California

California's Budget Period 1 award is $233,639,308.46, 100% funded by CMS/HHS — the largest Rural Health Transformation Program award in the country and its share of the federal $50 billion program, which runs five years with additional annual awards expected. CMS's February 27, 2026 Notice of Award approved a revised budget and lifted restriction on $183,639,308.47; a $50,000,000 line for Transformative Payments to Support Strategically Located Hospitals initially remained restricted in the "Other" cost category pending additional information.

The Department of Health Care Access and Information (HCAI) administers the program, branded California Rural Health Transformation (CalRHT), through its own dedicated hub and contact inbox (CalRHT@hcai.ca.gov), separate from the older California State Office of Rural Health page. HCAI's Director of California Rural Health Transformation staffs the program, advised by the Rural Health Policy Council (RHPC), whose members the HCAI Director appoints.

CalRHT is built around three thrusts: a Transformative Care Model (TCM) using regional care collaboratives and hub-and-spoke relationships to strengthen primary and maternity care; Technology and Tools, focused on EHR modernization, telehealth/eConsult, interoperability and revenue-cycle management; and Workforce Development, including doula/midwife training, community health worker expansion, and rural residencies. The plan explicitly excludes broadband expansion; telehealth work targets clinical tools and workflows, not connectivity.

Money moves through grant funding opportunities tied to the three initiatives. Named tags include doula/midwife training, community health worker (CHW) expansion, and rural residency, and $50,000,000 is set aside for Transformative Payments to Support Strategically Located Hospitals. HCAI has not published a single public percentage split; the full initiative-level breakdown is in the CalRHT Project and Budget Narratives (posted March 27, 2026).

The first grants are live. The Accelerator Partner Program RFA (Transformative Care Model testing sites) and the Family Medicine Obstetrics (FM-OB) Fellowship Subaward Program (workforce) both close August 14. The EHR Modernization Grant — funding first-time certified-EHR adoption or full replacement only, upgrades excluded — closes August 21 at 3:00 p.m. PT, with subaward notifications expected in September. A Workforce Development Recruitment and Retention (WDRR) opportunity is also on the runway. The dispatch list below carries the running record.

Key dates: the first Rural Health Policy Council meeting was July 28, 2026; informational webinars ran for the EHR Modernization Grant (July 27), WDRR (July 23 and August 4), and the Accelerator Partner Program (July 20). Application deadlines land August 14 (Accelerator and FM-OB) and August 21 (EHR Modernization). Confirm current windows on the CalRHT funding page; live dates surface in the dispatches below.

The Rural Health Transformation Program was created by Section 71401 of the One Big Beautiful Bill Act (2025) and is administered federally by CMS. California administers its award through HCAI under CMS-approved project and budget narratives; on January 30, 2026, as required by CMS, the state submitted a revised budget, and CMS's February 27, 2026 Notice of Award approved it and lifted most restrictions.

Eligibility runs on two tracks. Direct-to-state contracts go out as competitive RFAs, where firms bid as prime contractors — and California's is unusually open: out-of-state organizations can apply directly with no California partner required, as long as they can meet state contracting requirements and deliver services in rural California, and "rural serving" is keyed to who benefits (per the HRSA Rural Health Grants Eligibility Analyzer), not where the applicant sits. Subawards flow to rural providers — CAHs, FQHCs (including Tribal), Rural Health Clinics, health care districts and county behavioral-health sites — where vendors and consultants engage as subcontractors or implementation partners. Note two limits: county public health departments cannot be primary recipients (only State-selected partners or subrecipients), and broadband expansion is not permissible.

Track opportunities on the CalRHT funding page, join the HCAI mailing list, and email a resume and expression of interest to CalRHT@hcai.ca.gov to be considered for the Rural Health Policy Council.