Rural Texas Strong Initiative 3: Lone Star Advanced AI and Telehealth

Rural Texas Strong Initiative 3: Lone Star Advanced AI and Telehealth is sponsored by Texas Health and Human Services Commission (HHSC). This initiative aims to support provider-facing AI and telehealth technologies to improve clinical and administrative workflows, care coordination, telehealth infrastructure, and access to specialty care in rural Texas communities.

Rural Health Transformation Program | Provider Finance Department An official Texas Health and Human Services website . Rural Health Transformation Program Texas is receiving an estimated $1. 4 billion in federal funding over five years to improve rural health care throughout the state.

The Centers for Medicare & Medicaid Services (CMS) notified the Texas Health and Human Services Commission (HHSC) that HHSC is receiving the funding through the Rural Health Transformation Program. As part of the One Big Beautiful Bill Act, the program is allocating $50 billion to states over five years to help transform rural health care. Texas will receive approximately $281.

3 million each year during fiscal years 2026-2030. While Budget Period 1 is awarded, all future funding figures are estimates because CMS hasn’t issued final budget awards for the remaining budget years of the program.

Initiative Estimated Program Period Start Date Estimated Application Submission Deadline Estimated Date for Distribution of Notice of Award Anticipated Date to Route Contracts to Successful Applicants Initiative 1 Part 1: Make Rural Texans Healthy Again September 2026 May 26, 2026 June 19, 2026 July 15, 2026 Initiative 1 Part 2: Make Rural Texans Healthy Again September 2026 June 4, 2026 July 15, 2026 Aug.

31, 2026 Initiative 2: Rural Texas Patients in the Driver’s Seat April 2027 October 2026 January 2027 March 2027 Initiative 3: Lonestar Advanced AI and Telehealth May 2027 November 2026 February 2027 April 2027 Initiative 4 Round 1: The Next Generation of the Small Town Doctor and Team September 2026 June 9, 2026 July 17, 2026 July 30, 2026 Initiative 4 Round 2: The Next Generation of the Small Town Doctor and Team Sept. 30, 2026 Aug.

26, 2026 Sept. 10, 2026 Sept. 21, 2026 Initiative 5: Unified Care Infrastructure and Rural Cyber Protection June 2027 December 2026 March 2027 May 2027 Initiative 6 Part 1: Infrastructure and Capital Investments for Rural Texas September 2026 June 10, 2026 July 21, 2026 Aug.

14, 2026 Initiative 6 Part 2: Infrastructure and Capital Investments for Rural Texas November 2028 TBD TBD TBD Note: Dates provided are subject to change. In event of any conflict between the information provided in the table and the advertised solicitation documents, the solicitation and resulting contracts will control. Rural Texas Strong Update Rural Texas Strong Resources States were required to submit a one-time application to CMS.

HHSC submitted the “Rural Texas Strong” application to CMS on Nov. 3, 2025. Rural Texas Strong – Project Narrative (.

pdf) Rural Texas Strong – Other Supporting Materials (. pdf) Rural Texas Strong – Project Abstract Summary (. pdf) (Note: This PDF must be downloaded by right clicking on the file and clicking “Save Link As.

”) Rural Texas Strong – Project Narrative and Other Supporting Materials – Accessible Version (. pdf) The following documents were submitted to CMS on Jan. 30, 2026.

Budget Period 1 Revised Budget Narrative (. pdf) Budget Period 1 Revised Project Narrative (. pdf) Budget Period 1 Revised Program Organizational Chart (.

pdf) The following documents were approved by CMS on Apr. 7, 2026. Approved Budget Period 1 Revised Budget Narrative (.

pdf) Approved Budget Period 1 Revised Project Narrative (. pdf) Budget Period 1 Notice of Award (. pdf) For stakeholders interested in learning more about the Rural Texas Strong program, please view the following resources.

How to Prepare for HHSC Grants (. pdf) Rural Texas Strong – Fact Sheet (. pdf) Rural Texas Strong – Frequently Asked Questions (.

pdf) Gov. Greg Abbott's Endorsement Letter (. pdf) Notice of Funding Opportunity CMS Rural Health Transformation Program CMS Announces $50 Billion in Awards to Strengthen Rural Health in All 50 States Notice of Award Dec. 29, 2025 (.

pdf) HHSC is not meeting with potential vendors or applicants for the Rural Texas Strong Program to maintain fairness for all parties and protect future procurements related to the Rural Health Transformation Program. Rural Texas Strong: Supporting Health and Wellness Rural Texas Strong is the state’s approved application for Rural Health Transformation Program funding.

