States across the country are beginning to map out how they’ll use billions in new federal dollars to stabilize and transform rural healthcare. For rural hospitals, the stakes couldn’t be higher: these funds may determine whether they can sustain services, modernize care and crucially, whether they will have the budget and structure to hire and retain the nurses they need, including international nurses through employment-based immigration.
For healthcare organizations and recruiters working with foreign-educated nurses, understanding these changes isn’t optional it’s strategic. The way states design and deploy this money will directly shape demand for international nursing staff, visa sponsorship opportunities and long-term workforce planning.
Below, VisaMadeEZ breaks down what this new federal program means, where states are headed and how rural hospitals can align their immigration strategies with emerging funding priorities.
A New Federal Lifeline for Rural Healthcare
The Centers for Medicare & Medicaid Services (CMS) has launched the Rural Health Transformation Program (RHTP), a five-year initiative scheduled for 2026–2030. The program will distribute $50 billion nationwide $10 billion per year to support rural communities.
The funding model is split into two main parts:
- 50% distributed equally among all states, and
- 50% allocated based on:
- Rural population
- Land mass and geographic challenges
- Facility needs and infrastructure gaps
- Proposed policy actions and transformation plans
On paper, it’s one of the most significant federal investments in rural health in decades. In practice, it creates a patchwork of very different approaches across the states with direct consequences for rural hospital staffing, nurse recruitment and international nurse visa sponsorship.
Big Promises, Few Guarantees for Rural Hospitals
The stated goals of the Rural Health Transformation Program are broad and ambitious:
- Preserve and expand access to care in rural communities
- Modernize healthcare infrastructure and technology
- Strengthen workforce capacity, including nurses, physicians and allied health professionals
- Support new care delivery models, such as telehealth and value-based care
Importantly, funding is not performance-based, and states must submit annual progress updates. But one critical detail makes many hospital leaders uneasy:
> States are not legally required to pass funds directly to rural hospitals.
Instead, some states intend to use the dollars for statewide initiatives, pilots and grants that may or may not trickle down to providers on the front lines.
This uncertainty is compounded by another major policy shift: the same federal package that funds the RHTP also includes long-term Medicaid cuts, projected to reduce rural funding by $155 billion over the next decade, according to policy experts. For many rural hospitals, RHTP money is seen as a potential offset but only if it reaches them in time and in sufficient amounts.
For healthcare employers considering international nurse recruitment, that means:
- Some rural facilities will gain the financial stability to invest in long-term staffing, including foreign-educated nurses.
- Others may face even more pressure with tightening budgets, service cuts and increased risk of closure if funding bypasses them.
Strategic planning around nurse immigration and visa sponsorship needs to account for both scenarios.
New York Example: Planning for “Care Everywhere”
Some health systems aren’t waiting for all the details. In New York, Westchester Medical Center Health Network serving a large territory that includes many rural miles into the Catskill Mountains is moving ahead with its own transformation strategy.
CEO David Lubarsky, MD, notes that one-third of the system’s strategic plan is focused on “Creating Care Everywhere” an initiative that aligns with New York State’s rural health transformation objectives:
- Strengthening partnerships across rural and semi-rural communities
- Building technology-enhanced primary care and telehealth
- Developing a sustainable healthcare workforce
- Investing in long-term technological infrastructure
For an immigration-focused audience, the key takeaway is this:
Systems like Westchester are adopting multi-year strategies that require stable, reliable staffing pipelines. That includes expanding clinical teams with international nurses on immigrant visas (EB-3, sometimes H-1B where applicable), especially in hard-to-recruit rural and semi-rural areas.
Where states and systems commit to these kinds of long-term plans, VisaMadeEZ can help employers:
- Structure multi-year international nurse recruitment programs
- Navigate PERM labor certification, I-140 filings and consular processing
- Implement compliant, sustainable immigration strategies tied to rural service expansion
State Approaches: Early Engagement vs. Top-Down Planning
A defining feature of the RHTP so far is the wide variation in state engagement with hospitals. Some states are bringing rural providers into the process early. Others are shaping their plans with minimal direct input from hospitals.
Oregon: A Collaborative Model That Supports Workforce Planning
In Oregon, hospital leaders describe a more collaborative, data-driven approach.
Raymond Hino, CEO of Southern Coos Hospital & Health Center in Bandon, Ore., reports that the state has:
- Surveyed eligible rural facilities about their needs and readiness
- Created a nonbinding application process so hospitals could submit up to two project proposals
- Used this process to understand the expected volume and type of funding requests
Oregon is also rolling out a two-phase funding strategy:
1. Phase 1 (2026–2027): “Catalyst” grants
- Shovel-ready projects in:
- Behavioral health
- Maternal health
- Aging in place
- Chronic disease management
2. Phase 2: Regional, longer-term initiatives
- Shared infrastructure
- Sustainability-focused partnerships
Southern Coos plans to seek startup funding for a clinically integrated network (CIN) led by independent rural hospitals, with support from the Oregon Office of Rural Health. That kind of regional collaboration increases the need for coordinated staffing including nurses with diverse backgrounds and language skills.
