Hawaii
Hawaii Department of Health, Office of Primary Care and Rural Health (OPCRH)
Year 1 Award
$188.9M
Solicitations
01
CMS allocated RHTP funding to this state in December 2025. The state has not yet announced a lead agency, implementation timeline, or sub-grantee solicitation.
Analysis
Hawaii's Rural Health Transformation Program is distinctive in the national RHTP landscape for two reasons: its geography and its indigenous population structure. Hawaii is the only island-state in the program, with 95.1% of its land area classified as rural. Delivering healthcare across six inhabited islands separated by ocean creates logistical complexity that no continental state faces — providers on Molokai, Lanai, or the Big Island cannot simply refer patients to a neighboring county. The state's nine Critical Access Hospitals serve communities where the nearest alternative facility may be a 30-minute flight or a ferry ride away. With a rural population of approximately 279,500 — among the smaller rural counts nationally — Hawaii's $188.9 million Year 1 award translates to one of the highest per-rural-resident figures in the country. Hawaii's lead agency is the Department of Health's Office of Primary Care and Rural Health (OPCRH), which coordinates federal, state, and local rural health efforts statewide. The Governor's Office issued the CMS award announcement, and the program description references oversight coordination across state departments and healthcare organizations. Hawaii's application was built around six named initiatives covering digital infrastructure, telehealth, EMS, workforce, medical respite, and value-based care. As of late March 2026, Hawaii remains in Phase 0 — no sub-grant solicitation has been published, and the state indicates it is finalizing its budget in negotiations with CMS. Native Hawaiians are an indigenous group with a distinct federal recognition status. They are recognized and served under specific federal legislation — including the Native Hawaiian Health Care Improvement Act, which funds Papa Ola Lōkahi and the Native Hawaiian Health Care Systems — but they are NOT organized as federally recognized tribes under the federal Indian tribal framework. The Bureau of Indian Affairs tribal directory does not include Native Hawaiian organizations. The tribalNations field is set to 0 to reflect this accurately. Hawaii RHTP materials reviewed do not identify a tribal set-aside or a dedicated Native Hawaiian-specific funding track, though Native Hawaiians are disproportionately represented in rural and underserved Hawaii communities and are likely to be among the primary beneficiaries of RHTP-funded services.
Applications & Compliance
Implementation Model
Hawaii's implementation model is not fully defined pending CMS budget finalization and solicitation publication. Based on the Governor's office announcement and engage.hawaii.gov, the state is coordinating across multiple departments with the Department of Health's OPCRH serving as the administrative hub. The six initiatives are described as interconnected and coordinated — suggesting a state-administered model rather than a fully competitive open RFA. The application describes an "oversight team" coordinating "across state departments and healthcare organizations." Whether sub-grants will flow through a competitive RFA, a negotiated partnership model, or direct state-to-provider arrangements has not been published. Given Hawaii's small rural provider ecosystem — 9 CAHs, 35 FQHCs, 22 RHCs — a competitive model would involve relatively few eligible organizations. Providers interested in participating should monitor health.hawaii.gov/opcrh/ and engage.hawaii.gov/rhtp/ for solicitation announcements.
Investment Priorities
Rural Health Information Network (RHIN)
A statewide digital backbone connecting rural hospitals, clinics, and health centers through interoperable electronic health records, wireless networks, and integrated data hubs. The primary health IT infrastructure initiative for neighbor island providers.
Pili Ola Telehealth Network
Virtual care expansion through access points in schools, libraries, and community centers, with telehealth navigators facilitating patient connections. "Pili Ola" means "life connection" in Hawaiian.
Rural Infrastructure for Care Access (RICA)
Expansion of emergency medical services, mobile healthcare, community paramedicine, and behavioral health capacity across rural communities on all islands.
HOME RUN – Hawai'i Outreach for Medical Education in Rural Under-resourced Neighborhoods
Workforce development initiative creating training sites, residency programs, nursing pipelines, and recruitment and retention incentives to address rural provider shortages.
Rural Respite Network
Five new medical respite centers across the islands to support patients experiencing homelessness or transitional housing instability, reducing preventable hospital stays and emergency department utilization.
Rural Value-Based Innovation and AHEAD Readiness Fund
Competitive fund supporting rural providers in transitioning to value-based care models, including CMS's AHEAD model. The competitive structure suggests this initiative may operate as a sub-grant track.
What to Watch
CMS budget finalization and implementation details
OngoingHawaii's Governor's office stated that the state will finalize an updated budget based on the $188.9 million award and then begin releasing funds to "lead agencies and partners." The timeline for this budget finalization and the form of fund release have not been published. Monitor health.hawaii.gov/opcrh/ and engage.hawaii.gov/rhtp/ for announcements.
Sub-grant model for the Rural Value-Based Innovation and AHEAD Readiness Fund
2026Initiative 6 is described as a "competitive fund," which is the clearest signal that a sub-grant solicitation will be published for at least part of the program. This is the most likely first application opportunity for FQHCs, CAHs, and rural providers not already embedded as state partners.
Native Hawaiian provider access and eligibility
2026Native Hawaiians are disproportionately represented in Hawaii's rural and medically underserved communities. Organizations that serve Native Hawaiian populations — including Papa Ola Lōkahi and the four Native Hawaiian Health Care Systems — should monitor RHTP funding access. These organizations operate under the Native Hawaiian Health Care Improvement Act and have existing federal infrastructure but are not organized as tribes. Whether they will be treated as priority applicants or distinct partners in RHTP implementation has not been addressed publicly.
Initiative coordination vs. open solicitation
2026Hawaii's coordinated multi-department implementation model raises the question of whether most funding will flow through state-designated partners rather than an open competitive RFA. If the model is primarily state-directed, independent FQHCs and smaller rural providers may have limited direct application opportunities outside Initiative 6. Clarity on this question is the most important signal to monitor.