The West Virginia Department of Health (DH) today expressed serious concern that continued delay in legislative spending authorization for the federally awarded Rural Health Transformation Program (RHTP) puts critical rural health improvements, and future federal funding, at risk.
“West Virginia worked extremely hard to secure this nearly $200 million federal award. Timely execution is now essential to protect it,” said Dr. Arvin Singh, Secretary of Health for West Virginia. “The federal government approved a specific plan with defined milestones, timelines, and guardrails. We are obligated to execute that plan as approved. Delays may jeopardize meeting federal performance requirements, and unnecessary procedural hurdles increase the risk of lost time, lost momentum, and, potentially, lost opportunity for our rural communities.”
West Virginia has already been awarded nearly $200 million in federal funding for FY2026 to expand telehealth, strengthen rural workforce recruitment, modernize health technology, and improve chronic disease and behavioral health coordination. If West Virginia cannot fully authorize and deploy these funds in a timely manner, program implementation remains on pause and future federal funding may be jeopardized.
The award from the Centers for Medicare & Medicaid Services (CMS) was granted following federal approval of West Virginia’s detailed multi-pillar transformation application. Federal regulations require that federal grant funds must:
- Be spent within the approved application and scope of work
- Align with approved budget categories and cost principles
- Meet defined performance benchmarks and reporting requirements
Material changes to scope, budget categories, or program structure require prior approval from CMS under federal award modification standards. West Virginia cannot unilaterally redesign or materially alter the program outside the federally approved guardrails.
Implementation requires operational flexibility; exact expenditures may not always match projections line-for-line due to:
- Competitive Request for Proposal (RFP) and Assistance (RFA) pricing
- Workforce market conditions
- Vendor availability, and
- Timing adjustments within the federal performance year
Federal guidance anticipates such potential discrepancies, but unnecessary delays such as, layering additional state-level rigidity, or requiring parallel application amendment approvals and/or reporting beyond CMS requirements creates a dual-approval structure that compounds delay while federal performance-based timelines continue.
The CMS Rural Health Transformation Program framework is performance-based and time-bound.
Under federal requirements, delay, under-expenditure, or missed performance milestones may impact future funding that will impact the ability to increase rural health access and care.
Neighboring states are advancing similar rural modernization efforts in telehealth, workforce recruitment, and health technology infrastructure amidst a competitive vendor and workforce marketplace. In addition to potentially reducing the state’s ability to secure partners for rural West Virginians, delay means telehealth expansion launches later, workforce recruitment incentives are delayed, and rural providers wait longer for support.
DH remains committed to transparency, compliance with West Virginia law, and strict adherence to CMS grant requirements. DH respectfully urges timely legislative authorization consistent with the federally approved RHTP plan so that West Virginia can protect the nearly $200 million already awarded and begin implementation of the initiatives that will help transform the delivery of healthcare in West Virginia.
This RHTP is supported by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of the financial assistance award totaling $199M with 100% funded by CMS HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor endorsement, by CMS/HS, or the U.S. Government.
