A strong interest from states, combined with the flexibility of the Rural Health Transformation Program (RHTP), is highlighting a renewed commitment to primary care. Many governors and state lawmakers have agreed to allocate parts of their federal grant to strengthen primary care, and, in some instances, support efforts that existed before or are separate from RHTP.
The $50 billion RHTP allowed states broad latitude to design their plans, including goals that bolster primary care, such as expanding access, improving prevention and chronic disease management, workforce development and innovative care delivery.
Supporters have highlighted research showing that increased primary care investments lead to higher-quality care at lower costs. Higher investment in primary care is also associated with higher patient satisfaction, fewer hospitalizations and emergency department visits and lower mortality.
Some of the recent state examples include:
Iowa
Iowa Governor Kim Reynolds in her Condition of the State Address said they are beginning to award contracts for life-saving treatment through their Healthy Hometowns initiative. She said, “Our Healthy Hometowns plan also supports communities in creating local care teams who together can provide primary care and chronic disease management for their patients and ideally locate all providers within one building.”
For instance, a patient with diabetes and heart disease could see a primary care provider for a routine visit, then meet with a dietician to create a personalized meal plan, discuss medications with a pharmacy tech and consult with a care navigator about health goals. Governor Reynolds said, “It would be transformational. And it’s all within reach — right now.”
Maryland
Maryland Governor Wes Moore’s RHTP emphasized efforts to directly back advanced primary care practices and align rural funding with all-payer payment reforms that require primary care investment.
He also stressed that the federal dollars are building on existing efforts to enhance the health workforce pipeline by scaling up current training and retention programs for clinical providers and allied health professionals, as well as apprenticeship programs.
North Dakota
North Dakota Governor Kelly Armstrong and lawmakers supported spending $20 million for expanding rural primary care from its $398 million in RHTP money. Governor Armstrong said nearly 75% of North Dakota’s rural counties face primary care shortages.
“These challenges demand bold action. By expanding access, promoting long-term wellness and driving innovation, we have the chance to be the healthiest state in the nation.”
Pennsylvania
Pennsylvania Governor Josh Shapiro explained that in addition to RHTP, his 2025-26 budget makes “common-sense, strategic investments to further support Pennsylvania’s rural health care providers and access to health care in rural communities.
These include enhancing universal postpartum depression screenings and intervention efforts to ensure timely and equitable access to maternal and mental health care for mothers.”
Delaware
Delaware Governor Matt Meyer in his State of the State spoke about gaps in access and affordability. “Too many Delawareans lack primary care,” and “Primary care appointments are still too limited, and emergency room wait times are too long,” he has said.
Delaware plans to boost primary care by addressing preventative care, sustainable access, workforce development, innovative care and tech innovation with RHTP support.
New Mexico
Separate from RHTP, New Mexico’s Rural Health Care Delivery Fund in 2026 has prioritized primary care projects from Medicaid-enrolled providers that address documented community needs in underserved areas. The state is allocating the money to 32 rural health care organizations, with $20 million in total. “We created this fund because rural health care providers were struggling to keep their doors open, let alone expand,” said Governor Michelle Lujan Grisham. “These awards will help meet a pressing need for care in rural communities that have gone too long without adequate services.”
Shaping Federal Policy
Keen policy observers note that federal officials often recognize state-level successes and seek to advance such issues on a national level. For instance, in recent decades initial state achievements with health care access, education reform, welfare reform, crime reform, and other issues have served as examples and bolstered advocates as they pushed for change in Congress and with the Executive Branch.
The rural funding and the ways the states use it for primary care promise to provide valuable lessons not only for their states but the nation as a whole.