Oregon will administer its program through the Rural Health Coordinating Council (RHCC), which includes rural hospitals, EMS, clinics and primary care providers. Hino, who serves as one of the rural hospital representatives, says stakeholders are optimistic funds will be targeted where they’re needed most.
What this means for nurse immigration and staffing:
- Hospitals that receive catalyst or regional transformation dollars may be better positioned to:
- Support relocation and onboarding of international nurses
- Offer more competitive salary packages in rural areas
- Justify longer-term staffing commitments essential for employment-based green card sponsorship
- Collaborative structures like CINs can support centralized recruitment and shared immigration planning across multiple hospitals an area where VisaMadeEZ can design multi-site immigration strategies.
Michigan: Limited Provider Influence and Disappointment
Other states are taking a more top-down approach, leaving hospital leaders frustrated.
In Michigan, Jeremiah Hodshire, president and CEO of Hillsdale Hospital, led a Michigan Hospital Association task force that spent months drafting recommendations on how to use RHTP dollars to address immediate rural needs particularly in the face of Medicaid cuts under federal legislation.
Despite that effort:
- The Michigan Department of Health and Human Services (MDHHS) declined to adopt any of the task force’s recommendations.
- Michigan ranked 43rd in state awards, among the seven lowest-funded applications nationally.
- Hodshire expressed doubt that his hospital will see meaningful benefit from the funds.
MDHHS has proposed focusing its dollars on:
- Rural hospital partnerships with community organizations
- Health professional recruitment and retention
- Chronic disease prevention
- Integrated behavioral health access
- Technology and interoperability
- A digital referral network
The state describes its plan as aimed at long-term sustainability and growth, but hospital leaders worry that funds will be absorbed by statewide initiatives and administrative structures, not the bedside.
For immigration and workforce planning, this environment creates challenges:
- Hospitals with immediate financial stress may lack capacity to sponsor international nurses, even though they face severe staffing shortages.
- State-level programs might support indirect workforce tools (e.g., telehealth infrastructure, training, digital platforms) without addressing the core issue: not enough nurses in rural communities.
For rural hospitals in states like Michigan, VisaMadeEZ often recommends carefully staged immigration strategies starting with a small cohort of foreign-educated nurses and scaling up as financial and regulatory conditions allow.
South Carolina: Waiting on Decisions and Federal Feedback
In South Carolina, the federal government has approved the state’s plan to administer RHTP funds through Healthy Connections Medicaid, but key decisions are still pending:
- Who will receive the funds
- Which programs and services will be prioritized
- How dollars will flow to individual hospitals
Brian Sponseller, CEO of Carolina Pines Regional Medical Center in Hartsville, says hospitals have less control than expected, though they remain in active discussions with state officials. The health department is still awaiting additional feedback from the federal government.
This “wait and see” dynamic is common in many states and it complicates staffing decisions, especially long-term commitments like sponsoring *international nurses for permanent residence.
Healthcare employers in states that haven’t finalized RHTP allocations should consider:
- Integrating immigration planning into multi-scenario budgeting
- Building flexible staffing models that can scale up if RHTP dollars arrive or pivot to other funding sources if they don’t
- Using immigration counsel, like VisaMadeEZ, to design phased international recruitment, aligning visa timelines with anticipated funding windows
Oklahoma: Focus on System Building, Not Short-Term Relief
Some states are being very clear: they will not use these funds as one-time bailouts for distressed hospitals. Instead, they’re targeting system transformation.
In Oklahoma, Tom Vasko, CEO of Newman Memorial Hospital in Shattuck, describes a strategic, long-term approach. The state has framed its Rural Health Transformation Fund around six core initiatives:
1. Innovating the care model
2. Moving upstream to focus on prevention and population health
3. Facilitating regional collaboration
4. Shifting to value-based care
5. Growing next-generation rural talent
6. Building health data utility and analytics infrastructure
Across these initiatives, Oklahoma wants to invest in:
- Operational leaders and early implementers
- Rural hospitals with capacity to innovate, scale, measure and report results
- Providers ready to turn transformation dollars into lasting access, quality and financial stability
At Newman Memorial, leaders expect to pursue targeted funding over multiple years, not a single lump-sum grant. Potential investments include:
- Expanded specialty access and telehealth
- Preventive and chronic disease management programs
- Regional collaboration to reduce duplicated services
- Workforce recruitment and retention initiatives
- Data and analytics tools
- Continued transition to value-based payment models
For rural hospitals and networks that fit this profile, immigration becomes a powerful tool:
- Long-term transformation requires a stable, reliable nursing workforce something many domestic labor markets cannot provide alone.
