An Acentra Perspective for State Medicaid Agencies 

By Heidi Robbins Brown, Vice President of Medicaid Policy and Client Engagement 

The Next Phase of Rural Health Transformation Has Begun

As states move from the Rural Health Transformation (RHT) application and award phase into implementation, the criteria for success are changing. Future funding is expected to depend increasingly on implementation performance, reporting quality, and measurable progress, not just the strength of an initial application.

For state Medicaid agencies, the focus is shifting from planning to execution.

5 Actions States Should Take Now

• Develop a rescoring readiness strategy.

• Capture evidence of progress throughout the year.

• Strengthen governance and executive oversight.

• Build dashboards to monitor performance and reporting.

• Continuously monitor and respond to CMS guidance

From Application Scoring to Performance Scoring

During the initial award phase, CMS evaluated application quality, proposed initiatives, and policy commitments. As implementation advances, future annual rescoring is expected to place greater emphasis on execution, milestone achievement, reporting quality, and measurable outcomes.

The question is no longer, "What did you propose?" It's increasingly, "What have you accomplished?"

What We Expect CMS to Focus On

As the program matures, CMS is expected to emphasize:

• Progress toward approved transformation initiatives

• Execution of policy and operational commitments

• Reliable, high-quality reporting and data integrity

• Demonstrated improvements in rural health access, quality, and outcomes

Building strong governance and performance management capabilities today will help states meet tomorrow's expectations.

Managing Emerging Risks

CMS guidance, scoring methodologies, and reporting expectations will likely continue to evolve. States should avoid treating compliance as a one-time reporting exercise and instead establish ongoing monitoring and operational readiness.

Questions also remain regarding expenditure timelines for early RHT awards. Until CMS provides additional guidance, states should clearly distinguish between budget periods, reporting periods, periods of performance, and expenditure deadlines to reduce compliance and financial risk.

How Acentra Can Help

Acentra partners with state Medicaid agencies to strengthen implementation performance across the RHT lifecycle. Our experts support:

• Executive governance and program oversight

• Performance measurement and analytics

• Reporting operations and data quality

• Provider engagement

• Readiness assessments and mock rescoring evaluations

By combining Medicaid expertise with performance management capabilities, we help states build sustainable processes that support long-term transformation success.

Looking Ahead: Performance Will Define Success

RHT is entering a new phase, one in which sustained implementation and measurable outcomes will matter as much as initial planning. States that invest in governance, performance management, and continuous readiness will be best positioned to demonstrate impact, adapt to evolving CMS expectations, and compete successfully for future funding.

The next chapter of Rural Health Transformation will be defined not by the strength of an application, but by the strength of execution.