How the $50 billion CMS Rural Health Transformation Program is reshaping SUD and behavioral health care in rural America, and why CHESS Health is built for exactly this moment.
The Crisis Hiding in Plain Sight
Rural America faces measurable, persistent gaps in substance use and mental health treatment. These gaps are well-documented but rarely receive national attention. The data shows substantial disparities in access, treatment availability, and outcomes between rural and urban communities.
Geographic distribution of treatment infrastructure is a primary factor. Around 14% of behavioral health treatment facilities in the United States are located in rural communities, and fewer than half of those specialize in addiction treatment. For an individual in a rural area experiencing a substance use disorder, the nearest specialized treatment program may be hours away, if it exists at all.
The data points to several measurable disparities:
- Opioid overdose rates are 45% higher per capita in rural communities than in urban areas.
- Young adults in remote rural areas misuse methamphetamine at nearly twice the rate of those in urban areas.
- 9% of young adults in rural communities misused prescription pain relievers in the past year, compared to 8% of those in urban.
- Among individuals with both mental health conditions and substance use disorders, 74% received neither type of treatment.
- Rural residents are 4.5 times more likely to enter inpatient substance use disorder treatment as a result of a court order, and 9 times less likely to have access to medication-assisted treatment (MAT), than their urban counterparts.
- Medicare and Medicaid are the primary payers for 68% of substance use disorder inpatient hospital stays in rural areas, compared to 60% in urban areas.
- Alcohol and drug misuse carry a combined annual economic impact of $442 billion annually in the US in direct treatment costs and broader economic losses
Ready to align your rural health strategy with the RHT Program?
Treatment access alone does not account for these disparities. Stigma is also a measurable factor in communities where social networks are tight-knit and anonymity is limited. Forty-eight percent (48%) of rural residents believe that people with mental health disorders are looked down upon in their community, and 26% of rural families report that stigma prevents them from talking to friends about mental health.
Workforce availability compounds these gaps. States with proportionally large rural populations consistently face greater shortages of mental health providers and fewer facilities capable of delivering comprehensive treatment services. Geography, stigma, and provider availability together describe a treatment access gap that is structural rather than incidental.
What CMS Is Doing About It: The $50 Billion Rural Health Transformation Program
States must use funds to invest in at least three approved use. For health plans, state agencies, and behavioral health providers, the categories most directly relevant to SUD and mental health are:
In 2025, CMS established a federal response at scale. The Rural Health Transformation (RHT) Program, created under Public Law 119-21, authorizes CMS to distribute $50 billion over five years to support rural healthcare delivery systems. Each state receives approximately $200 million annually, with funding tied to specific approved use categories.
- [A] Prevention and Chronic Disease: Evidence-based, measurable interventions to improve prevention and chronic disease management.
- [C] Consumer Tech Solutions: Consumer-facing, technology-driven solutions for prevention and management of chronic diseases.
- [H] Behavioral Health: The program explicitly funds access to OUD and SUD treatment and mental health services in rural communities.
- [I] Innovative Care Models: Funding care models that improve outcomes, reduce costs, and shift care to lower-cost settings.
- [K] Fostering Collaboration: Local and regional partnerships and programs supporting collaboration between rural facilities and providers.
The program identifies digital therapeutics as an example under the Consumer Tech Solutions category, citing the SAMHSA advisory on digital therapeutics, which includes the Connections app as part of Oklahoma’s implementation, as a reference model for states to consider.
The program also specifies concrete outcomes states are expected to achieve:
The Treatment Gap Technology Must Bridge
Closing this gap doesn’t require more clinicians alone — it requires digital infrastructure that extends what existing clinicians, case managers, and community organizations can already do. Even where care exists, several structural realities compound to keep people from getting and staying in treatment.
- Access. Transportation and distance are barriers on their own, and workforce shortages compound them: rural providers cover wider service areas with fewer staff. The access gap shows up directly in treatment patterns — rural residents are 4.5 times more likely to enter SUD treatment by court order than urban residents, and 9 times less likely to have access to medication-assisted treatment. Broadband adds another layer: any digital response has to function in communities where connectivity itself is inconsistent.
- Anonymity and stigma. With fewer providers and facilities, there are fewer chances to seek help without being seen. Because substance use is criminalized, many people fear legal or social consequences if their use becomes known, and small-town visibility makes that fear harder to avoid.
- Scale and sustainability. Rural behavioral health systems run on thin, often turnover-prone staffing. Support tied to one counselor or one grant-funded position disappears when that person leaves. Medicare and Medicaid already cover 68% of rural inpatient SUD stays, compared to 60% in urban areas, meaning any new infrastructure needs to be sustainable on public-payer reimbursement rather than dependent on private revenue rural systems don’t have.
