This blog post is part of an NHeLP series about current initiatives to improve maternity care in California. The first blog post is on the California Department of Health Care Services Birthing Care Pathway. The second blog post is on California’s Transforming Maternal Health Model. This, the third and final blog post, is on the California Rural Health Transformation Program.
We know that the $50 billion allocated in H.R.1, or the One Big Beautiful Bill Act (OBBBA), for the five-year Rural Health Transformation Fund, was meager consolation to what is anticipated to be a devastating loss in funding to rural communities across the country through $1 trillion in cuts to Medicaid and other health systems through the bill. However, there has been a great deal of attention to rural health and rural communities through what the Trump Administration has now named the Rural Health Transformation Program (RHTP). The RHTP has five strategic goals: “making rural America healthy again,” sustainable access, workforce development, innovative care, and tech innovation. State applications for RHTP funding had to fall into one of a list of ten categories of interventions.
In April 2026, California was awarded $233.6 million from the RHTP (of a requested amount of $1 billion) for fiscal year 2026. California’s proposal, which was submitted by the California Department of Health Care Access and Information (HCAI), explained that the state would improve health outcomes in rural communities by increasing access to primary, maternity, chronic disease, and specialty care services. The California Rural Health Transformation (CalRHT) Program will increase access to these services by funding three distinct initiatives:
- Create a rural health transformation care model, comprising regional hub and spoke networks for rural communities anchored by hospitals, clinic, and birthing centers;
- Develop the rural health workforce by identifying needs, strengthening education pathways from high school to higher education pipelines, and growing non-physician maternal health provider roles such as community health workers, nurses, doulas, and midwives;
- Invest in rural health technology and tools including infrastructure and connectivity, improving electronic health records and health information exchange, and the use of Remote Patient Self-Monitoring tools.
Once again, the CalRHT Program’s focus on access to care as well as on individually tailored, person-centered maternity care, is very similar to the twin goals of increased access to maternity care providers, as well as the individually tailored whole-person care, that are integral in both the state’s Birthing Care Pathway as well as its TMaH model.
The CalRHT Program funding will not adequately fill the loss of funding attendant with H.R.1. Rural communities in California, which are already underserved regions that have consistently and systematically been denied access to health care, will continue to bear the brunt of maternity wing and hospital closures in the years to come. Nonetheless, it is possible that the combined efforts of the Birthing Care Pathway, TMaH Model, and CalRHT Program will at least help protect and expand care for pregnant and postpregnancy Medi-Cal enrollees, and hopefully lead to innovations in access to and delivery of care which can serve as models to improve care for others on Medi-Cal as well.
