Missouri ToRCH Care — Regional Network, Hub, and Technology Solicitations

Missouri received $216,276,818 in Year 1 RHTP funding and is implementing through the ToRCH Care (Transformation of Rural Community Health) framework — a hub-and-spoke regional model that distinguishes Missouri from every single-RFA state. Rather than issuing one broad competitive grant application, Missouri is building an infrastructure of seven regional coordinating networks and up to 30 multi-county community hubs, then procuring specific technology platforms, care delivery models, and workforce programs within that hub structure.

DSS's MO HealthNet Division is the lead, with DHSS and DMH as co-leads. DSS is hiring more than 100 people in 2026: approximately 90 to staff community hubs and 20–25 to run regional networks. These are state-administered positions, not sub-grant funded roles — a distinctive choice that signals Missouri is building institutional capacity rather than simply distributing federal funds to existing organizations.

The first competitive solicitations will be for technology platforms: the Remote Patient Technology procurement (Q2 2026) and the Social Care Referral Platform / Community Information Exchange (Q3 2026). Hub lead selection and regional network designations — which will determine which organizations become the fiscal and operational anchors of the program — are expected before or alongside these technical procurements.

No open solicitation has been published as of March 22, 2026. Organizations interested in Missouri's RHTP should use this period to engage with DSS's Rural Health Transformation Office and position for hub lead consideration.

Missouri is divided into 7 regions, each with a designated coordinating network. These networks are the primary governance layer — they direct resources, convene hub leads, and coordinate across facilities in each region. Network leads are expected to be institutions with regional reach: health systems, hospital associations, or major FQHCs. Network lead selection has not been published; whether selection is competitive or designated is TBD.

Within each region, 2–5 community hubs (each covering multiple counties) connect providers, behavioral health, EMS, public health, and social service organizations. Hub leads can be hospitals, FQHCs, or other rural entities. Critically, FQHCs can be hub leads in areas where hospital closures have eliminated the hospital as a potential lead — acknowledging the 12 Missouri rural hospitals in immediate jeopardy. Hub lead selection is the most consequential early decision for mid-tier organizations; it determines who controls resource flow within each sub-region.

The ToRCH model creates a hub-and-spoke entry problem. In most states, organizations apply directly to the state. In Missouri, the hub structure means your access to resources depends heavily on whether your organization becomes a hub lead, a hub member, or a technology vendor — three very different access points. Identify which role fits your organization before the solicitations open.