Rural communities remain deeply affected by the overdose crisis. Long distances to care, workforce shortages and hospital closures limit access to prevention, treatment and recovery services.
Provisional data from the Centers for Disease Control and Prevention (CDC) estimate 76,516 drug overdose deaths in the 12 months ending April 2025, a 24.5 percent decline compared to the previous year. Yet rural areas have not experienced the same pace of decline and continue to face persistent disparities, including higher mortality among women. Many rural counties lack licensed substance use disorder treatment providers, and emergency medical response times are often longer than in urban communities. The 988-crisis hotline has expanded behavioral health emergency support, but rural callers still face longer wait times. Most rural overdose deaths occur at home, where family members may not have naloxone or follow-up care access.
American Indian and Alaska Native (AI/AN) communities face the highest overdose mortality rates nationally. In 2022, AI/AN individuals experienced 55.7 overdose deaths per 100,000 people, higher than any other racial or ethnic group. Geographic isolation, chronic underfunding of tribal health systems and limited treatment options aligned with cultural needs contribute to these outcomes. Rural transformation efforts must include tribal health leaders and community-driven strategies to reduce these disparities
Persistent structural barriers compound these challenges. Behavioral health services are undervalued in many payment models, telehealth access is uneven, expiring and the behavioral health workforce remains limited. More than 140 rural hospitals have closed since 2010, reducing access to emergency services and to mental health and addiction care. The Rural Health Transformation Program RHT Program is designed to stabilize and modernize rural systems through locally led and sustainable solutions.
Rural Health Transformation and the Overdose Crisis
The RHT Program, launched by the Centers for Medicare & Medicaid Services (CMS), provides states and communities with tools to redesign rural health systems to meet local needs. Applications for the next program cycle close November 5, 2025. Congress established the RHT Program to support states in improving rural care delivery. The law allocates approximately $50 billion (about $150 per person in the US) between 2026 and 2030 to address:
Workforce shortages
Behavioral health integration
Care coordination
Payment and data modernization
States must submit a Rural Health Transformation Plan to receive funding. These plans outline how the state will expand access to care, support rural providers and strengthen behavioral health and substance use disorder treatment capacity.
RHT funds may be used to:
Expand behavioral health and treatment infrastructure
Build telehealth and digital health capacity
Support workforce recruitment and training
Update payment and data systems to support coordinated care
Integrating behavioral health into primary care helps connect people to treatment earlier and reduces reliance on emergency services. When implemented effectively, these changes shift care systems toward prevention and sustained recovery support.
H.R. 1 also includes broader federal budget changes affecting rural health. Independent analyses indicate projected reductions in federal Medicaid spending for rural hospitals over the next decade. The RHT Program provides new resources that may help stabilize rural health systems during this period, but the funding is time limited. Long-term planning will be necessary to maintain improvements in access to care.
The Role of Local Partners
Community-based organizations support rural overdose response every day. Nonprofits, recovery groups, harm reduction coalitions and first responders often act as initial points of contact in overdose emergencies. Partnerships between local organizations and hospitals connect people to treatment, recovery supports and follow-up care.
Federal policy has also helped strengthen these connections. The SUPPORT for Patients and Communities Act expanded access to medication-assisted treatment by allowing nurse practitioners and physician assistants to prescribe buprenorphine and supported the use of telehealth for substance use disorder treatment in rural areas. These provisions are important in rural regions where provider shortages and travel distances limit access to evidence-based care. The SUPPORT Act’s emphasis on integrating treatment services into primary care aligns directly with the RHT Program’s goal of building sustainable rural health delivery systems.
Local and tribal partners ensure that policy investments translate into practical outcomes by:
Expanding access to medication-assisted treatment
Distributing naloxone
Coordinating post-overdose outreach and follow-up
Supporting recovery services informed by community priorities
Aligning clinical and community strategies strengthens the continuity of care and supports long-term recovery.
Application Details and Next Steps
Eligible states and health systems can apply through the CMS Rural Health Transformation webpage before November 5, 2025. CMS recommends proposals include measurable goals, community engagement plans and strategies for sustaining improvements beyond the funding period. Collaboration among hospitals, communities and state leaders increases the likelihood of success.
A Collective Responsibility
Rural health transformation and overdose prevention are linked. Aligning federal, state and local solutions supports communities in responding to the overdose crisis and preparing for future health challenges. The RHT Program provides a framework for building coordinated and resilient rural health systems. Supporting this work ensures access to evidence-based care regardless of where someone lives.
