Arkansas has applied for $1 billion in funding from the federal Rural Health Transformation (RHT) Program.
Established under the One Big Beautiful Bill Act, the program is set to distribute a total of $50 billion to states, aiming to strengthen rural health care across the next five years. The Centers for Medicare and Medicaid Services within the U.S. Department of Health & Human Services will determine how much each state will be awarded by no later than Dec. 31 based on criteria outlined in the act.
The state submitted its 126-page proposal last Friday. The $1 billion would be distributed as five $200 million payments across the five federal fiscal years between 2026 and 2031, with the first disbursement of funding in early 2026. Arkansas could also potentially be awarded more or less than the proposed $1 billion budget.
Gov. Sarah Huckabee Sanders and the Arkansas Department of Finance and Administration (DFA) submitted the application, which focuses on four initiatives: Healthy Eating, Active Recreation and Transformation (HEART); Promoting Access Coordination and Transformation (PACT); Recruitment Innovation Skills and Education for Arkansas (RISE); and Telehealth Health Monitoring and Response Innovation for Vital Expansion (THRIVE).
All four initiatives will aim to leverage the latest developments in health care technology, including patient-centered artificial intelligence, and integrate evidence-based prevention programs, data collection and analytics.
The proposal allocates $150.5 million for the HEART nutrition and chronic disease management program; $393 million for PACT AI-enabled patient records and remote health monitoring; $161.5 million for RISE workforce development and training; and $266.75 million for integrating THRIVE specialty care and telehealth services into rural communities.
The budget also allocates $25 million for contracted administrative costs, $2.5 million in personnel costs and $700,000 in fringe benefits.
Andy Babbitt, currently the state comptroller and deputy director of the DFA, will direct the program in addition to his existing duties. The $2.5 million in personnel costs would support any extra positions needed to help run the program.
Outlined goals in the proposal are:
- Launch programs to “Make Arkansas Healthy Again,” where scalable, replicable models that improve health and wellbeing prove the benefit of continued state-level funding
- Strengthen the health care workforce without creating dependency on RHT Program funds
- Create new revenue streams and care delivery models while supporting provider transition to value-based payment models for long-term sustainability
- Provide one-time, strategic investments in infrastructure and technology to organizations and facilities to help transform the delivery of care in our rural market
According to a press release from the governor’s office, the application incorporated feedback from physicians, nurses, pharmacists, hospitals and other health care providers across the state, as well as higher education institutions and community-based nonprofits. The release said Sanders also established an online portal where more than 300 ideas for uses of the funding were submitted from across the state. Members of the Arkansas General Assembly also provided feedback.
The proposal included signed letters of endorsement from each of Arkansas’ elected U.S. officials: John Boozman, Tom Cotton, French Hill, Bruce Westerman, Steve Womack and Rick Crawford. Several health care leaders and state officials also provided endorsement letters.
Funding Caveats
In order to receive the funding, Arkansas has to meet several requirements laid out by the Centers for Medicare and Medicaid Services.
First, Arkansas must seek to have schools reestablish the Presidential Fitness Test by Dec. 31, 2028. The state must also implement nutrition requirements, along with nutrition education requirements in medical schools.
The state will also draft legislation to expand the scope of practice for pharmacists and other health care professionals, to be introduced in the 2027 legislative session, with a target enactment date of Dec. 31, 2027.
“This proposal has broad support across the State Legislature,” the federal application states.
Sanders also committed to signing an executive order requiring that vending machines include healthy options, “ensuring Arkansans have better choices available.”
“Improving the health and well-being of all Arkansans is a top priority for my administration,” Sanders said in the press release. “The Rural Health Transformation Program will allow us to build on all we have done so far, like investing in maternal health, combatting food insecurity, and promoting better health and nutrition statewide.”
Arkansas Rural Health
The application also gave multiple insights on the state’s rural health landscape.
“About 45% of Arkansans live in rural areas, making it one of the most rural states in the U.S.,” the proposal notes.
Thirty of 47 rural hospitals are at risk of closure, with 11 in immediate risk of insolvency. And 79% are operating at a loss on patient services.
Only 25 of 75 counties still have labor and delivery units, and rural maternal mortality rates are double urban counterparts.
“This funding will not only help us increase access to care but will also reduce inefficiencies throughout the health care system, ultimately benefitting Arkansans in smaller communities across the state,” Sanders said in the release.
Program and Funding Breakdown
The HEART program focuses on improving health outcomes and access to preventative care by creating a coordinated approach to nutrition, physical activity and chronic disease management.
The $150.5 million budget includes $67.5 million for a chronic disease prevention and management demonstration project, $26 million for local food access and nutrition programs, $25 million for facility enhancements to improve access to exercise and recreation spaces, and $23 million for school-based clinics and nutrition programs. HEART also features two separate $5 million and $4 million grants for outreach and education.
PACT aims to integrate specialty care, preventative screenings, telehealth, and trauma-ready services into rural communities while fostering data-sharing and regional collaboration.
Its $393 million budget — the largest of the four programs — includes $125 million for expanding specialty, preventive and telehealth services, $125 million for hospital acquisitions, partnerships and facility upgrades, $110 million to develop clinically integrated networks, and $25 million for expanding practice authority for health care professionals.
The RISE program aims to strengthen the rural health care workforce through expanded residencies and clinical training. It also plans to provides incentives to recruit and retain health care professionals in rural Arkansas.
Its $161.5 million budget includes includes $70.25 million for expanding residency programs and scholarships, $67 million for recruitment and retention incentives, $16.3 million for career advancement for nurses and other health professionals, and $8 million for a leadership academy.
The last of the four programs is THRIVE, which will fund telehealth platforms, monitoring for chronic diseases, and the modernization of emergency medical transport and services.
The $266.75 million budget includes $105 million for upgrades to medical and EMS equipment, $91.75 million to launch remote patient monitoring, $60 million for expanding telehealth, and $10 million for creating virtual specialty care networks.
“With a focus on education, prevention and access to care, this program will change the health of generations of Arkansans,” Arkansas DFA Secretary Jim Hudson said in the release.
Note: A previous version of this article incorrectly stated Andy Babbitt would receive a salary for directing the program. Babbitt will not receive any of the personnel funds.
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