Rural Health Transformation Is a Once-in-a-Generation Opportunity. Sustainable Crisis Systems Will Not Build Themselves.
Paul Galdys, MBA
Executive Principal Consultant - Recovery Innovations
John Draper, Ph.D.
President of Research, Development, & Government Solutions - Behavioral Health Link
Across the country, state leaders are asking an important question: How can we use new Rural Health Transformation Program (RHTP) investments to create lasting improvements in healthcare access, especially where communities are exceptionally resource-challenged?
The answer is not simply to fund more services, but to build stronger systems.
As states begin implementing their Rural Health Transformation Program strategies, many are prioritizing behavioral health, workforce development, crisis response, technology infrastructure, care coordination, and sustainable access to care. National analyses of state RHTP applications show a growing emphasis on strengthening rural behavioral health crisis systems through efforts that include expanding mobile crisis services, incorporating crisis receiving and stabilization centers, improving telehealth access, and building long-term workforce capacity.
This moment gives Recovery Innovations (RI) and Behavioral Health Link (BHL) an extraordinary opportunity to help states transform temporary funding into permanent capability. RI knows what works and what doesn’t from 30 years of crisis care service delivery in nine states along with consulting work in dozens of others. Behavioral Health Link (BHL) brings two decades of experience using technology to connect crisis care across entire states. Beginning in Georgia in 2006, BHL pioneered statewide crisis care coordination and developed technology to connect crisis contact centers, mobile response, and other services across the continuum. Today, BHL provides crisis care coordination technology in 15 states, connecting rural and urban communities through real-time referral and dispatch, care coordination, and facility and bed-registry tools that help people reach available acute and ongoing services.
Rural Communities Face a Different Crisis Care Challenge
Rural communities often experience:
Long travel distances to care
Behavioral health workforce shortages
Limited crisis stabilization capacity
Fragmented service coordination
Overreliance on emergency departments and law enforcement
Difficulty sustaining services after grant funding ends
Consider what a behavioral health crisis can mean in a rural community. A mother calls for help because her adult son is becoming increasingly suicidal. The nearest psychiatric facility may be more than an hour away, there may be no psychiatrist in the county, and the local emergency department may be the only immediately visible option. But imagine a different system: the crisis contact center knows what resources are available; a mobile team or appropriately equipped EMS/police response can reach him; telebehavioral health can bring clinical expertise to the encounter; the team can identify an available crisis setting rather than defaulting to an emergency department; and, after the immediate crisis, someone follows up to make sure he actually connects to ongoing care. The individual services matter. But what changes the experience is that they function as a system.
These challenges are well documented nationally and continue to affect behavioral health access throughout rural America. Yet rural communities also possess tremendous strengths: close community relationships, innovative providers, strong local leadership, and a willingness to develop creative solutions when traditional models do not fit local realities.
The question is not whether transformation is possible. The question is whether states will use RHTP investments to create systems that remain viable long after federal funding ends.
The Biggest Risk is Temporary Success
Many large funding initiatives create a familiar pattern:
A new program launches.
Staff are hired.
Services expand.
Communities celebrate.
Then the funding ends.
Without sustainability planning, reimbursement alignment, operational readiness, governance structures, workforce development, and performance management, many well-intentioned investments struggle to survive. This is particularly true in behavioral health crisis care.
A crisis center is not sustainable simply because it opens its doors.
A mobile crisis team is not sustainable simply because vehicles are purchased.
A crisis continuum is not sustainable simply because a state receives funding.
Sustainability must be designed from the beginning. The real test isn’t how many people are hired or programs launched in 2026–2030; it’s whether states emerge in 2031 with different financing, workflows, workforce models, technology, data and accountability than they had in 2025. This theme is reflected throughout RI’s recent work examining how Rural Health Transformation investments can strengthen behavioral health and crisis systems for the long term.
Why Crisis Care Should Be a Priority Investment
Behavioral health touches nearly every major goal of rural transformation:
Access to care
Hospital sustainability
Workforce development
Community health outcomes
Public safety partnerships
Technology innovation
Care coordination
When crisis systems function effectively, communities often experience:
Reduced emergency department utilization
Less unnecessary law enforcement involvement
Faster access to care
Improved patient and family experience
Better coordination across providers
More efficient use of scarce healthcare resources
States increasingly recognize this connection. Recent analyses of Rural Health Transformation investments highlight behavioral health integration, crisis continuum development, workforce expansion, telehealth, and sustainable payment models as central priorities.
Where Recovery Innovations and Behavioral Health Link Can Help
For more than two decades, Recovery Innovations has helped communities design, implement, and operate behavioral health crisis systems. Today, RI Consulting & Training is helping states move beyond planning and into implementation. In addition to operational readiness, our consulting work is increasingly focused on helping states leverage RHTP and other transformation investments to create sustainable crisis systems through (1) system and continuum assessments, (2) crisis continuum design, (3) Medicaid and payer sustainability – including parity, (4) workforce development, (5) governance and stakeholder alignment (regulatory structure optimization) and (6) technology.
