Montana
Montana launches rural health overhaul backed by $233 million federal investment
BOZEMAN, Mont. — Montana health leaders are racing to roll out a sweeping overhaul of rural health care, backed by a historic $233 million federal investment, after more than 600 people gathered Thursday for the first Rural Health Transformation Program Stakeholder Advisory Committee meeting at Montana State University in Bozeman.
The advisory committee, created to guide the state’s new Rural Health Transformation Program, met to review goals and gather public feedback on how to stabilize and modernize care in frontier and rural communities. No funding decisions were made at the meeting, which was open to the public, though some portions were closed.
In December 2025, Gov. Greg Gianforte and Department of Public Health and Human Services Director Charlie Brereton announced Montana had secured about $233 million in first-year funding from the Trump administration through the Centers for Medicare & Medicaid Services’ Rural Health Transformation Program, or RHTP. The state is slated to receive up to $1.2 billion over the five-year life of the program, the fourth-largest award among all 50 states.
“I think it’s a historic opportunity for the state,” Brereton said.
Brereton noted that only Texas, Alaska and California received larger first-year allocations.
Under federal rules, states must submit revised budgets aligned with their announced awards by Jan. 30, forcing Montana to quickly prioritize “high-impact programs with the capacity to absorb additional funding,” DPHHS officials said.
Montana originally submitted a $200 million budget but received $233 million, requiring a supplemental plan to detail how the extra $33 million will be used. Brereton said DPHHS is building an internal RHTP unit of about 20 state positions to manage implementation and oversight.
For the first $233.5 million dollars in funding, Montana must submit its initial federal progress report by August 2026 and then file annual and quarterly reports through 2030.
“That is a tight timeline to start spending these funds,” Brereton said.
The money flows from a $50 billion national RHTP fund created under President Donald Trump’s Working Families Tax Cuts legislation, which runs through 2030 and is designed to help states stabilize and restructure rural health systems. Congress established the program in H.R. 1, a 2025 law that set aside $10 billion a year for five years.
KFF Health News has reported that every state is guaranteed at least $100 million a year from the fund, with additional dollars distributed based on rural population, facilities and a technical score for each state’s proposal. Awards range from $147 million for New Jersey to $281 million for Texas in the first year.
Brereton emphasized that RHTP dollars will be subject to standard state of Montana procurement rules. Meaning DPHHS cannot simply pick and choose winners or sole-source most contracts.
Competitive grant applications through platforms such as Submittable, which many organizations used during the COVID-19 pandemic.
The state expects its first round of RHTP-related procurements to open in the second quarter of federal fiscal year 2026, roughly March 2026, with updates posted at ruralhealth.mt.gov and on the state’s eMACS procurement system.
DPHHS also plans regular updates to the Legislature through standing and interim committees, as well as frequent reports to CMS on spending, outcomes and progress toward program goals.
Montana’s approved rural health transformation plan is built around five core initiatives: workforce development, sustainable access, innovative care models, community health and prevention, and technology innovation.
DPHHS leaders said the plan is all in part due to public engagement before the state applied to CMS. The department conducted weeks of outreach to hospitals, more than 20 rural health stakeholders, all eight tribal nations and Urban Indian Organizations, and other agencies, drawing on a 900-person webinar and more than 300 formal responses to a request for information.
KFF Health News reporting describes the national program as an effort to give states space to be creative in how they fix systemic gaps in rural health care. Federal officials will begin reviewing states’ progress this summer and will announce 2027 funding levels by the end of October, based on performance and compliance.
Roughly $20 million of Montana’s first-year allocation will go toward a comprehensive workforce strategy led by the Department of Labor & Industry, which is partnering with DPHHS under the first initiative.
“I have always been proud to be from Montana, and I’ve long known that Montana punches above its weight class, but this is an incredible opportunity,” Labor & Industry Commissioner Sarah Swanson told the audience.
The workforce initiative has three sub-initiatives:
- About $15 million for recruiting and retaining rural health care workers, including a statewide talent-attraction campaign, scholarships and tuition assistance, and a major expansion of registered apprenticeship from entry-level roles to registered nurses.
- Just under $4 million to expand clinical training capacity, adding residency slots, exploring new rural residencies, and building rural training tracks for physicians, advanced clinicians and dental providers.
- About $1.1 million for retention and upskilling, including relocation support, wellness programs, community integration for new clinicians, and advanced training delivered virtually so rural workers don’t have to leave their communities.
