The Rural Health Transformation Program (RHTP) is a federal initiative that provides funding to states to strengthen rural health systems, with each state responsible for designing and implementing its own approach.
Rural Development Hub leaders described RHTP as more than a health program — an example of a challenge regions frequently encounter when new funding streams arrive: a program’s label doesn’t always match what implementation requires.
These observations emerged from a facilitated discussion among leaders of Rural Development Hubs — regional organizations that coordinate partners, align strategy across sectors, and help regions respond to long-term opportunities and challenges. Convened by Aspen CSG, the discussion brought together Hub leaders from multiple states participating in or preparing for RHTP implementation. While each state’s approach differs, participants consistently described three functions that help regions respond to new funding opportunities.
A program is reshaped three times on its way from a state plan to regional practice
Recognizing what’s already there
Interpret: connecting a new program to work already underway
On paper, RHTP’s priorities — recruiting and retaining health professionals, expanding broadband, and improving rural transportation — can appear to introduce a new agenda. Hub leaders described something different.
Reviewing her state’s RHTP plan, one Hub leader was struck by how familiar its priorities felt. Although the plan framed them as rural health issues, she saw workforce, broadband, and transportation as challenges her Hub had been addressing through rural development for years. Aspen CSG’s Collaborative Strategies for Rural Health & Economic Prosperity describes this same dynamic more broadly: rural health and rural development often pursue overlapping goals without a shared language to recognize it.
Another participant described a multi-track re-entry program for people leaving addiction treatment or the justice system. Built with paid stipends and multiple pathways back into employment, it was never designed as a health initiative. Yet it addresses a workforce challenge that RHTP identifies as a priority in several states.
Question for practitioners
Before treating a new program as a distinct initiative, ask which existing regional partnerships, strategies, or investments already address the same underlying challenge. The answer might change your implementation strategy.
Routing through what exists
Coordinate: absorbing new funding without building parallel structures
New funding often comes with its own reporting requirements, timelines, and expectations, creating pressure to build new infrastructure to meet them. Hub leaders described the opposite approach: route new funding through existing governance structures and partnerships rather than creating parallel systems.
Aspen CSG heard the same theme during its 2025 convening of Hub leaders, summarized in Building Regional Strength: A Call to Action. The report describes Hubs as regional infrastructure built through sustained work rather than any single grant cycle, and concludes that rural development is strongest when investment flows through regionally led systems instead of fragmented, sector-specific efforts.
The RHTP discussion illustrated what this looks like in practice. One workforce re-entry initiative spent roughly four years building relationships among employers, probation partners, and training providers before any new funding arrived. Because that coalition already existed, new funding could immediately strengthen the work instead of paying to build new partnerships. The lesson for other regions is straightforward: regional coordination capacity has to exist before funding arrives.
Another participant pointed to economic development districts as the kind of standing institution that time-limited programs should strengthen rather than duplicate. Participants also observed that institutional capacity matters just as much as regional coordination capacity. Rural hospital and health center boards often need governance and back-office support before new funding can be implemented effectively. New investments are more likely to succeed when they build on capable institutions rather than assuming that implementation capacity already exists.
Question for practitioners
Before new funding arrives, ask which standing regional institutions and governance structures could absorb it — and whether those institutions currently have the back-office or governance capacity to do so.
Fitting the local context
Adapt: bringing local detail into a state-administered program
RHTP is coordinated in most states by an Office of Rural Health or Department of Health and Human Services (the exact agency varies by state). These agencies design programs at a scale that makes certain local realities difficult to see: which workforce partners consistently place people in jobs, where language access is a barrier, or which populations standard program designs are likely to miss.
In one region, this meant workforce programming designed specifically for Spanish-speaking residents and marginalized rural youth. In another, a Hub leader described seeing her organization’s language incorporated into her state’s RHTP plan before implementation had begun, illustrating how regional organizations can shape state planning before funding decisions are finalized.
Because Hubs work across sectors, they help translate state priorities into approaches that reflect local conditions. They connect health investments to workforce, housing, transportation, and other regional systems rather than keeping implementation confined to health care alone.
The conversation also highlighted that adaptation is not only about geography; it is also about governance. Participants noted that standard funding structures often do not align well with Tribal sovereign nations, requiring approaches that respect Tribal governance and align with Tribal priorities and measures of success. Local adaptation is not a single adjustment applied across an entire region — it requires tailoring implementation to the governance context in which each community operates.
Together, these examples illustrate how Hubs improve implementation quality by helping funding strategies and program design reflect the governance, relationships, and lived realities of the regions they serve.
One participant cautioned that implementation discussions can become dominated by hospital finance and payment policy, crowding out broader conversations about regional well-being. Whether that narrowing happens depends on whether cross-sector voices, including Hubs, remain engaged throughout implementation.
Question for practitioners
Where governance context differs across the region — including Tribal sovereign nations — ask what adaptation looks like there specifically, rather than applying one adjustment region-wide.
Looking beyond RHTP
Federal funding streams often get replaced or redesigned through the years as new priorities are identified. However, what remains is what was built to implement them: relationships, governance, and regional strategy. Rural Development Hubs are one model for building and sustaining that capacity over time.
For regional organizations, the more important question is not whether to participate in the next funding opportunity, but whether that foundation is already in place before it arrives.
Aspen CSG will continue convening Hub leaders around implementation challenges like this one.
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