RHTP Series 17 | TD 17-A

Lead Agency Verification Tracker: Section 1

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Technical Document | Series 17: Fifty State Profiles Production Support Document: Not for Publication Status: Complete: 50/50 Confirmed Last Updated: February 2026

Purpose

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This tracker provides the lead agency reference layer for all 50 Series 17 state profiles. Section 2 of each profile requires a confirmed lead agency designation, authority gap assessment, and source citation. This document consolidates confirmed agencies, flags structural anomalies relevant to the authority gap analysis, and notes five cluster assignment discrepancies between the YAML extraction and the Production Sequence.

Tracker organization follows the Series 17 Production Sequence writing order, not alphabetical, not geographic. Exemplars first, then Phases 2 through 6 by cluster.

Primary sources used for confirmation:

• RuralHealthInfo.org State RHTP Applications list (sponsoring organization field)
• CMS Project Abstracts PDF (edit.cms.gov/files/document/rht-program-state-provided-abstracts.pdf)
• Official state RHTP application documents and governor press releases
• SHVS “From Planning to Action” lead agency tracking article (January 16, 2026)

Status Summary

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Section 1A: Full 50-State Tracker (Production Order)

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Section 1B: Structural Anomalies for Section 2 Authority Gap Analysis

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These designations require specific analytical treatment in the Section 2 authority gap discussion. Standard profiles assume a single department with defined regulatory and funding authority. These cases diverge.

Governor’s Office Leads: Mississippi, Arkansas, Hawaii

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Mississippi (#3): Governor’s Office is the sole official sponsoring organization. Mississippi Division of Medicaid (DOM) and Mississippi State Department of Health (MSDH) are operational partners. For Section 2: the non-expansion architecture limits DOM’s Medicaid transformation leverage; MSDH likely carries operational weight. The Governor’s Office designation creates political continuity dependency: if executive priorities shift, implementation authority structure shifts with it. The authority gap between the sponsoring entity and the operational agencies is real and analytically central to the Mississippi Exemplar.

Arkansas (#13): Governor Sanders’s office submitted directly. ADH and the Division of Medical Services are operational partners. The Governor’s Office lead reflects centralized executive control over a high-profile MAHA-aligned application. Arkansas committed to SNAP waivers and other priority policies. Political continuity risk is lower than Mississippi (Sanders is in first term, no 2026 election) but agency implementation capacity questions remain.

Hawaii (#50): The “Executive Office of the State of Hawaii” is the confirmed official designation. Hawaii’s QUEST Integrated Medicaid managed care system means Med-QUEST Division and HMSA partnerships are the operational engine. The Governor’s Office coordination layer may function more as an integration mechanism across agencies than as an operational lead. The authority gap is diffuse rather than concentrated. Hawaii’s challenge is cross-agency coordination, not a single missing authority.

Non-Governmental Lead: Arizona (#37)

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The Arizona Center for Rural Health (ACRH) at the University of Arizona is the official sponsoring organization. This is the most structurally anomalous designation in the 50-state set. ACRH is a HRSA-funded State Office of Rural Health housed within UA’s College of Public Health, not a state agency. ACRH has no Medicaid payment authority, no regulatory capacity over providers, and no power to compel state agency participation.

AHCCCS (Arizona Medicaid) and ADHS almost certainly serve as state agency partners. For Section 2, the critical question is whether AHCCCS holds the actual CMS cooperative agreement relationship or whether ACRH is the legal grantee. If ACRH is the grantee, Arizona has the most constrained implementation authority of any state in the program: a convening entity without enforcement levers attempting to coordinate a state system that requires both. The authority gap analysis for Arizona is the most substantive in the Phase 5 cluster.

Non-HHS Agency Lead: Alabama (#6)

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ADECA is Alabama’s economic and community development agency. It manages federal community development block grants, economic development programs, and workforce infrastructure. Its designation as RHTP lead reflects Alabama’s framing of rural health transformation as an economic development challenge rather than a clinical one. ADECA lacks direct clinical oversight, Medicaid policy authority, and provider licensing levers. The Alabama Medicaid Agency (AMA), ADPH, and SHPDA are co-sponsors with substantive operational capacity. For Section 2: Alabama’s authority gap is structural: every clinical or payment-model decision requires coordination through agencies that ADECA cannot direct.

Multi-Agency Co-Leads

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Virginia (#25): DMAS is the designated submitting entity and holds the cooperative agreement. The Office of the Secretary of Health and Human Resources (Secretary Kelly) provides executive coordination across DMAS and VDH. In practice: DMAS leads Medicaid and payment model components; VDH leads public health and workforce components. Treat DMAS as primary lead with Secretary HHR as executive integration layer. Authority gap is moderate: two well-resourced agencies with defined portfolios, but no single point of operational accountability.

Washington (#26): Three-agency co-lead: Health Care Authority (HCA), Department of Health (DOH), and Department of Social and Health Services (DSHS). HCA manages Medicaid (Apple Health) and likely holds the grant relationship as the largest RHTP-relevant agency. Tri-agency structure creates coordination complexity but Washington has strong interagency collaboration infrastructure. Authority gap risk is moderate: diffusion across three agencies with distinct statutory mandates could slow decision-making.

New Jersey (#39): NJ DOH manages public health licensing and rural health programs; NJ DHS administers Medicaid (NJ FamilyCare). Cross-department co-leadership is the most complex multi-agency arrangement outside of Washington. For Section 2: confirm which department holds the cooperative agreement and what decision protocols govern disagreements between the two departments.

Delaware (#47): DHSS is the parent department; the Division of Public Health is the operational subdivision. Co-lead designation reflects internal departmental structure rather than cross-agency coordination, significantly lower authority gap risk than cross-department arrangements.

Rhode Island (#48): EOHHS holds the cooperative agreement as the executive umbrella office. DOH is the operational co-lead. Rhode Island’s Global Waiver architecture gives EOHHS genuine integration leverage across Medicaid and public health. The authority gap is narrow: EOHHS’s integrated design is precisely what most other states lack.

Nevada Health Authority (#36)

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NHA is a standalone legislative authority separate from Nevada DHHS and the Department of Health Care Financing and Policy (DHCFP). NHA has programmatic health authority but DHCFP administers Nevada Medicaid. For Section 2: confirm NHA’s enabling statute and the scope of its authority relative to DHCFP, particularly for payment model and managed care components of the RHTP application. The earlier “flag” in the tracker was based on unfamiliarity with NHA. The agency is the correct and confirmed designation.

Section 1C: Cluster Discrepancy Log

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Section 1D: Sources by State

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