(1) System and Continuum Assessments
Before investing millions of dollars, states need a clear understanding of existing strengths, gaps, utilization patterns, workforce challenges, and community needs. RI helps states conduct comprehensive system assessments that inform strategic investment decisions and identify the highest-return opportunities for transformation.
(2) Crisis Continuum Design
Every state wants a coordinated crisis system. Few begin with a shared operational blueprint. RI assists states and communities in designing crisis continua that may include:
988 integration
Technology to increase efficiency and accountability
Mobile crisis response
Crisis receiving and stabilization services
Peer support infrastructure
Care transitions
Regional access strategies
Rural and frontier service delivery models
Increasingly, that crisis coordination blueprint also needs to define how information follows the person across the continuum—so that each service knows what came before, what comes next, and whether the connection to the next source of care actually occurred.
(3) Medicaid and Payer Sustainability
Many behavioral health providers remain overly dependent on grants and state, county or local general funds. A critical component of sustainable transformation is helping providers maximize appropriate reimbursement through Medicaid, managed care, Medicare, and commercial insurance. Recent RI implementation work has focused heavily on provider billing readiness, payer engagement, reimbursement strategy, and braided funding approaches designed to reduce long-term reliance on temporary funding sources –representing an average projected reduction in grant, state, county, and local funding demand by 61% or $77 million annually.
(4) Workforce Development
No crisis system succeeds without a workforce. RI helps states develop strategies related to:
Recruitment and retention
Peer workforce expansion
Clinical supervision
Training infrastructure
Career pathways
Organizational sustainability
In rural communities, workforce transformation may also mean helping scarce clinicians work differently—using telehealth, shared technology, regional coverage models, peers, and better coordination so that expertise can reach communities where it would never be feasible to permanently locate every type of specialist.
(5) Governance and Stakeholder Alignment
The strongest crisis systems are built through collaboration. RI facilitates engagement among:
Behavioral health authorities
Medicaid agencies
Hospitals
Managed care organizations
Providers
Law enforcement
EMS
People with lived experience
Community stakeholders
This approach has been reflected in RI’s recent rural stakeholder engagements focused on identifying barriers, developing solutions, and creating actionable implementation plans tailored to local conditions.
(6) Technology as the connective infrastructure
In rural crisis systems, technology is not simply another investment category—it is often the infrastructure that makes the continuum possible. Communities may never have enough clinicians, mobile teams, crisis facilities, or specialty providers to place every service in every community. Technology can help states make scarce resources function as a coordinated statewide or regional network.
That means connecting 988 and other crisis contact centers, mobile response teams, EMS and 911, crisis receiving facilities, hospitals, and community providers; supporting real-time dispatch and referral; making service capacity visible; enabling warm handoffs and follow-up; and giving states the data to understand whether people actually received the care they needed.
For Behavioral Health Link, this is a critical part of the RHTP opportunity: using technology not simply to automate existing processes, but to help states create a connected crisis-care infrastructure in which someone in a rural community can be identified, connected to the right response, followed across transitions, and supported after the immediate crisis has passed. In this respect, shared technology infrastructure can become an important tool for equity—helping make high-quality crisis care accessible to people regardless of where in the state they live.
What Transformation Could Look Like in Practice
We identified nine states with Rural Health Transformation Program activities that explicitly advance at least one component of behavioral health crisis care. Those states are Kentucky, Rhode Island, Nebraska, South Dakota, South Carolina, Wyoming, Idaho, Washington, and Mississippi.
Kentucky: integrated crisis continuum and technology
Nebraska: facility modification and implementation grants
South Dakota: CCBHC-based mobile and stabilization expansion
Rhode Island: 24/7 walk-in stabilization and peer/recovery linkage
South Carolina: rural crisis-response teams
Wyoming: statewide telepsychiatry and crisis intervention
Idaho: mobile-crisis enhancement and SUD alignment
Washington: rural behavioral-health-system sustainability and mobile-crisis support
Mississippi: psychiatric emergency and regional emergency-system capacity
Others, such as North Carolina, Vermont, Alabama, Kansas, and Hawai’i are leaning into crisis care-types of services while almost all CMS-approved RHTP applications offer a path to strengthening crisis systems as well as applying technology to enhance system performance.
While several of these state plans project exciting transformational opportunities, we will highlight the plans for Kentucky and Mississippi here. Both combine critical crisis care infrastructure investments optimized by technologies that will manage, coordinate and monitor care journeys for generations to come.