- Employment-based immigration can align with multi-year projects, allowing hospitals to build specialized, sustainable teams around chronic disease, population health and telehealth.
VisaMadeEZ works with transformation-minded organizations to:
- Embed international nurse recruitment into broader strategic plans
- Coordinate immigration timelines with grants, pilots and phased funding
- Ensure compliance with federal immigration, labor and healthcare regulations while pursuing innovation
Strategic Implications for International Nurse Hiring
Across states, a common theme is emerging:
RHTP funds are more likely to support system-building efforts than simple backfilling of operating losses. That has specific implications for healthcare organizations that rely on or are considering hiring international nurses.
1. Rural Workforce Shortages Aren’t Going Away
Even if RHTP funds are perfectly deployed, they won’t solve domestic nursing shortages, especially in rural areas. Many communities face:
- Aging local populations
- Limited nursing education capacity nearby
- Low retention of nurses who move from urban to rural settings
That’s why international nurses will remain a critical part of the solution. For rural hospitals, using immigration programs such as EB-3 immigrant visas is often the only realistic path to filling chronic vacancies.
2. Immigration Planning Must Match State Strategy
Rural hospitals should track how their state intends to use RHTP dollars and ask:
- Will funds support workforce development, recruitment or retention?
- Are there planned investments in telehealth, population health or specialty services that will require more nurses?
- Is the hospital part of a regional network or clinically integrated system that can co-design shared staffing solutions?
Where states are emphasizing long-term transformation (like Oklahoma or Oregon), hospitals have a strong case for integrating international nurse hiring into their funding proposals and strategic plans.
3. Financial Viability and Compliance Are Key
Immigration-based hiring requires:
- Demonstrating the ability to pay the prevailing wage
- Maintaining long-term employment relationships
- Complying with all federal regulations on recruitment and working conditions
Hospitals under severe financial strain may find it harder to meet these criteria. That makes it crucial to:
- Use RHTP-related planning to stabilize finances where possible
- Build realistic staffing budgets that incorporate foreign-educated nurses
- Partner with an immigration law firm familiar with healthcare-specific compliance risks
How VisaMadeEZ Supports Rural Hospitals and Healthcare Organizations
At VisaMadeEZ, our practice is built around helping healthcare organizations including rural hospitals, critical access facilities, health systems and long-term care providers hire and retain international nurses.
In the context of the Rural Health Transformation Program, we help clients:
1. Align Immigration Strategy with Funding and Policy
- Review your state’s RHTP plan and assess implications for staffing
- Identify where international nurse hiring can reinforce grant objectives, such as expanding access, enhancing care quality or supporting regional networks
- Design multi-year recruitment roadmaps that match funding timelines and operational goals
2. Navigate Complex Visa and Green Card Processes
We provide full-service immigration support, including:
- PERM labor certification and EB-3 immigrant visas for foreign-educated nurses
- Guidance on immigration strategy for rural and underserved areas
- Coordination with hospital HR, recruitment and legal departments
- Assistance with consular processing, documentation and onboarding timelines
3. Support Compliance and Risk Management
- Ensure wage, recruitment and working condition compliance
- Help integrate immigration activity into broader corporate compliance and credentialing frameworks
- Advise on best practices for retention, contract structuring and ethical recruitment
Moving Forward: Turning Policy Uncertainty into Strategic Opportunity
The Rural Health Transformation Program will not reshape the rural healthcare landscape overnight. State approaches differ widely, funding flows will be phased and hospitals will continue to operate under financial pressure. But for rural providers, especially those willing to innovate, RHTP can be a catalyst.
For healthcare organizations looking to hire international nurses, the message is clear:
- Don’t wait for perfect certainty build flexible, compliant immigration strategies that can adapt as state plans solidify.
- Use RHTP conversations and planning sessions to elevate staffing including international recruitment as a core element of sustainability.
- Recognize that long-term system-building and employment-based immigration naturally complement each other.
If your hospital or healthcare organization is exploring how to integrate international nurse recruitment into your rural health strategy, VisaMadeEZ is ready to help you navigate both the immigration system and this new funding environment.
Contact VisaMadeEZ to discuss how your organization can leverage international nursing talent within the evolving framework of the Rural Health Transformation Program and build a more resilient, sustainable rural healthcare workforce for the years ahead.
