Ohio's Rural Health Transformation Project will implement initiatives to improve health for rural Ohioans through innovation, healthcare access, and prevention. - The Ohio Rural Health Transformation Program (RHTP) presents this plan to strengthen healthcare access, outcomes, and workforce capacity across Ohio’s 73 non-urban counties. The 4.4 million residents living in these rural communities are impacted by limited access to care, hospital closures, workforce shortages, and high rates of chronic and behavioral health conditions. Rural and Appalachian Ohioans experience higher rates of heart disease, diabetes, COPD, cancer, and suicide than state averages. Thirteen counties are maternity care deserts, and nearly one in five rural hospitals is at risk of closure. Provider shortages are widespread: primary care availability is nearly half that of urban regions, and behavioral and oral health gaps persist. These challenges are compounded by lower education levels, higher poverty, and an aging population—one in three rural Ohioans is over age 60. Ohio’s plan aligns with federal priorities to Make Rural America Healthy Again through sustainable access, workforce development, innovative care, and tech advancement. Key Initiatives: Rural Health Innovation Hubs – Establish Clinically Integrated Networks (CINs) and Regional Centers of Excellence linking hospitals, clinics, EMS, pharmacists, and community partners to coordinate care, reduce costs, and expand capacity. Legislative reforms will allow low-risk birthing centers in rural hospitals. Emergency Care Transformation – Scale a successful pilot enabling EMS to provide treat-in-place or alternate-destination care, reducing unnecessary emergency department use through training, system upgrades, and improved connectivity. School-Based Health Centers – Establish clinics on K–12 and college campuses offering primary, behavioral, dental, and telehealth services for students and community members, serving also as rural clinical training sites. OH SEE – Expand statewide mobile vision, hearing, and dental care based on a 13-county pilot to ensure early diagnosis and treatment for children. Rural Workforce Pipeline – Build a continuum from high school through professional training and employment, featuring upskilling for community health workers and pharmacists, five-year rural service commitments, and partnerships among schools, universities, and employers. Cross-Cutting Strategies: RHTP embeds telehealth, remote monitoring, and interoperable electronic medical records across initiatives. Policy actions include expanding pharmacist scope of practice, establishing rural birthing centers, reinstating the Presidential Fitness Test, and requiring physician nutrition CME. More than 300 partners (hospitals, FQHCs, universities, EMS, associations) collaborated on the plan. Implementation will occur through local partners with state oversight. Sustainability: Each project is designed for long-term viability through billable service models, shared-service efficiencies, and alignment with Medicaid and value-based payment systems. Workforce incentives, technology adoption, and legislative reforms will ensure continuity beyond the grant period. Expected Outcomes by 2031: • Establish regional integrated networks across all rural counties. Expanded rural SBHCs. • Reduce avoidable emergency visits through EMS innovation. • Improve diabetes and hypertension outcomes statewide. • Increase the rural health workforce by at least 20%. • Strengthen maternal, behavioral, and preventive care access. Conclusion: This represents a bold, data-driven transformation of rural healthcare in Ohio. Through technology, policy innovation, and cross-sector collaboration, the program will create a sustainable model that improves care quality, strengthens the workforce, and enhances health outcomes for rural Ohioans.