Swanson said the state intends to train and upskill 700 Medicaid expansion enrollees into health care jobs, build a pipeline through middle and high school programs such as HOSA, and support the development of up to 400 new rural preceptors within a year.
All workforce investments will carry a five-year service commitment to work in Montana’s health care system and cannot be used for construction or to replace existing funding.
The initiative will be measured against eight key metrics, including year-over-year 5% growth for five years in the number of nurse practitioners, physicians, registered nurses, dental hygienists, EMTs and physician assistants. That translates into annual statewide targets such as about 23 new nurse practitioners, 27 physicians, 258 registered nurses, 24 dental hygienists, 34 EMTs and 21 physician assistants. Two additional measures, rural turnover rates and clinician burnout, are still being sorted out.
Swanson tied the work to “406 Jobs,” a Gianforte executive order issued last August that aims to align education and workforce systems and insists that solutions be industry driven and community led, especially in rural and tribal communities. She said the RHTP effort must be shaped by hospitals, physicians and local leaders from places like Fort Peck and Livingston.
Under the program’s innovative care models initiative, Montana plans to shift more rural providers from fee-for-service to value-based care, expand emergency medical services, and broaden the role of community pharmacies.
“This will look at transitioning more rural health care providers to value-based care models which focus on reimbursing for the quality of the care provided as opposed to simply the number of services,” said Rebecca de Camara, Medicaid and Health Services executive director.
De Camara said the state has already been revamping primary care case management and evaluating options for dual-eligible residents who have both Medicare and Medicaid, including whether the PACE model would fit Montana.
De Camara said officials are also looking at authorizing Treat-in-Place, allowing EMS providers to deliver reimbursable on-site care when appropriate, rather than requiring transport to qualify for payment. That would require changes to Medicaid billing codes and significant upgrades to ambulances and related equipment.
Currently, EMS providers receive no Medicaid reimbursement when they respond to a call but do not transport a patient, a situation she described as financially unsustainable. Building on an ongoing legislative interim study of the EMS system, the state will examine how to expand community paramedicine, modernize dispatch and retrofit or replace ambulances.
Another priority is expanding rural pharmacy services by allowing pharmacists to work at the top of their license, including prescribing some medications, providing basic primary care and managing chronic diseases. The state plans to create pharmacist point-of-care testing sites, draft a Medicaid state plan amendment to allow reimbursement, and use these changes to ease pressure on clinics and emergency departments.
Metrics for this initiative include:
- Holding average monthly costs for dual-eligible members at about $305 per person.
- Increasing use of EMS treat-and-no-transport billing codes while reducing avoidable emergency department transports for high utilizers.
- Raising the share of pharmacists who prescribe for Medicaid enrollees.
- Shifting a greater share of Medicaid spending from inpatient to outpatient care, building on broader hospital transformation work.
Other pieces of Montana’s RHTP plan focus on community health and infrastructure, including behavioral health services, child and family care, and local nutrition and prevention projects.
Amanda Harrow, a DPHHS project manager, said the state will support the expansion of crisis safe spaces. These are alternatives to hospitalization for people in behavioral health crises.
Through Certified Community Behavioral Health Clinics, and fund minor renovations and repairs for rural and tribal facilities. The initiative will invest in community spaces that support healthy lifestyles by funding one-time projects like food system action plans, farmers markets that also benefit local producers and school nutrition efforts designed by local communities.
By the time of its first CMS report, the state aims to:
- Finalize subrecipient grants and oversight models for school-based care, mobile health vans and tribal programs.
- Expand Montana State University’s “Care for Your Own” nursing program, which supports American Indian students and has strong retention and graduation rates.
- Evaluate community pediatric programs for long-term sustainability.
- Initiate procurement for rural infrastructure projects, including safe-space build-outs and minor facility repairs.
- Launch community nutrition and health grants by late 2026 or early 2027 after stakeholder convenings.
Harrow said the state will track progress with a broad suite of metrics, including:
- Increasing the number of crisis safe spaces statewide to 11 by the end of the five-year grant.
- Improving preventive health measures such as well-child visits in the first 30 months of life across rural counties, A1C control for residents with diabetes, and blood pressure control among those with hypertension.
- Monitoring body mass index data and behavioral health emergency department admissions per 1,000 residents, with an eye toward reducing hospitalizations as safe spaces expand.