HHSC is establishing a Rural Texas Strong team to serve as the primary contact for this new program. Use the dropdown menu below to learn more about Rural Texas Strong’s six initiatives, as described in the Project Narrative. Updates will be made as CMS and HHSC work together to finalize approved budgets and project design.

Initiative 1: Make Rural Texans Healthy Again Eligibility for award : Rural Hospital Districts. Key stakeholders : Public hospitals, rural health clinics, federally qualified health centers in rural counties, emergency medical services, all health care workers, and all residents of a participating jurisdiction.

Procurement process : Direct awards HHSC will issue grants to rural hospital districts that choose to participate to enhance or create community-based prevention, wellness and nutrition programs, or services aimed at improving one or more of the following chronic disease conditions: Chronic respiratory disease Diabetes education and management should be a major focus, as shown in the associated outcome measures in the state’s application.

Local governments that receive this funding will be given significant flexibility in carrying out solutions to improve outcomes. Local governments will be required to identify vulnerabilities in the overall local rural health care ecosystem and to focus solutions on technological innovations that integrate mid-level practitioners and pharmacists, along with behavioral health and primary care clinics and providers.

Local governments will be required to carry out one or more of the following options: Purchase equipment, subsidize the facility cost of, or issue subcontracts or subgrants for a community wellness center. The center may offer preventive chronic disease screenings, gym equipment, group exercise classes, fitness and strength training, and nutritional education classes.

Partner with regional grocery stores, farmers markets, or local food pantries to sponsor regular pop-up grocery markets to make available fresh U.S.-grown produce, dairy and meat, healthy cooking demonstrations for all ages, or nutritional, ready-to-heat meals. (Funding cannot be used to purchase the food itself, based on CMS restrictions.)

Establish and operate an after-hours primary care clinic to reduce non-urgent visits to an emergency department. Provide low- or no-cost chronic disease screenings (prevention) and low- or no-cost primary care visits.

Provide non-urgent transportation support to improve access to pharmacies (to improve Texans’ adherence to medication); grocery stores that sell U.S.-grown produce, dairy and meat; and primary or preventive health care appointments. Establish care systems for active remote monitoring for patients with more serious or complex health issues.

Promote continuity of care by making technology (such as computers and electronic tablets) available at community partner organizations or entities for people who are dually eligible for Medicare and Medicaid.

The technology and other resources will allow people to research and enroll in health coverage options, such as the Dual-Eligible Special Needs Plan, and understand what Medicare options include local behavioral and preventive care providers. Include other strategies designed to increase individual rural Texans’ access to healthy foods, prescriptions and other items related to improving their health.

Hospital districts that receive the grants will be allowed to retain grant funding that exceeds their demonstrated costs as an incentive for achieving quality outcome measures. Targets for each grantee will be established at the time of the grant award but will be aligned with the overall outcome measures described in the Rural Texas Strong Project Narrative (. pdf).

These approaches can improve quality of life, mental health, worker productivity, and health outcomes while reducing patient expenses, hospital visits and disease. These local solutions will be sustainable. As chronic conditions improve among community residents, there will be a decrease in the overall cost burden for local health care.

Initiative 2: Rural Texas Patients in the Driver’s Seat Eligibility for award : Two or more clinically integrated networks, accountable care organizations or similar cooperatives.

Key stakeholders : Rural hospitals, rural health clinics, federally qualified health centers in rural counties, payers, pharmacists, independent physician practices, behavioral health providers, rural communities, patients, families and consumer tech innovators.

Procurement process : Request for proposal This initiative will invest in technology to establish consumer-facing health portals that engage patients and facilitate the exchange of health information between patients, providers and payers. Through consumer-facing portals, patients can: Communicate directly with their health care team through messaging.

Access documentation about medical visits, conduct virtual visits, and provide 24/7 access to personal health information. The health care portals will integrate with other applications and consumer technology to make them more attainable. These include: Devices that make sure consumers take medication.

Smart watches that record heart rates, oxygen saturation levels and blood pressure. Continuous glucose monitors. Devices that monitor compliance with using a continuous or bilevel positive airway pressure machine.

Portable in-home dialysis equipment. Other remote monitoring technology. In addition to the patient portal, funds will be available to purchase equipment that remotely monitors the health of consumers, or other portable health technology that is compatible with the portal.

The following criteria will be used to select the entities: Subject matter expertise and commitment to improving access to technology, specifically for health information exchanges and provider technology solutions. At least 60% of the entity’s membership includes rural providers. HHSC will also use the CMS Health Tech Ecosystem framework for patient-facing apps to guide contracting criteria.

