DES MOINES, IOWA (November 5, 2025) — Governor Kim Reynolds has announced that the state has submitted its application for the Rural Health Transformation Program, a federal funding initiative managed by the Centers for Medicare and Medicaid Services (CMS).
The bold and comprehensive proposal, titled Healthy Hometowns, is aimed at building a high-quality, sustainable system of care that improves the health, well-being, and quality of life in rural communities across the state.
If fully awarded, Iowa could receive $200 million per project year period, totaling $1 billion over the five-year grant.
“Since taking office, my administration has emphasized the importance of supporting and revitalizing rural Iowa through targeted investments and policy initiatives. Rural communities are the backbone of our state—home to nearly half of all Iowans and the foundation of our economy, culture, and identity,” Gov Reynolds said.
“Healthy Hometowns is a pivotal opportunity to build a high quality, sustainable system of care that vastly improves health, well-being, and quality of life for rural Iowans.”
“Iowa’s application reflects years of thoughtful planning and collaboration,” Iowa HHS Director Larry Johnson said. “It’s a plan rooted in the values of hard work, innovation, and community. Iowans deserve a health care system designed for them — and with Healthy Hometowns, we’re delivering just that.”
Despite their vital role, rural communities face unique and growing challenges in accessing health care.
Nearly every Iowa county with below-average health insurance coverage is rural. Rural Iowans drive an average of thirty minutes to the nearest hospital and 24 minutes to see a primary care provider. These barriers are compounded by workforce shortages, chronic disease prevalence, and economic disparities.
Healthy Hometowns is Iowa’s strategic response — developed in collaboration with rural hospitals, health systems, and community partners — to address these challenges through a hub-and-spoke model of care. The initiative includes six key components:
- Hometown Connections: Expanding Centers of Excellence and developing Health Hubs with investments in telehealth, medical equipment, and care for uninsured Iowans.
- Best and Brightest: Recruiting and retaining top-tier health professionals in rural communities through targeted incentives.
- Combat Cancer — Prevent and Treat: Increasing access to cancer screening and treatment, forming cancer-specific hubs, and supporting families and research.
- Communities of Care: Co-locating providers for coordinated multidisciplinary care supported by community health workers.
- Health Information Exchange: Ensuring seamless access to health records across the state to support continuity of care.
- EMS Community Care Mobile: Bringing care directly to rural residents through mobile health services and high-risk transport support.
Within five years, the state anticipates measurable improvements, including:
- Fewer emergency department visits for preventable conditions
- More rural residents receiving care locally
- Increased provider-to-population ratios
- Expanded telehealth access across rural Iowa
Iowa’s proposal also includes commitments to key federal policy priorities, including:
- Reinstating the Presidential Fitness Test in alignment with Executive Order 14327
- Adding nutrition education to continuing medical education for physicians
- Joining the PSYPACT compact to expand access to mental-health providers
- Removing Certificate of Need requirements for outpatient behavioral health services
Notices of state awards are expected on December 31, 2025. More information about Iowa’s Rural Health Transformation proposal, including its application, is available online.