- Lowering suicide rates and cutting by 10% the share of students reporting mental health-related risk behaviors.
- Boosting the number of certain behavioral health providers to about 200 over the life of the program.
KFF Health News has noted that total RHTP awards vary widely on a per-rural-resident basis and that states governed by Republicans tended to score higher on the discretionary technical portion of the funding formula, although federal officials have denied politics played any role. Analysts and researchers are watching closely to see how states deploy the money, and whether they adopt administration-backed policies such as broader fitness testing, SNAP food restrictions or changes to certificate-of-need laws.
In Montana, state leaders say their focus is squarely on rural realities from long travel distances and workforce shortages to strained behavioral health systems and limited training capacity.
During the gathering on Thursday, attendees asked what happens in five years when this unique funding is gone. Brereton said when they designed the plan with one use funds in mind.
“Sustainability was absolutely top of mind for DPHHS so that we’re not establishing or creating cliffs everywhere we turn,” he said. “Our plan is centered on one time only investments that get provider organizations, communities and others to the place that they need to be in order to continue services into the future.”
Providers, local officials and residents are encouraged stay engaged via ruralhealth.mt.gov and attend stakeholder meetings as the transformation effort unfolds.
Brian Miller won the Democratic primary Tuesday for the U.S. House seat in Montana’s eastern district.
The Associated Press called the race for Miller, an attorney in Helena, who fended off a challenge from state Sen. Jonathan Windy Boy, a longtime legislator from Box Elder, and Sam Lux, a farrier from Great Falls.
In the Republican and rural eastern district, any Democrat will be an underdog, and Miller will face off against incumbent Republican U.S. Rep. Troy Downing, who was unopposed Tuesday.
Libertarian Patrick McCracken is also running.
In the primary, Miller took 58% of the vote. Lux took 27% and Windy Boy took 16%, according to the Montana Secretary of State’s website.
In April, Windy Boy paused his campaign amid “serious sexual abuse” allegations raised by the Montana Democratic Party — but Windy Boy restarted his campaign and later called the allegations “political attacks.”
Miller is representing the victim of the alleged abuse and her mother, although he said he didn’t take on the role until after Windy Boy initially suspended his campaign.
The Western Montana Food and Farm Trail, a new agritourism initiative led by Farm Connect Montana, launches May 30, offering locals and visitors a new kind of food and farm adventure across Western Montana.
Running June 1 through October 31, the self-guided Trail spans more than 200 miles and features more than 100 farms, ranches, farmers markets, restaurants, breweries and food businesses across the Missoula, Bitterroot, Flathead and Mission Valleys. Along the way, participants are invited to meet growers and makers, taste what’s in season and experience the culture and care behind Western Montana’s local food community.
At the center of the experience is the passport-style Trail Field Guide, illustrated by Missoula-based artist Courtney Blazon. The guide features illustrated maps, curated itineraries, seasonal highlights and more than 100 local food destinations throughout the region. The guide also includes more than $130 in special offers from participating farms and businesses.
Participants can collect stamps at Trail stops along the way to qualify for prizes, giveaways, or simply as a way to document their journey. End-of-season prizes include raffles for three CSA memberships valued at over $600 each, as well as local food and farm gift certificates, product bundles and Courtney Blazon-designed market totes.
The Trail is a regional collaboration led by Farm Connect Montana in partnership with Land to Hand Montana, The O’Hara Commons and Sustainability Center and Abundant Montana, organizations working to strengthen local food systems across Western Montana. The project aims to support local farms and food businesses through expanded visibility and agritourism opportunities while reconnecting locals and visitors with the people, places and stories behind their food.
“In creating the Western Montana Food & Farm Trail, we hope to inspire both residents and travelers to discover the stories behind their food and connect with the people cultivating a more vibrant, resilient and locally rooted food community,” said Bonnie Buckingham, Executive Director of Farm Connect Montana. “Participation in the Trail is a win for everyone. It creates new opportunities for farms and local food businesses to reach wider audiences while encouraging participants to explore new places, support local producers and experience Western Montana in a more meaningful way.”
“Land to Hand is thrilled to partner with Farm Connect on the Food and Farm Trail to highlight the robust agricultural heritage of Western Montana,” said Gretchen Boyer, Executive Director of Land to Hand Montana. “This initiative is more than just a guide – it’s an invitation to celebrate and support the local farmers who nourish our communities every day. By connecting residents and visitors directly to the source, we’re strengthening our local food system and honoring the people and landscapes that sustain the Flathead Valley.”
