February 28, 2026—Top 5 Insights
Before we jump in, "You don't win by just being against things. You win by being for things and making them happen." – Margaret Thatcher.
1. Under the RHTP, can I build and renovate?
Hey providers—here’s your quick-hit guide to asking yourself, "Can I build and renovate under the Rural Health Transformation Program (RHTP)?"
With federal cash flowing, construction’s tricky even with reading CMS and State guidance. My observations: no new construction, no land buys, but minor alterations and renovations could have a limited green-light if they tie straight to the State's initiative goals and if your state allows them.
States are rolling out their own spin. Some are crystal-clear; others are vague. Here’s the rundown on the ones posting real details:
- Kansas: Renovations require prior CMS approval + count toward a cap.
- Oregon: Minor alternations like room swaps or ADA paths seem okay on a case-by-case basis.
- Alaska: Clinic/EMS upgrades get nods.
- Florida: Heavy on mobile units/telehealth.
- Wisconsin: Digital infrastructure focus.
- New Jersey: Vehicles yes. No land nor major renovation spends.
Based on I've seen so far, Texas doesn't have any information on Category J/Minor Alterations listed yet in their FAQ. Remember, CMS allows for each state to use up to 20% of their funding on Minor Alterations. Currently, Texas has allocated $250 million from Year 1 to certain hospital districts, and there is no Category J included therein - only Category A and Category E.
Bottom line: Nothing is a sure deal.
Lean in on Kansas/Oregon/Alaska for models, realize every state has a cap and flexibility to allow or not allow and document everything. If your state’s quiet, refresh on CMS’s national FAQ; it’s the safety net.
Got a project brewing? Drop me the details and questions.
2. From Lone Star Heat to Arctic Freeze: Why Texas Won't Spill on Rural Health Funds
Texas HHSC cites procurement "fairness" to limit pre-bid talks, stakeholder meetings, and public hospital district lists. They apply quiet periods broadly and include direct awards. No pre-bid chats, no stakeholder huddles, and no listings of which hospitals districts.
Milestones press on (planning ramps Q1-Q2 FY2026). With $281M Year 1 at stake and tight timelines, providers, that is you, face uncertainty on allowability, jurisdictions, and access. Other states are warming up, but Texas remains chilly.
Check out HHSC's guidelines here on competitive procurement. Information that is shared publicly seems to be the silver lining.
What information would you like to see post publicly? Reply with your thoughts.
