By Tiffany Ferguson, LMSW, CMAC, ACM, FCM, ACPA-C
Earlier this year, I wrote about the Centers for Medicare & Medicaid Services’ (CMS’s) Rural Health Transformation (RHT) Program, a $50 billion, five-year initiative intended to strengthen healthcare delivery across rural America. The program provides $10 billion annually from fiscal years 2026 through 2030, with funding directed toward improving access, strengthening the rural healthcare workforce, supporting innovative care models, and advancing technology.
At the time, much of the discussion centered on whether the RHT Program could meaningfully offset the broader financial pressures facing rural hospitals and health systems. It remains important to recognize that short-term transformation funding cannot directly replace ongoing reimbursement concerns in our states.
And I am sure anyone who receives the CMS news briefs is being inundated with emails, state by state, with details on each state’s awarded program. In a recent summary provided by CMS/Medicaid, there are also further details that came out related to the expectations for states and healthcare organizations to demonstrate a stronger commitment for health outcomes.
This new initiative seeks to shift Medicaid’s quality strategy toward outcomes, rather than continuing to expand the number of reporting requirements imposed on states, health plans, and providers. CMS has invited states and other stakeholders to sign a voluntary pledge focused on four principles: prioritizing outcomes over process, converging quality-measure inventories, producing more real-time data when feasible, rather than claims and chart abstractions, and ensuring that payment rewards align with outcome metrics.
As of Sept. 24, a total of 37 states had signed the pledge, representing approximately 56 million Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries. CMS also reported that a May 2026 analysis of Medicaid managed-care contracts across 42 states and programs identified approximately 450 reporting requirements, representing 258 unique quality measures. According to CMS, only a smaller share of those measures was directly tied to improvements in beneficiaries’ health outcomes (Note: I could not find any specific details or examples related to these findings from the website).
Although the initiatives are separate, their priorities are closely aligned. The RHT Program calls for evidence-based, measurable interventions related to disease prevention, chronic disease management, behavioral health, prenatal care, workforce development, technology, access, and innovative care delivery. It also supports value-based arrangements intended to improve quality, reduce costs, and shift care into lower-cost settings.
This is fully synonymous with the health outcomes pledge.
For example, distributing remote monitoring devices or expanding telehealth availability may demonstrate that a project was implemented for RHT. However, implementation alone does not establish that patients experienced better disease control, improved access, fewer preventable complications, or more effective care coordination.
It should be noted that these developments offer an opportunity to reduce unnecessary reporting, particularly around process metrics, and focus attention on measures that more directly reflect whether people are healthier because of the care they receive. Although there are concerns that success will depend on whether rural organizations actually have the infrastructure necessary to demonstrate and sustain those results, alignment of metrics and shifting towards health improvement is a step in the right direction.