Hawaiʻi’s Rural Health Transformation Plan
On Dec. 29, 2025, the Centers for Medicare & Medicaid Services (CMS) awarded Hawaiʻi $188,892,440 through the Rural Health Transformation Program. The Rural Health Transformation Program (RHTP) is a $50 billion, 5-year fund created by the One Big Beautiful Bill Act awarded to all 50 states through a competitive application process.
This award represents Hawaiʻi’s funding for Federal fiscal year 2026 and is the first year of a five-year program, with additional annual awards expected through 2030, subject to federal approval and performance.
Governor Josh Green worked directly with national leaders at the U.S. Department of Health and Human Services and CMS to help shape the Rural Health Transformation Program as a nationwide initiative, ensuring rural communities in all 50 states — including Hawaiʻi — were eligible for funding.
RHTP funds are designed to invest in new or yet to be funded areas to provide for lasting improvement in rural health. Notably, the funds cannot supplant or replace existing funds.
Why This Matters for Hawaiʻi
Healthcare in Hawaiʻi is heavily concentrated on Oʻahu, while 95.1% of the state’s land area is rural, creating major barriers for residents on neighbor islands and in rural Oʻahu. Long travel distances, limited specialty care, workforce shortages and aging infrastructure have left too many communities without timely access to primary care, behavioral healthcare and emergency services.
This investment allows Hawaiʻi to close that gap — bringing modern healthcare closer to where people live, work and raise their families.
Hawaiʻi’s Rural Health Transformation Plan
The $188.9 million award was based on factors about the State and details in the Hawai‘i Rural Health Transformation Plan submitted by the State. Despite being one of the lowest scoring states in terms of data-driven factors (e.g., total rural population, geographic size), Hawai‘i will receive among the highest amount in terms of dollars per capita, and among the very highest in terms of dollar per rural resident due to program proposal quality.
The size of this award was driven by the strength of the Hawai‘i Rural Health Transformation Plan, drafted by the Governor’s Office in coordination with the Department of Health, Department of Human Services, University of Hawai‘i, and local health leaders. The submitted five-year plan seeks to transform the rural health care delivery system in a sustainable manner that will improve healthcare access, quality, and outcomes for the rural population that comprise 40.8% of the state (all neighbor islands and rural parts of Oahu).
The plan is built around six interconnected initiatives that strengthen access, workforce, infrastructure, technology and sustainability.
The Six Initiatives
1. Rural Health Information Network (RHIN)
A statewide digital backbone connecting rural hospitals, clinics and health centers through interoperable electronic health records, secure wireless networks, referral systems and shared data platforms.
2. Pili Ola Telehealth Network
A statewide telehealth system expanding virtual care by deploying access points in schools, libraries, workplaces and community centers, supported by telehealth navigators and remote patient monitoring.
3. Rural Infrastructure for Care Access (RICA)
Expansion of emergency medical services, mobile healthcare, community paramedicine and behavioral health capacity, including a real-time statewide emergency and trauma coordination center.
4. HOME RUN – Rural Healthcare Workforce Pipeline
New rural training sites, residencies, nursing transition-to-practice programs, high-school healthcare certificates, scholarships and incentives to recruit and retain healthcare professionals.
5. Rural Respite Network
Five new medical respite centers in Kauaʻi, Maui, Kona, Hilo and Waiʻanae to reduce preventable hospital stays and support recovery for patients experiencing homelessness or post-acute medical needs.
6. Rural Value-Based Innovation and AHEAD Readiness Fund
A competitive fund helping rural providers adopt value-based care and population-health models, preparing Hawaiʻi for the CMS AHEAD payment system.
See the Plan
On September 15, CMS released the RHTP Notice of Funding Opportunity (NOFO), unveiling details about application requirements and funding metrics. In less than two months, the State of Hawaiʻi submitted its application on November 4, outlining its plan for the funds and adhering to all requirements established by CMS.
CMS required all states (from Rhode Island to Texas) to make an initial $1 billion request, with five annual budgets of $200 million. Actual funds would be determined by competitive scoring metrics outlined in the NOFO. Preliminary estimates suggested a competitive application from the State of would yield a roughly $150 million annual award given its lower data-driven factors. The State secured its first-year award of $188.9 million by scoring among the best by competitive program design factors.
See the application submitted to CMS here. Note: this plan is not the final cooperative agreement with CMS and will be subject to change.
The State must modify its budget and programs in line with a final cooperative agreement established between CMS and the State of Hawaiʻi. Once received, such funds cannot be used to replace or offset other federal or state spending, approved uses of funds are narrow in nature and must follow state procurement laws.
What Happens Next
Hawaiʻi has entered formal discussion with CMS regarding implementation of the award. The state will finalize an updated budget based on the $188.9 million FY 2026 award following negotiations with CMS, then begin releasing funds to lead agencies and partners.
An oversight team will coordinate across state departments, healthcare providers and community organizations to ensure the plan is delivered on time, on budget and with measurable improvements in access, quality, workforce stability and system sustainability.
Additional funding is expected in future years as the five-year program continues. For more information on the award, click here.