Kentucky: Building a Connected Crisis Journey. Kentucky provides an early example of how RHTP investments can be used not simply to add services, but to redesign how people move through the behavioral health crisis system. The state’s Rural Health Transformation strategy includes technology-enabled crisis stabilization and mobile response, expanded telebehavioral health, EmPATH psychiatric emergency services, community paramedicine, and EMS models that can treat people in place or transport them to appropriate alternatives to hospital emergency departments. Importantly, Kentucky is also investing in follow-up after EmPATH visits and in the technology and data infrastructure needed to connect services. The emerging vision is a more integrated rural crisis journey—from initial contact and response, to the appropriate level of care, to follow-up and recovery—rather than a collection of disconnected programs.
Mississippi: Connecting Regional Systems Around the Person. Mississippi’s plan offers another compelling vision of rural transformation by combining new behavioral health capacity with the infrastructure needed to connect care across communities. The state proposes developing at least three Psychiatric Emergency Services units while creating Coordinated Regional Integrated Systems that bring together EMS, hospitals, public health, social services, and behavioral health resources. At the same time, Mississippi plans substantial investments in health information technology, interoperability, telehealth, and data-driven coordination. The significance is not simply the addition of psychiatric emergency capacity, but the potential to connect those new resources to a broader regional system—helping rural residents reach the right level of care, improving transitions following emergencies and hospital discharge, and making scarce behavioral health resources more accessible across geographic boundaries.
The most promising RHTP strategies are not simply attempting to place more services in rural communities. They are beginning to rethink how rural healthcare itself can operate. In areas where workforce and geography make it impossible to replicate an urban service network, states can build models that combine strong local capacity with regional resources and statewide connectivity. We see these themes echoed across emerging state plans: Kentucky is envisioning a more connected journey from mobile and EMS response through crisis stabilization, telebehavioral care, and follow-up; Mississippi is pairing new psychiatric emergency capacity with regional networks connecting EMS, hospitals, behavioral health, and community services; and South Dakota is investing in the technology, interoperability, and coordinated behavioral health infrastructure needed to connect care across rural and frontier communities. Across these approaches, mobile care, telehealth, alternative EMS destinations, crisis stabilization, shared technology, real-time coordination, and longitudinal data can allow scarce resources to function as an integrated system rather than a collection of disconnected programs. That may ultimately be one of RHTP’s most important legacies.
Building Capacity That Remains
One of the most important questions any state can ask is: “If the funding disappeared tomorrow, what capability would remain?”
Would the state still have:
Better data and technology infrastructure that allows the state to see access, demand, system performance and outcomes across the continuum?
Stronger partnerships?
Sustainable reimbursement models?
Improved workforce infrastructure?
Operational crisis services?
Clear performance expectations?
Stronger governance?
Here is another important question for states to consider in evaluating their RHTP investments: Will we know whether the transformation worked?
RHTP gives states an unusual opportunity not only to build new capacity, but to build the technology and measurement infrastructure needed to understand how people move through the system—who receives care, how quickly they receive it, whether handoffs are completed, whether people remain connected after a crisis, where they fall through gaps, and what outcomes follow.
This is another area where BHL’s experience can contribute: designing crisis technologies around the outcomes that matter—not simply documenting transactions, but helping systems understand the person’s journey across crisis contacts, responses, referrals, transitions, and follow-up.
If states emerge from RHTP with stronger services, sustainable financing, connected technology, and the ability to continuously measure and improve the journey of people receiving care, they will have created something far more valuable than a successful five-year initiative. They will have built the infrastructure for a learning rural healthcare system.
A National Opportunity
The Rural Health Transformation Program represents one of the most significant healthcare investments rural America has seen in decades. States across the country are already identifying behavioral health and crisis care as critical components of their transformation strategies.
At Recovery Innovations and Behavioral Health Link, we share a belief that everyone experiencing a crisis deserves timely, compassionate and effective care—regardless of where they live. RHTP gives states an extraordinary opportunity to build the services, workforce, financing, technology and connections needed to make that promise real in rural America, and to build systems capable of sustaining it long after the initial investment ends.
RI’s mission statement: To provide the highest quality of care, through direct services & by empowering others, to help all individuals in crisis recover with dignity and rejoin their communities.
RI vision statement: A world where anyone in crisis has access to immediate, compassionate, and effective clinical care, support by those who have experienced recovery.
BHL’s mission statement: Our mission is to provide crisis intervention and access management services that empower behavioral health professionals to give guidance for a life of recovery and resilience.
BHL’s vision statement: Everyone in crisis gets care that feels like care when and where they need it.
Ready to Move from Planning to Action?
Every community starts from a different place. RI and BHL partner with counties, states, and health systems to design, implement, and sustain effective, connected crisis care systems, with the technology to make it all work.
Contact us today to explore how our team can help your community advance its crisis system goals.
Related Resources
CMS Rural Health Transformation Program (RHTP)
CMS RHTP Award Summaries
How to Turn RHTP Funding into Sustainable Services