To celebrate the launch, regional Trail launch parties will take place in Missoula, the Bitterroot Valley and the Flathead Valley throughout early June, featuring Field Guide distribution, local food vendors, giveaways and opportunities to learn more about the Trail.
Trail Field Guides ($10) will be available for purchase beginning May 30 both online and at participating businesses, farmers markets and community locations throughout the region. A full list of Field Guide purchase locations and details, as well as a digital map and Trail listings, special events and more information is available at farmconnectmontana.org/trail.
Funding for this project was made possible through the U.S. Department of Agriculture’s Agricultural Marketing Service.
Regional launch events
• Missoula Launch Party — LaLonde Ranch, Sun., June 7, 1-4 p.m.
• Bitterroot Launch Party — O’Hara Commons Market, Wed., June 10, 4-6 p.m.
• Flathead Launch Party — Backslope Brewing, Tue., June 16, 4-7:30 p.m.
An “I voted” sign points to a Vote Center on June 1 in Los Angeles.
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Six states — California, Iowa, Montana, New Jersey, South Dakota and New Mexico — hold elections on Tuesday. Most of the attention is on California and Iowa, where there are competitive primaries for governor. In both states, the Democratic Party also sees a road map to control of Congress in the fall.
In California’s unique primary system, voters send the top two vote-getters to November’s general election, regardless of candidates’ political parties. Democratic Gov. Gavin Newsom is term limited, and California voters will also pick who should move on to the general election in five new Democratic-leaning congressional districts.
In Iowa, Democratic voters will choose a candidate in a key Senate race — the Republican in the race is already the de facto nominee. In order to win a majority in the Senate, Democrats must pick up four seats, forcing the party to win in Republican-leaning states like Iowa. For governor, the race is the first good chance Democrats have to win the office in years, but Republicans still need to select their nominee.
Here are key races to follow:
Or skip to specific races:
California governor | California U.S. House | Iowa governor | Iowa U.S. Senate | New Jersey and Montana
You can also check out June 2 voter resources from the NPR network.
California decides top two gubernatorial contenders
It’s been a chaotic scramble to pick the next leader of the country’s largest state. After three prominent Democrats — former Vice President Kamala Harris, Sen. Alex Padilla and state Attorney General Rob Bonta — decided not to run, Democratic voters haven’t had a clear front-runner for the first time in decades. Voters have more than 60 candidates to choose from, but only a fraction of those are considered serious contenders. Only the top two vote-getters will move on to the general election in November.
California Democratic gubernatorial candidate Xavier Becerra hugs a supporter at the Long Beach Arena on May 31 in Long Beach, Calif.
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The race got a shakeup when former Democratic Rep. Eric Swalwell, the presumed favorite, dropped out of the race after he was accused of sexual misconduct by several women. Most recently, polls show the contest could be between two Democrats — the Health and Human Services secretary under former President Joe Biden, Xavier Becerra, and billionaire philanthropist Tom Steyer.
Before Becerra was appointed to Biden’s Cabinet, he served 12 terms in Congress and was elected as the California attorney general in 2016. He’s considered by many as the candidate with the strongest political background. Becerra’s pitch is that he is a proven leader who can hold his own and protect California from President Trump.
Steyer has forked over more than $213 million of his own fortune on the race and is also financially backed by Our Revolution, a group aligned with Sen. Bernie Sanders, I-Vt. Steyer’s platform is centered on taking a stand against special-interest groups in politics.
Polling just a few points behind Becerra and Steyer is Republican Steve Hilton. The former Fox News host was endorsed by President Trump in April, after which Riverside County Sheriff Chad Bianco, another Republican in the race, quickly dropped in the polls. Hilton’s platform focuses on increasing affordable housing supply for first-time homebuyers, bolstering tech industries and reviving California’s film industry.
Democratic gubernatorial candidate Tom Steyer speaks with students during a Get the Youth Vote with Bruin Democrats event at UCLA’s campus on June 1 in Los Angeles, Calif.
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The outcome of California’s new congressional districts
In response to Texas redrawing its congressional lines to create five Republican-leaning districts at the behest of President Trump, Californians approved Proposition 50 in November last year. The measure temporarily sidestepped the independent redistricting commission tasked with drawing nonpartisan influenced congressional boundaries, in favor of politically gerrymandered districts. That allowed state Democrats to redraw their map so five previously Republican-held districts now lean Democratic.
