Montana details $233M first‑year RHTP award, governance and $360M incentive pool for rural health

DPHHS briefed lawmakers on March 11 about the state’s Rural Health Transformation Program (RHTP), describing the federal award, governance structure and a fast‑moving set of procurements and hires to obligate funds within CMS timelines.

The grant and scope: "The RHTP is an opportunity for Montana to pull in up to $1,200,000,000 over the next 5 years," Rebecca Decameron, the agency’s Medicaid and Health Services executive director, told the committee. She said the first‑year award of $233,000,000 must be spent on five initiatives specified in Montana’s plan: workforce development and retention; rural facility sustainability and partnerships; new care delivery and payment models; community health and preventive infrastructure; and modernized health IT.

Governance and the Center of Excellence: DPHHS described a two‑tier governance model—an internal steering committee for strategy and an RHTP unit for day‑to‑day operations—plus a stakeholder advisory committee of 30+ consultative members. The proposed Montana Rural Health Center of Excellence (COE) will analyze county‑ and facility‑level data to produce voluntary, data‑driven recommendations and to recommend incentive payments for providers and communities that choose to participate. Decameron said the COE will inform an opt‑in incentive program and that participation is voluntary.

Incentive funding and milestones: The department flagged a substantial incentive pool saying, "a big flag for this budget overview is just how much of the funding is actually going into the incentive payments: $360,000,000," Decameron said. DPHHS must obligate first‑year funds by Oct. 31, 2026. Near‑term deliverables include a March vendor fair (700+ registrants) and multiple RFPs and procurements through March; the COE board and incentive payments are planned to begin later in 2026, with the COE finalizing recommendations in March 2027.

Rural EMS and service pilots: The RHTP initiative also funds EMS modernization: community paramedicine expansion, a treat‑and‑no‑transport Medicaid benefit that likely will require a state plan amendment in 2027, pre‑hospital blood administration pilots, and emergency dispatch modernization.

Concerns and questions: Committee members asked about how small or independent critical access hospitals and frontier providers will be represented on COE governance; Decameron and Director Charlie Brereton emphasized a governance composition weighted toward independent critical access hospitals and noted internal plans to ensure smaller facilities see funding. Lawmakers also asked about technical assistance for applicants and procurement timing; Decameron said grants managers will be hired and vendor fairs scheduled to provide support.

Ending: DPHHS urged rapid progress to meet CMS timeframes; lawmakers and stakeholders pressed for clear procurement schedules, equitable outreach to remote providers and a transparent COE process as the department moves to obligate funds and issue RFPs over the coming weeks.