1: Capacity Building Application Due - 10/01/2024 - Cohort 1: Readiness Assessment Due - 03/01/2025 - Cohort 1: Go-live with Reentry Benefits - 07/01/2025 - Cohort 1: Interim Progress Report - 05/01/2026 - Cohort 1: Final Progress Report - 10/01/2026 - Cohort 2: Intent to Participate Due - 11/01/2024 - Cohort 2: Capacity Building Application Due - 04/01/2025
The 2026 federal budget will significantly impact Apple Health (Medicaid) in Washington, including major eligibility changes, reduced funding, and new rural health transformation funding to states. Washington is anticipated to be eligible for a share of $10 billion per year (2026–2030) for rural health transformation projects. Nearly 2 million people currently rely on Medicaid in the state, including substantial rural, maternal, and OUD populations. Key contacts: Evan Klein evan.klein@hca.wa.gov; Jon Noski jon.noski@dshs.wa.gov; Shirley Prasad shirley.prasad@wahbexchange.org Event schedule: - Federal budget (Continuing Resolution) signed - 07/04/2025 - Application deadline for rural health transformation funding - 12/31/2025
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Washington RHT Webinar Q&A 2025
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Washington State Health Care Authority invites carceral facilities to participate in a voluntary Medicaid-supported Reentry Demonstration Initiative, aiming to provide pre-release health services to incarcerated individuals. Initial funding is available starting July 1, 2024, with the first cohort launching July 1, 2025. Event schedule: - Q&A webinar - 04/29/2024 - 11:00 AM PT - virtual - Virtual office hours - 05/13/2024 - 11:00 AM PT - virtual - Virtual office hours - 05/23/2024 - 11:00 AM PT - virtual - Deadline for Intent to Participate - 06/01/2024 - PT - submission to HCAReentryDemonstrationProject@hca.wa.gov - First cohort launch - 07/01/2025 - PT - participating Washington State carceral facilities
Core Initiatives
Washington State plans to apply for the five-year Rural Health Transformation Program funding beginning fiscal year 2026. The document outlines tribal engagement and priority areas including workforce, technology, hospital support, and tribal set asides.
Event Schedule
Core Initiatives
Washington is planning its application for the federal Rural Health Transformation Program, potentially securing $100 million annually. The plan prioritizes technology-enabled care, workforce investment, chronic disease management, prevention, and infrastructure. Key partners include state agencies and tribal consultation, with public input and provider engagement underway.
Washington is preparing its application for a projected $100 million annual RHTP allocation. Stakeholder input has centered on rural hospitals, workforce, technology, prevention, and behavioral health. Application priorities include workforce and technology investments, supporting tribal health, and expanding access to essential services.
This document provides additional guidance for applications to the Washington state Rural Health Transformation Advisory Committee (RHT-AC). It details committee composition and the application process, particularly for Tribal and professional association representatives.
The Reentry Demonstration Initiative will invest up to $303 million in federal Medicaid transformation funding to help WA prisons, jails, and youth carceral facilities deliver pre-release healthcare services for Medicaid-eligible individuals. The program features staged milestones, direct technical and IT infrastructure support, and the requirement for an intent to participate and implementation plan per facility. Engagement will roll out across three cohorts from 2024 through 2027. No individual facility/recipient awards yet announced. Key contacts: HCAReentryDemonstrationProject@hca.wa.gov Event schedule: - Cohort 1: Intent to Participate Due - 06/01/2024 - Cohort 1: Capacity Building Application Due - 10/01/2024 - Cohort 1: Readiness Assessment Due - 03/01/2025 - Cohort 1: Go-live with Reentry Benefits - 07/01/2025 - Cohort 1: Interim Progress Report - 05/01/2026 - Cohort 1: Final Progress Report - 10/01/2026 - Cohort 2: Intent to Participate Due - 11/01/2024 - Cohort 2: Capacity Building Application Due - 04/01/2025
Contacts
Core Initiatives
This compendium summarizes FY26 Rural Health Transformation Program applications from multiple states, each addressing rural health access, workforce, infrastructure, and innovation. Major funding requests and initiatives cover obstetric and maternal health, digital expansion, telehealth, prevention, value-based care, and hospital stabilization. Specific program or award recipient details are not provided—this is a federal-level executive summary.
Core Initiatives
The Rural Health Transformation Program (RHTP), authorized by the One Big Beautiful Bill Act of 2025, allocates $10 billion annually to states for rural health system transformation from 2026–2030. Washington must submit a state plan to access funds, with major priorities in rural health access, workforce, quality, partnerships, and financial stability. Large potential losses in Medicaid/ACA coverage could impact hundreds of thousands of rural WA residents along with critical access and rural hospital viability.
