Hawaiʻi is poised to receive nearly $189 million in federal funding to expand health care access in rural and Neighbor Island communities, a major investment state officials say could transform how care is delivered beyond Oʻahu.
Gov. Josh Green announced Tuesday that Hawai'i has been awarded $188.9 million through the Centers for Medicare & Medicaid Services’ (CMS) Rural Health Transformation Program, part of a $50 billion national initiative funded under President Donald Trump’s Working Families Tax Cuts to strengthen rural health care systems nationwide.
Hawaiʻi’s award ranks among the highest in the country on a per-capita basis when measured by rural population, the governor’s office told Aloha State Daily.
The funding will support a five-year Hawaiʻi Rural Health Transformation Plan focused on improving health care delivery in communities where access is limited by geography, workforce shortages and aging infrastructure. The initial award covers federal fiscal year 2026, with additional annual funding expected through 2030, contingent on state performance.
Although Hawaiʻi is often viewed as urbanized, more than 95% of the state’s land area is considered rural. Health care services remain heavily concentrated on Oʻahu, requiring many Neighbor Island residents to travel long distances for specialty care, behavioral health services and emergency treatment.
Federal rules cap administrative costs at 10% of the award, with the remaining funds directed toward program implementation, the governor’s office told ASD.
CMS will distribute the funding to the governor’s executive office, which will allocate it among initiative leaders under a cooperative agreement that includes federal oversight. The state does not have sole discretion over how the funds are divided, and the final allocation is still being negotiated with CMS, a government representative told ASD.
Oversight will include quarterly and annual reporting on spending and outcomes, with both state and federal teams monitoring progress. CMS’ newly created Office of Rural Health Transformation will also be involved, the spokesperson said.
The rural health plan was developed through a statewide planning effort launched in July 2025 that included meetings with healthcare leaders, providers and residents across the islands, along with public feedback collected through the state’s Engage Hawaiʻi website. Performance metrics will be geographically specific to ensure resources reach the most underserved rural areas.
The plan focuses on six initiatives, including creation of a statewide health information network linking rural providers through shared digital systems, expansion of telehealth services, investments in emergency medical services, mobile health care and behavioral health capacity, and workforce programs aimed at recruiting and retaining healthcare professionals in rural communities.
Additional investments include upgrades to health technology, efforts to reduce cybersecurity risks facing rural providers and expanded medical respite services for unhoused and post-acute patients.
State officials said some improvements, such as emergency medical service upgrades and rural workforce incentives, could begin soon after funds are released. Larger system changes, including telehealth expansion and care team development, are expected to take longer, with long-term initiatives projected to have the greatest impact, according to the governor's office.
The Hawaiʻi Department of Health declined to comment.
“The DOH will defer comment on this subject to the governor’s office at this time,” Kristen Wong, information specialist for the department, told ASD.
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