The race to obligate

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State health agencies face an important challenge: moving quickly to obligate Rural Health Transformation Program funds while building the compliance, governance, and operational structures needed to translate funding into sustainable outcomes.

The states best positioned for success will treat obligation not as an isolated administrative milestone, but as one step in a broader transformation strategy. That means creating an efficient path from award through implementation, monitoring, and measurable impact.

Dive into our thinking:

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Four priorities for states

Simplify participation

Traditional grant processes can create barriers for organizations with innovative ideas but limited grant-writing resources. Streamlined Letters of Interest, applicant outreach, technical assistance, and educational sessions can help broaden participation and accelerate funding deployment.

Build scalable oversight

Funding obligation is only the beginning. States need practical approaches for monitoring subrecipients, maintaining compliance, supporting reporting requirements, and reducing future audit risk. Technology-enabled and risk-based monitoring models can help agencies scale oversight efficiently.

Expand program capacity

Many states are managing aggressive timelines with limited staff resources. Partnerships with academic institutions, regional organizations, and other qualified entities can provide additional administrative and operational support while maintaining accountability and transparency.

Establish governance early

States moving fastest are investing in governance, reporting, risk management, and stakeholder coordination before funds are distributed. A strong foundation can help accelerate implementation and support sustainable program outcomes.

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KPMG helps balance speed and compliance by supporting:

Transformation Management Office (TMO) design and implementation
Funding solicitation development and execution
Compliance and subrecipient monitoring frameworks
Grant and procurement management processes
Stakeholder engagement and change management
Integrated planning, risk management, and performance measurement capabilities

Success will not be measured solely by whether funds are obligated on time. It will be measured by whether those investments improve access, strengthen rural health infrastructure, and advance better outcomes for rural communities. States that move quickly while putting the right structures in place will be best positioned to turn funding into lasting transformation.