Rural Texas Strong Program – Initiative 1 (Part 2): Make Rural Texans Healthy Again Grant Program

The Texas Health and Human Services Commission (HHSC) is administering the Rural Texas Strong Program – Initiative 1 (Part 2): Make Rural Texans Healthy Again, a large-scale federally funded initiative designed to improve health outcomes in rural communities across Texas. HHSC serves as the state agency responsible for overseeing health and human services programs, and this funding opportunity is supported through the Centers for Medicare & Medicaid Services under the Rural Health Transformation Program. The initiative reflects a broader federal and state priority to address systemic disparities in rural healthcare access, chronic disease prevalence, and preventive care infrastructure. The primary purpose of this grant program is to support rural hospitals in enhancing or establishing community-based prevention, wellness, and nutrition programs. These initiatives must focus on improving outcomes related to chronic diseases, specifically diabetes, cardiovascular disease, chronic respiratory disease, and obesity, with a strong emphasis on diabetes and obesity education and management. The program is designed to strengthen local healthcare ecosystems by enabling hospitals to implement one or more predefined intervention strategies that improve access to care, promote healthier behaviors, and reduce avoidable hospital utilization. Eligible activities under the program include a wide range of interventions such as establishing community wellness centers, offering chronic disease screenings, operating after-hours primary care clinics, providing transportation for non-emergency healthcare access, and implementing remote patient monitoring systems. Additional allowable activities include partnerships with food providers to increase access to healthy foods and the use of technology to support healthcare enrollment and education. While minor renovations are permitted to support program delivery, large-scale construction and capital expansion are prohibited. All expenditures must align strictly with approved project activities and federal cost principles. The funding structure is substantial, with an estimated total program funding pool exceeding $153 million and individual awards capped at $5 million. Award amounts are calculated based on the number of individuals served through obesity-related and diabetes-related interventions, using a predefined formula. The grant operates over a multi-year project period anticipated to run from September 30, 2026, through September 30, 2031, with funding distributed across five structured spend periods. Early years utilize a cost reimbursement model, while later years incorporate a pay-for-performance model tied to measurable health outcomes. Eligibility for this opportunity is limited to rural hospitals located in Texas, as defined by state statute. Applicants must demonstrate legal authority to apply, maintain good standing with regulatory bodies, and meet all administrative and financial compliance requirements. Applications must be submitted through the HHSC Grants Management System and include a comprehensive set of required documents, including a project narrative, work plan, sustainability plan, budget, and supporting certifications. Partnerships are allowed and encouraged but must be formalized through documented agreements. The application process includes a structured timeline beginning with the funding announcement on May 4, 2026, followed by an optional applicant conference, a deadline for submitting questions, and a final application deadline of June 4, 2026, at 10:30 a.m. Central Time. Applications undergo a multi-step evaluation process, including compliance screening, scoring based on defined criteria such as disease burden and organizational characteristics, and final selection based on state priorities and funding availability. Evaluation criteria emphasize measurable community need and organizational commitment, including metrics such as diabetes-related emergency visits, obesity rates, and whether the applicant commits to hiring a qualified dietician. Successful applicants will be required to meet rigorous reporting, monitoring, and performance standards throughout the grant term, including participation in data reporting systems and submission of regular financial and progress reports. The program also includes post-grant reporting requirements to assess long-term impact and sustainability.

Align project activities directly with required implementation methods and measurable chronic disease outcomes; ensure realistic service projections tied to funding formula; prioritize diabetes and obesity interventions; include strong sustainability planning beyond grant term