- One-size-fits-all care. Rural areas often can’t offer specialized care and support tracks for special populations. A single program serving an entire county has to serve everyone in it, and for groups with distinct needs, ethnic and tribal communities, veterans, women, LGBTQIA+ individuals, youth, justice-involved individuals, non-English speakers, those needs often go unmet within a general, one-size-fits-all model.
Implementation requires attention to all of these factors. The RHT Program’s own guidance identifies the need to address digital equity, specifically broadband access, digital literacy, and cultural and linguistic appropriateness of platforms. States pursuing digital solutions will need to account for these dimensions in their transformation plans.
What “Aligned” Actually Means: CHESS Health Across the SUD Continuum
Alignment with the Rural Health Transformation Program comes down to three tests: does a solution map to an approved use of funds category, generate the outcomes data states need to demonstrate value, and scale across a rural service area without adding implementation burden?
The RHT Program explicitly funds access to opioid use disorder treatment, substance use disorder treatment, and mental health services under its Behavioral Health use category, and requires states to address at least three approved use of funds categories across their initiatives. CHESS Health maps to five through a single integrated partner, which simplifies procurement and concentrates impact instead of spreading it across multiple vendors.
Here is how that alignment maps to the program’s fund categories:
Behavioral Health [H]
The RHT Program explicitly funds access to OUD and SUD treatment and mental health services in rural communities.
CHESS Health extends the reach of those services digitally — keeping individuals engaged in recovery between clinical touchpoints, reinforcing coping skills and evidence-based practices 24/7, and reducing the relapse-driven costs that burden health plan budgets and state emergency systems: ER visits, detox readmissions, and preventable re-hospitalizations.
Prevention and Chronic Disease [A]
The program funds evidence-based, measurable interventions that improve prevention and chronic disease management.
CHESS Health reaches at-risk individuals before acute care is needed with automated SBIRT and screening across schools, public health agencies, and community organizations, personalized digital interventions, and linkages to care where relevant. For those identified with SUD, which is classified as a chronic disease, CHESS Health offers evidence-based digital recovery support for long-term management.
Consumer-Facing Technology [C]
The program funds technology-driven solutions that improve access to care for rural populations who cannot easily reach a facility.
CHESS Health delivers digital tools that work on any smartphone or device, available 24/7, with no travel required. For rural communities where distance is a genuine barrier, consumer-facing digital engagement isn’t a convenience, it’s how care reaches everyone.
Fostering Collaboration [K]
The program funds local and regional partnerships and programs supporting collaboration between rural facilities and providers.
CHESS Health builds the infrastructure for that collaboration with a closed-loop referral network connecting providers, health plans, and community organizations, tracking every referral through to completion, and generating the data rural systems need to demonstrate quality improvement and justify continued investment.
Innovative Care Models [I]
The program funds care models that improve outcomes, reduce cost, and shift care to lower-cost settings. Peer-powered, family-centered, digitally-delivered recovery support is exactly that model.
CHESS Health’s outcomes measurement infrastructure provides the data that value-based and alternative payment arrangements require to function.
Why This Matters Beyond the Grant Period
Five-year federal programs are only as durable as the systems they build. States will be evaluated on measurable outcomes, and they will need to demonstrate financial sustainability well before the grant period ends. The RHT Program requires states to show how time-limited investments support long-term self-sustainability, and feasibility and robustness of evaluation metrics are explicit scoring criteria.
Outcomes measurement is a differentiating factor among digital health vendors — not all build reporting infrastructure in as a core feature rather than an afterthought. Engagement rates, retention metrics, recovery outcomes, and referral completion data serve as the evidence base that supports continued investment once federal funding concludes.
Rural health systems that build durable data infrastructure and care coordination capacity during the grant period will be better positioned to sustain SUD care under value-based arrangements after RHT funding concludes. This is the outcome the program’s evaluation criteria are designed to support.
One Partner. The Full Continuum. Rural-Ready.
The Rural Health Transformation Program distributes $50 billion over five years, with each state receiving approximately $200 million annually for rural healthcare delivery. The remaining decision for states and health plans is which partner can deliver against that mandate at scale.
CHESS Health is purpose-built for this mission:
- Evidence-based: Outcomes data across SUD prevention, treatment, and recovery, grounded in peer-reviewed research and recognized by SAMHSA.
- Human-driven: Peer support and family-centered care at the core of every solution, delivered by certified recovery specialists available around the clock.
- Rural-ready: Digital tools built to provide 24/7 access to support, resources, and community regardless of location.
- Committed Partner: Dedicated customer success support behind every CHESS Health contract, so programs scale with state and health plan needs and remain sustainable beyond the initial implementation.
States and health plans don’t need to manage four separate vendor relationships to cover prevention, care coordination, recovery support, and family engagement. CHESS Health delivers the full SUD continuum, from the first screening through long-term recovery, built for the communities the RHT Program was designed to serve.