Washington’s Rural Health Transformation Program application outlines a statewide effort to transform rural care infrastructure, focusing on access, workforce, partnerships, technology, and financial stability. Multiple strategic initiatives address needs of rural hospitals, tribal communities, maternal health, and behavioral health. The plan relies on robust partnerships, network development, and innovative payment models to sustain rural hospitals and address disparities.
This 2024 report identifies critical gaps in Washington State's mobile crisis response system for older adults, emphasizing fragmentation, workforce shortages, and accessibility challenges. It recommends improved funding, cross-sector collaboration, workforce development, enhanced facility capability, and prioritizing equity across underserved communities.
Core Initiatives
The 2026 federal budget will significantly impact Apple Health (Medicaid) in Washington, including major eligibility changes, reduced funding, and new rural health transformation funding to states. Washington is anticipated to be eligible for a share of $10 billion per year (2026–2030) for rural health transformation projects. Nearly 2 million people currently rely on Medicaid in the state, including substantial rural, maternal, and OUD populations. Key contacts: Evan Klein evan.klein@hca.wa.gov; Jon Noski jon.noski@dshs.wa.gov; Shirley Prasad shirley.prasad@wahbexchange.org Event schedule: - Federal budget (Continuing Resolution) signed - 07/04/2025 - Application deadline for rural health transformation funding - 12/31/2025
Contacts
Core Initiatives
Washington received approximately $181 million in year one funding from CMS to support rural hospitals, clinics, and providers. The program is administered in partnership by the Health Care Authority, Department of Health, and Department of Social and Health Services, with ongoing public input shaping the state's strategy.
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Event Schedule
Core Initiatives
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Core Initiatives
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Core Initiatives
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Core Initiatives
Washington was awarded over $181 million for Budget Period 1 of the Rural Health Transformation Program, launching six major initiatives to strengthen rural hospital innovation, workforce, care access, and community health. Priorities were informed by extensive stakeholder engagement with explicit attention to Tribal health, behavioral health, and technological transformation. The RHTP aims for long-term, statewide system transformation, not just short-term grants. Key contacts: RHT Program Inbox Event schedule: - Application deadline: RHT Advisory Committee - 04/24/2026 - HCA RHT Webpage - Washington RHT Program Webinar #2 - September 16, 2026 - 1:00 PM PT - Teams meeting (online) - Budget Period 1 Performance Start - 12/29/2025
Contacts
Core Initiatives
On June 30, 2023, CMS approved Washington’s Medicaid Transformation Project 2.0 Section 1115 waiver, enabling the state to fund Medicaid services for eligible individuals 90 days before release from carceral settings. This guide provides phased implementation timelines, mandatory and optional service descriptions, and operational steps for facility participation. Key contacts: Unknown - HCA Reentry Initiative Inbox askmedicaid@hca.wa.gov; Provider Enrollment Support; HCAAHEligPolicy@hca.wa.gov Event schedule: - Cohort 1 Go-Live - 07/01/2025 - PT - Cohort 1 Additional Facilities - 11/01/2025 - PT - Cohort 2 Go-Live - 01/01/2026 - PT - Cohort 2 Additional Facilities - 03/01/2026 - PT - Cohort 3 Go-Live - 07/01/2026 - PT - Reentry Initiative policy update effective date - 2026-04-01 - Washington State - Reentry Initiative: Provider enrollment learning series webinar - 2025-01-08 - Online - Application submission - short stay or unknown release date - Within 2 business days of intake
Contacts
Core Initiatives
The Washington Reentry Initiative extends Apple Health (Medicaid) benefits for eligible youth and young adults in carceral settings, both pre- and post-adjudication in alignment with the 2023 Consolidated Appropriations Act. Implementation proceeds via facility cohorts, expanding mandatory reentry and case management services to prepare for individuals' release. The program seeks to ensure continuity of coverage and care, including case management and medication access, for justice-involved populations statewide. Key contacts: hcavolunteerassister@hca.wa.gov; HCAAHEligibilityPolicy@hca.wa.gov Event schedule: - CAA Section 5122 (Pre-adjudication) Implementation Required - 07/01/2025 - PT - All CAA-only facilities - CAA Section 5121 (Post-adjudication) Implementation Required - 07/01/2025 - PT - All CAA-only facilities
Contacts
Core Initiatives
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