This has left those Republican incumbents figuring out their political futures. Rep. Ken Calvert, the longest-serving Republican from California, and Rep. Young Kim are running in the same district, for example, in a race that’s gotten quite heated.
Then there’s Rep. Kevin Kiley. After being drawn into a much more Democratic-leaning district, he decided to run in a new seat and announced he was leaving the Republican Party and running as an independent instead, though Kiley said would still caucus with the Republicans.
Because of California’s primary system, some of these more competitive seats are creating competitive primaries between Democrats, allowing primary voters to signal to the party what kinds of candidates speak to them most in places that have the most to lose — and gain.
Iowa’s GOP gubernatorial primary
Iowa Republican voters could decide the party’s nominee for governor in the state’s first open race for the office since 2011, as sitting Gov. Kim Reynolds opted not to run for reelection.
With five Republicans on Tuesday’s ballot, Rep. Randy Feenstra is the only one endorsed by Trump. The race will test whether Trump’s endorsement holds weight in a state where his approval rating has slipped over the economy and the war in Iran. Feenstra’s lead may be declining, as one recent poll shows political newcomer and Iowa businessman Zach Lahn could have a shot at winning the GOP primary.
There is a good chance, though, that Iowans won’t know the outcome of the race on Tuesday because a candidate must secure 35% of the vote to win outright. If no one clears that threshold, the nominee will be decided at a Republican convention where delegates — not primary voters — make the final choice.
But the Republican-backed candidate isn’t a shoo-in come November. Cook Political Report categorizes the governor’s race as a toss-up with a slight Republican advantage. Whatever Republican wins on Tuesday will face unopposed Democratic State Auditor Rob Sand in the general election. Sand is popular among voters and has, so far, outraised any other candidate for governor.
Democrats look to flip Iowa Senate seat
Democratic voters in Iowa will pick which candidate they think has the best shot at beating the Republican nominee for Senate, expected to be Trump-endorsed Rep. Ashley Hinson, on Tuesday. This is a seat that Democrats believe they have a shot at flipping come November. It’s part of a larger strategy of expanding their map — and winning in states currently held by Republican senators — if they want a chance to retake the Senate majority.
Iowa Democrats have a choice between state Rep. Josh Turek and state Sen. Zach Wahls. Both candidates are courting different Iowa voters, though. Turek is vying for the independent-leaning vote, while Wahls is hoping to gain the support from committed Democrats. Turek flipped a state House district held by a Republican, while Wahls represents a Senate district that is solidly blue. Both argue they are the candidate who has the right message to win in November.
And with three competitive congressional races on the ballot, some Democrats in the state are feeling like the road to a Democratic majority in Congress runs through Iowa.
Looking beyond Tuesday
New Jersey and Montana also have competitive races that could decide which party has control of Congress.
In New Jersey, all eyes are on Congressional District 7. Four Democrats are hoping to oust Republican Rep. Thomas Kean Jr. The sitting congressman has been notably absent from Washington for weeks due to what Kean cites as unspecified medical issues. He has missed more than 100 House votes since his last recorded vote on March 5.
Two races in Montana may be more competitive than originally expected with the last-minute announcements — shortly before the filing deadline — by Republicans, Sen. Steve Daines and Rep. Ryan Zinke, that neither would seek reelection.
While an open Senate seat does not make Montana, which has long been considered a Republican stronghold, necessarily competitive for Democrats, an independent candidate is outraising candidates in both major parties. Seth Bodnar, Iraq war veteran and former president of the University of Montana, is hoping voters will send him instead, mostly on the message that he won’t work for either party and is focused on changing the direction America is heading. In Bodnar’s case, he has enough voter signatures to land himself on the November ballot, but the Montana Secretary of State’s Office hasn’t yet certified those signatures.
Democrats are working to flip Montana’s 1st Congressional District as well. When Zinke announced he was retiring from Congress, it was seen as an opening for Democrats to compete. Now, four Democrats are angling for the open seat, including front-runner Sam Forstag, a smokejumper who is endorsed by popular progressive Rep. Alexandria Ocasio-Cortez, D-N.Y.
June 2 voter resources from the NPR Network
California | Iowa | Montana | New Jersey | New Mexico | South Dakota
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