Iowa Governor Kim Reynolds has announced the submission of the state’s application for the Rural Health Transformation Program, a federal initiative managed by the Centers for Medicare and Medicaid Services (CMS). The proposal, called Healthy Hometowns, seeks to improve health care in rural communities across Iowa. If approved, the program could bring up to $1 billion in funding over five years, with $200 million available each year.
Governor Reynolds emphasized the significance of supporting rural areas. “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,” she 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.”
Larry Johnson, Director of Iowa Health and Human Services (HHS), highlighted collaboration behind the plan. “Iowa’s application reflects years of thoughtful planning and collaboration,” he 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.”
Rural communities in Iowa face ongoing challenges such as limited access to hospitals and primary care providers. Most counties with below-average health insurance coverage are rural. On average, residents drive 30 minutes to reach a hospital and 24 minutes for primary care services. These issues are further complicated by workforce shortages and economic disparities.
The Healthy Hometowns initiative was developed in partnership with rural hospitals, health systems, and community organizations using a hub-and-spoke model. Key components include expanding telehealth services; recruiting healthcare professionals; increasing cancer screening access; co-locating providers for coordinated care; improving health information exchange; and providing mobile emergency medical services.
State officials expect measurable improvements within five years: fewer preventable emergency department visits; more local care options for residents; higher provider-to-population ratios; and expanded telehealth access.
The proposal also addresses federal policy priorities such as reinstating physical fitness testing aligned with Executive Order 14327; adding nutrition education requirements for physicians’ continuing education; joining an interstate compact to expand mental health provider access; and removing certain regulatory barriers for outpatient behavioral health services.
Award notifications from CMS are expected on December 31, 2025. Additional details about Iowa’s Rural Health Transformation proposal can be found online.
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