South Carolina RHTP — Pre-Solicitation Framework

South Carolina received $200,030,252 in Year 1 RHTP funding (~$183/rural resident). The lead agency is the South Carolina Department of Health and Human Services (SCDHHS). South Carolina is a non-Medicaid expansion state — approximately 53% of rural hospitals in non-expansion states operate at a negative margin nationally, and South Carolina's rural short-term PPS hospitals face structural financial pressure from thin payer mix.

South Carolina has only 3 CAHs, which is unusually low for a state its size; the safety net instead runs through its extensive FQHC network (139 sites) and rural health clinics (105 sites). This provider structure is likely to shape solicitation design: competitive grants that advantage organizations with federal grant track records would position FQHCs strongly. The SC Office of Rural Health (SCORH) is coordinating stakeholder engagement as a non-decision-making partner — "all RHT funding decisions are made solely by SCDHHS" per SCORH — and is accepting stakeholder interest survey responses as an early signal process.

Five investment initiative names are verbatim from the SCDHHS award announcement: Connections to Care (digital infrastructure expansion including electronic health records, telehealth connectivity, and resource databases); Leveling Up (scaling existing pilot programs for chronic disease management and workforce development to statewide reach); Wellness Within Reach (mobile health units, crisis response teams, and pop-up clinics to extend care to underserved areas); Shoring Up to Sustainability (workforce recruitment, facility upgrades, and provider training investments); Tech Catalyst Fund (seed funding for rural health technology startups and community-based innovations).

No distribution mechanism has been announced. No solicitation timeline has been committed by SCDHHS. South Carolina has no federally recognized tribes. No tribal set-aside or tribal eligibility provisions apply to this program. State-recognized tribal communities may apply as community-based organizations if they meet general eligibility criteria — contact SCDHHS for clarification when the solicitation is published.