For Rhode Island, the challenge of providing health care in rural communities is not necessarily about distance on a map. In some parts of the state, it can come down to whether a doctor, dentist, behavioral health provider or other medical service is available at all.
That is the problem state officials are now trying to address with a $156.17 million federal Rural Health Transformation Program award.
The money is part of a five-year federal initiative created to strengthen health care in rural communities across the country. Rhode Island received more than $156 million for its first year, with the state developing a series of initiatives intended to expand access, modernize health care and strengthen the rural health workforce.
Rhode Island’s definition of rural health is broader than the federal designation.
Federally, only New Shoreham, or Block Island, and Westerly are designated as rural areas. Rhode Island uses its own definition for the program, identifying 18 communities with populations and population densities that meet the state’s criteria for rural health challenges.
Those communities are Burrillville, Charlestown, East Greenwich, Exeter, Foster, Glocester, Hopkinton, Jamestown, Little Compton, New Shoreham, North Smithfield, Portsmouth, Richmond, Scituate, Smithfield, Tiverton, West Greenwich and Westerly.
Together, those communities represent roughly 18% of Rhode Island’s population.
From a grant to a health care system
The state’s plan goes well beyond building or expanding traditional medical offices.
Rhode Island’s Rural Health Transformation Program includes initiatives involving primary care, behavioral health, dental services, hospital-at-home care, emergency medical services, health information technology, workforce development and community-based care.
One of the state’s goals is to make federally qualified health centers and other community providers stronger anchors for rural communities.
Another is to move more care into the communities themselves through mobile and community-based services.
That could include mobile dental and family medicine services, nutrition programs, behavioral health support and health services connected to schools and other community locations.
The state has allocated approximately $7.2 million in the first year for rural community-based and mobile health services.
But “mobile health” does not necessarily mean putting every service inside a van and driving it from town to town.
That distinction could become important as the program moves from planning into implementation.
Health officials have described community-based care as potentially including providers traveling to homes, schools, community centers and other locations where rural residents already live and gather.
Access looks different from town to town
The need for new approaches becomes clearer when looking at provider availability.
According to the Rhode Island Executive Office of Health and Human Services, six of the state’s rural communities currently have no local physicians when measured by physicians per 1,000 residents: Exeter, Glocester, Little Compton, New Shoreham, Richmond and West Greenwich.
For residents in those communities, simply having health insurance does not necessarily mean having convenient access to care.
Transportation can also become part of the equation.
Block Island provides one of the clearest examples. The island’s geographic isolation can turn a routine appointment into a day-long trip off the island.
Wood River Health operates a dental clinic at the Block Island Health Center twice a month. The clinic serves patients of all ages, including Medicaid patients.
That type of service illustrates one of the central ideas behind the state’s rural health strategy: bringing care closer to residents rather than expecting residents to repeatedly travel to where the health care system happens to be located.
Technology is another piece of the plan
The program also puts significant emphasis on health information technology.
Rhode Island’s plan calls for investments in digital infrastructure that can support telehealth, improve connectivity between providers and help health care organizations coordinate care and participate in value-based payment models.
The state is also looking at ways technology can support care coordination and the use of artificial intelligence in health care.
For residents in communities where specialty care may not be available locally, expanded telehealth capacity could provide another way to connect patients with providers without requiring every appointment to involve a long drive.
Workforce remains a central issue
Infrastructure alone cannot solve a shortage of health care professionals.
The state’s plan includes workforce development efforts designed to recruit, train and retain health care workers in rural communities.
That includes clinical training placements, mentorship and education-to-employment pathways in high-demand health care fields.
The approach reflects a larger challenge facing rural communities: attracting health care professionals can be difficult when there are fewer providers, fewer facilities and larger geographic areas to cover.
Rhode Island is therefore attempting to address access and workforce issues at the same time.
The money is now moving into implementation
The federal award was announced in December 2025. In April 2026, the state submitted a budget amendment covering anticipated spending for fiscal years 2026 and 2027 after the Centers for Medicare & Medicaid Services approved the state’s plan.
The state’s first-year plan contains 13 initiatives.
Among the largest proposed investments is $32.2 million for helping hospitals, primary care practices and federally qualified health centers transition toward value-based payment models. Other initiatives address behavioral health, rural community health networks, health information technology, mobile health and emergency medical services.
The state is also establishing a Rural Stakeholder Advisory Council to provide community and provider input as the program moves forward.
A separate national tracking project, Rural Care Journey, is following how states are implementing the Rural Health Transformation Program and documenting new funding opportunities, projects and state-level developments. Its Rhode Island tracking shows the state moving into the implementation and stakeholder-engagement phase of the program.
For Rhode Island’s rural communities, the significance of the program will ultimately be measured less by the size of the federal award than by what residents experience locally.
A new telehealth connection, a dental appointment that no longer requires an off-island trip, a behavioral health service closer to home or a newly recruited health care professional could represent a much more tangible measure of whether the program is working.
The first-year funds are scheduled to be spent by Sept. 30, 2027, giving the state roughly a year to move many of these plans from policy documents and funding proposals into services residents can actually use.
For the 18 communities included in Rhode Island’s rural health definition, that transition is now underway.
Disclosure: Tony Jones is a member of the Rhode Island Rural Stakeholder Advisory Council.
