NEJM Interviews NEJM Interview: Carmel Shachar on the opportunities and risks presented by the Rural Health Transformation Program.
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Feb 11, 2026 Carmel Shachar, assistant clinical professor of law at Harvard and health policy expert, discusses the Rural Health Transformation Program. She covers why rural funding gained traction after Medicaid cuts. She explains the program’s split funding, tight application timeline, which states won awards, and examples like AI, broadband, and care hubs. She also highlights policy incentives, implementation risks, and ongoing obligations for states.
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Program Built Fast To Stabilize Rural Care
- The Rural Health Transformation Program was created rapidly in 2025 to stabilize rural health amid broader federal Medicaid cuts.
- The fund also advances the administration's policy priorities while targeting bipartisan rural concerns.
Act Fast And Plan For Ongoing Evaluation
- States faced an aggressive application schedule and had to act quickly to secure grants.
- Expect ongoing CMS evaluation and tie future payments to meeting NOFO commitments each year.
All States Received Funds
- Every state received some funding, with awards varying by size but none excluded.
- Awards ranged from about $147 million (New Jersey) to $281 million (Texas).