There is a $50 billion federal program moving through every state in America right now. If your tribal nation has a health department, a clinic, or a technology need, money from this program could end up in front of your leadership — and the decisions you make with it will have consequences for years.

Most tribes have not been properly briefed on what is actually happening. This post is an attempt to change that.

What Is the Rural Health Transformation Program?

The Rural Health Transformation Program (RHTP) was authorized by Congress in 2025 under the One Big Beautiful Bill Act and is administered by the Centers for Medicare and Medicaid Services (CMS). It allocates $10 billion per year from 2026 through 2030 — $50 billion total — to all 50 states to modernize rural health care infrastructure.

Every state has received a Year 1 award. Awards range from roughly $147 million to $281 million per state per year. Arizona, for example, received $166 million for 2026 alone. The program runs through 2030.

Tribal nations are explicitly included as eligible subgrantees. That means your health department could qualify for funding to purchase:

• Telehealth infrastructure
• Remote patient monitoring equipment
• Electronic health records or care coordination software
• Population health data platforms
• Cybersecurity tools and risk management programs
• Health information exchange capabilities
• Artificial intelligence and augmented intelligence tools
• Revenue cycle management systems

That is a significant list. And it comes with a significant problem.

The Problem Nobody Is Talking About

Here is how RHTP actually works in practice:

The state holds the money. Funding flows from CMS to each state's lead agency — in Arizona, that is AHCCCS. The state then runs a subgrant process. Organizations — including tribal health departments — apply for funding and the state approves or denies those applications.

The state hires advisors. To manage the volume of applications and ensure proper oversight, states are procuring technical advisory firms to review subgrantee proposals and advise the state on what to approve. Minnesota has already issued an RFP for exactly this. Other states are following.

Those advisors work for the state. Their job — stated explicitly in procurement documents — is to advise the state on whether your proposed purchase is appropriate and whether the vendor you chose is a good fit. They are not your advocate. They are the state's.

Technology vendors are circling. Any program that allocates hundreds of millions of dollars for technology purchases attracts vendors. They are submitting bids, attending state planning sessions, and positioning their products for tribal health departments that may not have the internal expertise to evaluate competing claims.

Nobody at the table is specifically there for you.

This is not a conspiracy. It is simply how large government programs work. The state has its interests. Vendors have theirs. The tribal nation — with its unique sovereignty, data governance obligations, federal trust relationships, and operational realities — does not have a dedicated voice in that room unless it brings one.

What We Have Seen Happen

Over 20 years of working with tribal governments and health departments, we have seen versions of this play out repeatedly:

The system that was "the standard." A vendor presents a solution as the industry standard for tribal health systems. The tribe approves it. Two years later, the vendor sunsets the tribal-specific module, and the tribe is left on a migration path it did not budget for.

The implementation that never finished. A technology purchase is approved under a grant program. The vendor deploys a partial solution, collects payment, and the implementation stalls. Because the grant is time-limited, the tribe is left with a partially configured system and no recourse.

The contract nobody read carefully. A software agreement includes automatic renewal clauses, data ownership language that is ambiguous at best, and support terms that shift after the first year. The tribe signed it because the grant window was closing and nobody had time to review it properly.

The upgrade nobody budgeted for. Hardware is purchased at grant cost. Three years later it is out of warranty, unsupported, and incompatible with new systems. The original grant did not include lifecycle planning, and the tribe has no replacement budget.

These are not hypothetical scenarios. They are patterns. And the RHTP, with its compressed timelines, large funding amounts, and dozens of technology categories, creates ideal conditions for all of them.

What We Do

DeSoto Consulting LLC is not a technology vendor. We do not sell software, hardware, or managed services to tribes. We are not affiliated with any platform or product. We have no stake in which technology you choose.

We work for the tribe. That independence is the entire point.

Specifically, here is how we engage with tribal health departments navigating RHTP funding:

1. Pre-Application Technology Assessment

Before you apply for funding, we help you define what you actually need — not what a vendor tells you that you need. We review your current technology environment, identify the gaps that genuinely affect your health department's ability to serve your community, and help you articulate those needs in grant application language that meets state requirements.

Example: A tribal health department wanted to apply for telehealth funding. A vendor had already proposed a $180,000 platform. We reviewed the proposal and identified that the tribe's existing EHR had built-in telehealth functionality that required only a configuration change and a modest training investment — saving the tribe from committing $180,000 of grant funds to a redundant system.

2. Vendor Proposal Review

When a vendor submits a proposal for your consideration — whether you solicited it or they came to you — we review it independently. We evaluate pricing against market benchmarks, assess contract terms for risk, verify vendor claims about functionality and support, and identify anything that warrants a harder question before you sign.

Example: A tribal clinic received competing proposals for a population health analytics platform. We reviewed both, identified that one vendor's "tribal-specific" module was a rebranded version of a generic rural health product with no actual tribal data governance accommodations, and helped the clinic ask the right questions to expose that before a decision was made.

3. Contract and Agreement Review

Technology contracts are written by vendor legal teams to protect vendors. We review agreements for data ownership provisions, exit clauses, support tier definitions, automatic renewal language, and terms that create long-term financial obligations beyond the grant period. We flag risks in plain language and help you negotiate better terms before signing.

Example: A health department was presented with a five-year SaaS agreement as a condition of grant-funded software. The agreement included a data portability clause that gave the vendor 90 days to return data upon termination — but only in a proprietary format. We required the vendor to amend the clause to include standard export formats before the tribe would sign.

4. Technology Governance Advisory

RHTP-funded technology does not disappear when the grant period ends. You own it, support it, and are responsible for it. We help tribal health departments think through what happens after the check clears: staffing requirements, ongoing support costs, upgrade cycles, data backup and security obligations, and how a new technology acquisition fits into your broader IT environment.

Example: A tribal health department was considering a remote patient monitoring program that required patients to use cellular-connected devices. We identified that a significant portion of the patient population lived in areas with no reliable cellular coverage — a fact not addressed anywhere in the vendor's proposal — and helped the department evaluate alternatives before committing.

5. Ongoing Advocacy During State Review

As states evaluate subgrantee proposals, questions arise and decisions get made. We stay in the process with you — reviewing state feedback, helping you respond to information requests, and ensuring that the tribal-specific context of your application is not lost in a process designed for rural hospitals and clinics.

What We Are Not

We are not here to tell you what to buy. We are not here to steer you toward any particular vendor. We are not a managed service provider, a reseller, or a system integrator.

We are also not free. We charge for our time, and we are transparent about that. The value we provide is independence — and independence has to be paid for by the tribe, not subsidized by a vendor relationship that would compromise it.

What we can tell you is that in our experience, the cost of independent advocacy is almost always less than the cost of a bad technology decision.

The Window Is Narrow

RHTP implementation is accelerating. States are issuing RFPs for advisory services. Vendors are already engaging tribal health departments. Grant application windows will open and close on state timelines, not tribal ones.

If your nation is navigating this program — or is about to — and you want someone in your corner who has no other agenda, we are available.

Reach out directly: Click Here

Sergio DeSoto

DeSoto Consulting LLC has provided independent technology advisory services to tribal governments and tribal health departments for over 20 years. We are not affiliated with any technology vendor, managed service provider, or health IT platform.