If you live in Houston or Harris County, a hospital is probably minutes away. But drive an hour outside the city — into Waller County, Grimes County, Wharton County, or Colorado County — and the picture looks completely different.
That’s the reality Governor Greg Abbott is working to fix. He announced this week that the Texas Health and Human Services Commission (HHSC) will receive $281 million in federal funding for year two of Rural Texas Strong, a five-year initiative designed to rebuild healthcare in communities that have been struggling for decades.
The numbers tell a sobering story. Texas has led the nation in rural hospital closures — more than any other state since 2005, according to APM Research Lab. Today, 28% of Texas counties have no hospital at all, and 84 rural Texas hospitals are currently at risk of closing, according to the Center for Healthcare Quality and Payment Reform.
Right outside Houston, communities in counties like Wharton, Grimes, Austin, and Colorado are classified as rural. Wharton County, for example, is a federally designated primary care and mental health shortage area, according to HRSA data. That means not enough primary care doctors and not enough mental health providers to meet the need.
For Houstonians, this isn’t just someone else’s problem. Many of us have family in these communities. When people in surrounding counties can’t access preventive care close to home, conditions go untreated longer — and the consequences are real for patients and families across the region.
Rural Texas Strong is Texas’s approved plan under the federal Rural Health Transformation Program, a $50 billion national initiative funded through the One Big Beautiful Bill Act and administered by the Centers for Medicare & Medicaid Services (CMS). Texas is set to receive an estimated $1.4 billion over five years (2026–2030), with approximately $281 million arriving each year.
The money is organized around six targeted initiatives:
One of the most significant aspects of this program is its structure. With $281 million arriving annually for five years, rural healthcare providers can plan for the long term — hiring staff, upgrading facilities, and building programs — rather than relying on one-time grants that disappear.
Texas has the highest uninsured rate of any state, with roughly 1 in 5 residents living without coverage, according to APM Research Lab. Rural communities bear a disproportionate share of that burden. This funding is designed to directly address the gaps that have made rural Texas one of the most medically underserved regions in the country.
HHSC is actively rolling out grant opportunities and contracts tied to each initiative. Rural hospitals, healthcare providers, and community organizations across Texas can find procurement opportunities through the Electronic State Business Daily or the HHSC Grants Page.
