Tennessee
Tennessee Department of Health (TDH)
Year 1 Award
$206.9M
Solicitations
01
All sub-grantee application windows have closed. Awards are under review.
Analysis
Tennessee received $206,888,882 from CMS on December 29, 2025, one of the larger awards in the Southeast. The per-rural-resident figure of approximately $94 is the second lowest among the five states in this batch, reflecting Tennessee's large rural population of over 2.2 million — concentrated in Appalachian eastern Tennessee and mid-state rural counties. TDH, under Commissioner John R. Dunn, is the designated lead agency. Tennessee moved to Phase 1 by establishing the Tennessee Rural Health Care Center of Excellence at UTHSC ($12 million sub-grant from TDH) and launching an initial round of sub-grantee solicitations through that intermediary, with a January 15, 2026 proposal deadline. This is a notable structural choice: TDH used a Center of Excellence model rather than a direct-to-provider competitive RFA — meaning the primary sub-grantee entry point is UTHSC, which in turn issues planning and implementation grants to eligible organizations. Tennessee's Appalachian rural health context is central to program design. Eastern Tennessee counties — Appalachian communities with higher rates of substance use disorders, cardiovascular disease, diabetes, and chronic respiratory illness — are significant targets for the program's behavioral health, prevention, and emergency services investments. The Eastern Band of Cherokee Indians (EBCI) is geographically adjacent to the western NC border but is a North Carolina-based federally recognized tribe, not a Tennessee-based tribe; EBCI is not an eligible sub-grantee in Tennessee's RHTP. Tennessee has no federally recognized tribes. The state has six state-recognized Indigenous groups, but state recognition does not confer RHTP eligibility standing. Tribal provisions are not relevant to Tennessee's RHTP sub-grantee eligibility. Tennessee is also notable for a policy tension flagged in January 2026: a portion of Tennessee's federal rural health funding may be conditioned on eliminating the state's Certificate of Need (CON) law, which currently restricts facility expansion and new service line entry. This political debate — CON repeal as a condition of rural health investment — could affect which facilities benefit from RHTP-funded service expansions and how quickly new infrastructure can be built.
Applications & Compliance
Implementation Model
Tennessee uses a hybrid implementation structure. TDH is the CMS prime awardee and lead agency. For sub-grantee distribution, TDH has funded the Tennessee Rural Health Care Center of Excellence at the University of Tennessee Health Science Center (UTHSC) with a $12 million sub-grant. The Center of Excellence operates as an intermediary: it issues planning grants (up to $100,000 per award, 12-month projects) and implementation grants (up to $500,000 per award, up to 36 months) to eligible organizations including nonprofits, healthcare institutions, academic institutions, and community-based organizations serving rural Tennessee. The first application window had a January 15, 2026 full proposal deadline and an April 1, 2026 contract start date. Beyond the Center of Excellence track, TDH is implementing several initiatives directly — including the Memory Care Assessment Network, Last Mile Teams (community paramedicine and mobile health), and a $100 million expansion of value-based payments through TennCare. For these state-administered initiatives, provider eligibility and application processes have not been separately published. Organizations seeking sub-grantee opportunities through TDH directly — rather than through UTHSC — should monitor tn.gov/health/rural.html for solicitation announcements.
Investment Priorities
Make Rural Tennessee Healthy Again
The broad prevention and chronic disease management initiative. Targets reduced rates of diabetes, cardiovascular disease, and "diseases of despair" (substance use, suicide) in rural Tennessee communities. Aligned with TDH's existing Health Resiliency Program (HRP) infrastructure.
Last Mile Teams
Emergency medical services expansion including additional ambulances, community paramedicine programs, and mobile health and maternal care units. Addresses gaps in rural EMS response capacity, which is particularly acute in eastern Tennessee's mountainous geography where transport times are long.
Memory Care Assessment Network
Dementia navigators and a network of rural memory care assessment points, targeting older adults in rural communities who face barriers to specialty cognitive evaluation. Tennessee's aging rural population makes this a high-priority investment.
Rural Non-Emergency Medical Transportation (NEMT)
Expansion of NEMT infrastructure to address transportation-related access barriers in rural counties. Relevant to Medicaid beneficiaries who cannot access care without transportation support.
Health Information Exchange (HIE)
Modernization of health information exchange infrastructure to improve data sharing across rural providers. Tennessee's rural provider landscape — 323 RHCs and 15 CAHs — creates interoperability challenges.
TN Community Compass
Community health navigation and care coordination. Likely includes community health worker and patient navigator programs connecting rural residents to preventive care, behavioral health, and social supports.
Tennessee Rural Health Care Center of Excellence (UTHSC)
Grants administration and research infrastructure. The Center of Excellence receives a $12M sub-grant from TDH to identify rural health gaps and administer planning and implementation grants statewide. It is both an implementation initiative and a grant distribution mechanism.
What to Watch
UTHSC Center of Excellence grant awards — April 2026
April 2026The first round of planning and implementation grants through UTHSC will be awarded with April 1, 2026 contract start dates. These awards will signal which organizations and project types TDH/UTHSC prioritize and which gaps remain unfunded. Organizations that missed this round should monitor UTHSC (rural-health.uthsc.edu) for subsequent rounds.
TDH direct solicitations for state-administered initiatives
TBD 2026Last Mile Teams, Memory Care Assessment Network, and the $100M TennCare value-based payment expansion are state-administered rather than routed through UTHSC. TDH has not published separate solicitations for these. Watch tn.gov/health/rural.html for RFA or procurement announcements for these programs.
Certificate of Need (CON) policy tension — legislative watch
2026 legislative sessionReports in January 2026 indicate that a portion of Tennessee's federal rural health funding may be linked to CON reform. If the Tennessee General Assembly conditions RHTP implementation on CON changes, this could alter which facility types are eligible to use RHTP funds for service expansion. Organizations with expansion plans should monitor state legislative developments.
Appalachian eastern Tennessee as priority geography
OngoingEastern Tennessee counties face the highest burden of diseases of despair, respiratory illness, and limited specialty care access. Whether TDH publishes geographic eligibility criteria or prioritization language that explicitly targets Appalachian counties will significantly shape which organizations can compete — and how strong geographic need will be scored in competitive processes.
FQHCs and CAHs — capacity for implementation grant scale
OngoingWith only 15 CAHs and 100 FQHC sites, Tennessee's safety net capacity to absorb implementation grants is meaningful but not unlimited. The UTHSC Center of Excellence implementation grants cap at $500,000 per award over 36 months — a scale accessible to smaller community organizations but likely insufficient for major CAH infrastructure projects. Watch for whether TDH issues larger direct awards outside the UTHSC track.