Proposals should support exchanging data with patient identity verification, eliminate manual check-in forms, and provide tailored, data-driven support to people at risk of or living with diabetes and obesity.

Priority will be given to clinically integrated networks, accountable care organizations or companies identified as CMS Early Adopters with the ability to equip providers and patients with tools to manage and share their health information in a secure and easily understood way. Subcontractors must be willing to provide value-added services, such as digital literacy training for rural residents and providers.

The contractors will coordinate activities with HHSC and meet at least quarterly throughout rural transformation periods to make sure they are following the implementation plan. The goal is that assessment and project planning happen in rapid succession, so contracts can be executed, and advancements make their way to consumers as soon as possible.

Initiative 3: Lone Star Advanced AI and Telehealth Eligibility for award : Two or more clinically integrated networks, accountable care organizations or similar cooperatives. Key stakeholders : Rural hospitals, rural health clinics, emergency medical services providers, federally qualified health centers in rural counties, community mental health centers, certified community behavioral health clinics, rural patients and tech innovators.

Procurement process : Request for proposal Through this initiative, Texas will use artificial intelligence (AI) and telehealth to predict and improve patient outcomes, maintain care and more efficiently adjust medication and therapy for patients and providers.

These innovations in health care delivery will bridge service gaps across rural Texas and address critical barriers to care in rural communities, including limited access to specialty providers, high rates of chronic disease, and health care workforce shortages.

Not all rural Texans have access to the internet or reliable cellular coverage at home, so this initiative will also include resources necessary to establish local, patient-focused hubs where they can receive telehealth care. This initiative will involve close coordination with Initiative 2 and Initiative 5, which also prioritize tech innovation.

Personalized AI-driven support, in alignment with the CMS Health Tech Ecosystem , can also be used as support for patients. Early focus areas will include maternal health, behavioral health and preventive screening by: Supporting clinicians with administrative tasks. Giving payers the ability to receive appropriate medical information to process prior authorizations more quickly.

Create more accurate coding for claim submission and processing. More easily recognizing care coordination opportunities for comprehensive health coverage. Each site will measure outcomes across clinical quality, patient experience and cost reduction, creating evidence-based outcomes that can be scaled.

Telehealth can increase access to specialists, resulting in faster treatment and less travel. All telehealth services in this initiative will be directed toward prevention, behavioral health treatment, or remote monitoring of chronic conditions by relevant specialists. Telehealth can benefit providers by lessening the sense of isolation, while improving patient outcomes.

This project aims not only to improve outcomes by county, but to create a scalable, evidence-based model that can endure beyond Rural Texas Strong. HHSC will issue funding as a competitive request for proposals for two or more entities (such as clinically integrated networks or other similar accountable care organizations) with subject matter expertise and commitment to improving access to technology.

Selected entities must devote effort to increasing access to provider-focused, ambient AI tools that will support clinical documentation, billing and prior authorization requests. Similar to Initiative 2, entities will be restricted to using software and hardware that fully complies with CMS Health Technology Ecosystem criteria and is built to integrate with consumer-facing equipment and applications.

Priority will be given to technology created by companies identified as CMS Early Adopters . Clinically integrated networks, accountable care organizations or other cooperatives will be required to establish a communications framework where providers using the technology are able to regularly collaborate to share best practices and troubleshoot challenges as they integrate AI and telehealth into practice models.

Additionally, the funding recipients must develop a comprehensive plan to identify how these tools will be used to support the independence of rural providers.

Initiative 4: The Next Generation of the Small Town Doctor and Team Eligibility for award : Rural health care providers Key stakeholders : Rural hospitals, rural health clinics, federally qualified health centers in rural counties, community mental health centers, certified behavioral health centers, rural pharmacies, rural nursing homes, public health districts, pediatric long-term care providers, and rural emergency medical services.

Procurement process : Request for application Description : This initiative will provide funding to ensure the next generation of small-town doctors are surrounded by sufficient mid-level practitioners and allied health professionals to give rural residents access to all levels of care in their communities. Locally driven efforts will focus on at least one of four approaches: Developing career paths for local high school students.

Providing scholarships for recent high school graduates. Offering relocation or signing bonuses for early, mid, or late career professionals. Creating a new residency training program, fellowship or combination program, including partnering with academic institutions or an existing teaching hospital.

Eligible provider types will include hospitals, behavioral health clinics, rural health clinics, federally qualified health centers, pharmacies, emergency medical services providers, independent primary care physicians, independent specialty physicians, and other allied health professionals.

