Transforming Rural Health: What Indiana’s GROW Initiative Means for Providers and Communities

Summary: To help strengthen the rural health landscape, Congress included the Rural Health Transformation Program within the One Big Beautiful Bill legislation. This program establishes a $50 billion investment aimed at supporting long-term sustainability and improving access to care in rural communities. Indiana’s implementation of the Rural Health Transformation Program is known as Growing Rural Opportunities for Well-Being (GROW). 

Rural healthcare in America continues to face significant pressure. Smaller, rural facilities cannot match the market power of larger health systems to secure adequate commercial reimbursement, but they are still subject to the same rising costs affecting all providers. At the same time, Medicare and Medicaid reimbursements continue to fall short of the cost of delivering care, contributing to widening financial challenges for rural providers.

In KSM’s “State of Local Government in Indiana” report, local leaders identified healthcare access, behavioral health, and underfunded public health systems as growing challenges, particularly in rural communities. County officials, in particular, reported declining satisfaction with access to care and limited resources to meet rising demand. Indiana’s implementation of the Rural Health Transformation Program provides a timely opportunity for regions and communities to begin responding to these challenges.

To help strengthen the rural health landscape, Congress included the Rural Health Transformation Program within the One Big Beautiful Bill legislation. This program establishes a $50 billion investment aimed at supporting long-term sustainability and improving access to care in rural communities.

Indiana’s Approach: The GROW Initiative

Indiana’s implementation of the Rural Health Transformation Program is known as Growing Rural Opportunities for Well-Being (GROW). The GROW initiative establishes a governance framework that requires collaboration across healthcare providers, public health agencies, local governments, and community organizations. Through the GROW initiative, the state has been allocated nearly $207 million for the first year, with similar amounts anticipated for the remaining four years. The GROW blueprint outlines 11 state-led initiatives that align with the federal priorities and a 12th initiative dedicated to regional grants. Regional grants represent the largest share of anticipated investments, totaling $604 million over five years, which is about 60 percent of the total.

To support this structure, Indiana has grouped counties into eight regions. Each region will have a committee and submit a single application for funding to the state. The state’s GROW executive oversight committee will approve each region’s committee membership, which will include one member from each of the following categories:

• An elected state official
• A provider representative
• A non-provider medical worker
• A patient
• A pharmacy
• A local health department
• A medical managed care organization

Business interests and community members or groups will also be considered for committee participation.

Once committees are certified by the state, they are eligible to submit a funding proposal that describes how the programs will be achieved and the funding required for their region. Applications will be released by the Family and Social Services Administration in March, with responses due July 1, 2026. Funding will be awarded starting in October to each district committee based on their proposal.

 

What To Do Now

1. Ensure your county and healthcare organization have a voice on the regional committee.
   The GROW regional committees will be the critical decision-makers in this process. While the state will have the final say on committee membership, they will rely on state associations and local leadership to identify participants. County public health officials, elected officials, nonprofit agency executives, community advocates, and hospital leaders should network among themselves and with neighboring counties in order to demonstrate strong regional cohesion.
2. Understand the details of Indiana’s GROW initiative.
   To position themselves effectively, organizations will need a deep understanding of the state’s priorities and oversight structure. It will be important to thoroughly understand Indiana’s GROW program and the specific activities and measures it contains. For public-sector leaders, this includes understanding governance expectations, reporting requirements, and how GROW-funded initiatives align with broader public health and community priorities.

As highlighted in KSM’s “State of Local Government in Indiana” report, navigating public health requires sustained, cross-sector collaboration. Indiana’s GROW initiative and the broader Rural Health Transformation Program create a framework for that collaboration, translating shared priorities into coordinated, regionally driven action.

KSM’s healthcare and government consultants can help rural providers, community organizations, and public-sector leaders interpret program requirements, structure effective coalitions, and position their initiatives for sustainable impact. To learn how our team can support your efforts to strengthen rural health in your region, contact us via the form below.