Participating providers, together with community leaders (including local economic development corporations, local governments, philanthropic partners, and schools), will be contractually required to: Develop and update a health care worker retention plan. Implement retention strategies.

Grantees using local funding for relocation grants will be contractually responsible for supporting new physicians and practitioners through training, mentoring and succession planning by providing value-added services, such as: Social community engagement opportunities. Continuing medical education for burnout and resiliency. Local housing, such as in-kind or subsidized.

HHSC will issue at least one award per county that is identified as rural, with preference given to governmental, nonprofit or privately held entities headquartered in Texas. HHSC will also issue funds via intergovernmental contracts for information technology upgrades to make sure web-based licensing, certification or registration systems for newly trained health care professionals is efficient.

Expenditures will be limited to those that are essential and directly related to provider types or professionals identified as a recruitment target for local providers. To maximize the allocation of funds to eligible providers, providers within counties will qualify based on their health professional shortage areas (HPSA) score for one of three need-based tiers. Allocations will range for each entity.

The higher the HPSA score, the more funding will be allocated. Before HHSC allocates funds, each grantee will develop and submit for approval a retention plan to make sure newly recruited staff are welcomed into a supportive community with an ongoing culture of mentorship. Applicants within a county will compete for their county-level award.

If only one applicant applies and is eligible, it will receive funding. For counties with multiple applicants, HHSC will establish a process to give top applicants an opportunity to make an oral presentation with a selected team of reviewers. Applicants will be selected based on a predetermined scoring process.

Initiative 5: Unified Care Infrastructure and Rural Cyber Protection Eligibility for award : Vendors listed as a Managed Security Services Provider with the Texas Department of Information Resources. Key stakeholders : Rural hospitals, rural health clinics, federally qualified health centers in rural counties, behavioral health hospitals, rural veteran nursing homes and tech innovators.

Procurement process : Request for offer Description : This initiative will establish a unified care infrastructure and bolster cybersecurity defenses across rural providers.

By deploying a managed security solution — including endpoint detection and response; comprehensive, all-time security operations center monitoring, and comprehensive user training — risk can be significantly reduced, ensuring the security of sensitive patient data, and enhancing the overall security of an organization. Endpoint detection and response provides real-time, continuous monitoring and data collection.

Its primary functions include: Virus and ransomware protection that actively scans for and prevents known and unknown malware. Exfiltration monitoring that detects and blocks attempts to maliciously transfer sensitive data. Analyses that identify suspicious behaviors and patterns that indicate potential compromise.

By mitigating ransomware and other cyberattacks, this investment preserves access to care, keeps hospital systems online, and prevents workforce disruption and burnout. It also protects revenue streams and improves the financial viability of rural providers by maintaining continuity in billing and operations.

The Texas plan will create a shared platform for hospitals, clinics, behavioral health providers and rural veteran nursing homes for significant, sustained technological advancements.

Initiative 6: Infrastructure and Capital Investments for Rural Texas Eligibility for award : Rural hospitals, rural health clinics, behavioral health providers, opioid and substance abuse programs, emergency medical services (EMS), pharmacies, public health offices and other eligible providers.

Key stakeholders : Rural hospitals, rural health clinics, federally qualified health centers in rural counties, behavioral health hospitals and clinics, local mental health authorities, opioid recovery programs, emergency medical services, pharmacies, long-term pediatric care providers, and public health offices.

Procurement process : Request for application Through this initiative, rural hospitals, clinics, behavioral health providers, opioid and substance abuse programs, EMS, pharmacies, and public health offices will be permitted to add and replace the equipment they need to improve patient care, within the required limitations on new construction and remodel projects.

Funds will be used to replace allowable equipment, including lab equipment, CT, ultrasound or mammography equipment, stretchers (especially self-loading), wheelchairs, patient beds, telemetry units, nurse call systems, ambulance buses, generators, defibrillators, crash carts, medication dispensing units, sleep labs, vital sign monitors, and oxygen tanks.

HHSC will use a scoring matrix for proposed projects categorized by urgency, impact, and alignment with strategic goals. Projects that contribute to a facility’s long-term financial stability, or can demonstrate a high degree of confidence in the proposed scope, schedule, cost and purported benefits of the project, may receive priority.

Preference will be given to projects that will use equipment or construction materials manufactured in the U.S. Texas’ Rural Health Transformation Program, Rural Texas Strong, is supported by the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $281,319,360. 67 in budget period 1 with 100 percent funded by CMS/HHS.

The website contents are those of HHSC and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS, or the U.S. Government. Email HHSC Rural Texas Strong for questions about the Rural Texas Strong Program.