Regional Grants

How will applications be assessed, and who conducts the review?
Regional grant applications will be reviewed through a competitive scoring process led by theGROW State Steering Committee, and their designees. Proposals will be scored on factors such as:

• Strength and breadth of the regional coalition
• Data-driven needs assessment
• Alignment with required categories and KPOs
• Evidence of non-duplication and filling gaps
• Quality of sustainability and governance plans
• Commitment to participation in statewide GROW initiatives (further clarification on regional grant participation is outlined in the RFF)

All eight regions are expected to receive funding, but award size will vary by population served and quality of application.

How will the state ensure the use of AI in reviewing regional applications is fair? Will AI be used?
The core scoring and funding decisions will be made by human reviewers. The state may use technology tools (including limited AI or analytics) to assist with tasks such as consistency checks or data aggregation, but no application will be approved or denied solely by an AI system. Any use of AI will be transparent, standardized, and overseen by human reviewers to protect fairness.

Just to clarify, the regions don't self-select the regional committees, but the state executive oversight selects the individuals who will make up the regional committees? Who is going to certify the submission groups?
HFS will work with state associations to identify individuals who will lead the Regional Coalitions and the Regional Committee members. The State Executive Oversight Committee will approve the composition of each Regional Committee based on required roles (e.g., rural hospitals, provider, non-provider medical worker, CBOs, patient, LHD, Medicaid MCO, business, pharmacy, legislator). The same executive body (or its designee) will certify each Regional Coalition as eligible to submit a unified regional application.

How are committees ensuring the right people are included in decision-making? What does it mean for regional community members who volunteer?
Each Regional Committee must include specific stakeholder types (e.g., rural hospitals, CBOs, patient representative, LHD, Medicaid MCO, business sector). Community members or groups who volunteer will be considered during committee formation and can:

• Serve in required roles (e.g., CBO, patient representative)
• Participate in advisory councils, workgroups, or project design processes

Final membership is approved by the State Executive Oversight Committee to ensure balanced representation and avoid dominance by any single entity.

How does the overall governance structure work together?

• Governor / State Executive Oversight Committee: Final authority over awards, compliance, and course correction.
• RHTP State Steering Committee: Reviews progress, advises on strategy, and lifts cross-regional issues.
• IDOH Regional Grant Initiative Team: ongoing oversight of regions throughout grant period; state management of contracts, grant agreements, leads application review and scoring and makes funding recommendations with final approval by the State Executive Oversight Committee.
• Regional Grant State Contractors:  Serve as the coordinator of all activities associated with the regional activities, direct communication with IDOH Regional Grant Initiative Team for clarifications and escalations as needed.
• Regional Coalition Leader: Design, prioritize, and oversee projects within their  region; monitor budgets and outcomes; ensure alignment with state requirements.
• Regional Committees: ongoing strategic guidance to regional coalitions – must approve application before submission to state.
• Regional Grant Technical Assistance Provider (state-contracted): will provide application assistance, performance monitoring, and cross-regional learning support.

Governance is layered so decisions are locally informed but state-accountable.

Once the committees are formed and their proposal is submitted this summer, will they direct the process for surrounding institutions/health systems/providers to potentially partner achieving their outcomes? Or as a health system, do we need to contact the state/committee to participate?
Once Regional Committees are set and proposals are submitted, they will identify partners and aligning regional activities with the outcomes outlined in their proposals. Participation is not limited to organizations already at the table. Health systems and other providers that wish to be involved should proactively reach out to the Regional Committee or to the regional grant technical assistance providers.

Can you share more information about data collection, tracking success and measuring results?
Data collection and performance measurement will follow a standardized, statewide framework to ensure consistency across all regions. Each Regional Coalition will track progress toward the outcomes identified in its proposal using a mix of health indicators, system‑capacity measures, and implementation metrics. The state will provide templates, technical assistance, and shared reporting tools to support this work, and regions will submit regular updates that highlight progress, challenges, and opportunities for improvement. The goal is to create a clear, practical approach to monitoring results that strengthens accountability while supporting continuous learning and adaptation.

Does the coalition stay in place for the five year period?
Yes.

How is rurality being assessed/defined?
Counties with HRSA Rural Designation are considered fully rural and organizations within those counties may be direct recipients of the RHTP funds as part of the regional application. Organizations in these counties should be prioritized in regional coalitions and subsequent applications. These 64 counties are noted in the regional map as solid-colored counties.

There will be nine additional counties which may also be considered direct recipients eligible for RHTP funds as noted with stripes in the regional map.  The stripes indicate a county has either a HRSA rural designation with a distinction that only some parts of the county are eligible for rural health grants; or a non HRSA rural designated county, but has a HRSA designated critical access hospital.  It is important to note that organizations in metropolitan areas within the striped counties will only be funded with justification as to how they are serving rural residents. Regional applications should provide this detailed explanation within the work plan narrative. Partially rural counties are identified as counties eligible for funding directly from the RHTP grant.

Will the regions mirror existing public health preparedness districts? If not, have those lines been drawn yet?
The Rural Health Regional Map is based on the HRSA designation of counties in Indiana eligible for rural health grant funding. From there, the eight regions align with natural care/referral patterns and trauma/preparedness regions.

How can we ensure rural hospitals are represented on the Regional Committees?
Each Regional Committee is required to include at least one healthcare provider representative, and the program strongly expects that in rural-focused regions, this role will be filled by a rural hospital or rural health provider organization. Regions will be encouraged to involve multiple rural hospitals as subrecipients and advisory partners, even beyond the minimum committee seat.

How can we ensure community mental health centers/CCBHCs are represented?
Community mental health centers and CCBHCs are explicitly identified as key stakeholders throughout GROW and can serve as:

• Provider representatives on the Regional Committee
• Subrecipients for behavioral health projects
• Leads or co-leads on behavioral health and workforce initiatives

The Sstate will strongly encourage behavioral health representation in both the committee membership and project portfolio.

What should the involvement for non-rural counties be?
Non‑rural counties are not the target of RHTP funding, but their involvement should be part of improving outcomes in rural counties. Some examples include serving as a partner when service area supports rural outcomes, contribute training and workforce development, specialty care access or participate in other initiatives that span more than one county, such as behavioral health integration or maternal health readiness.

Will there be a forum where the districts can learn from each other in the first few months during the application development process?
Not at this time, but this request can be made to the Make Rural Indiana Healthy Again Regional Grants technical assistance providers. Information about these providers will be shared soon.

When there is not agreement on the regional committee plan, who steps in to support conflict resolution?
The Make Rural Indiana Healthy Again Regional Grant technical assistance providers will assist in convening and facilitating coalition formation and application development. Ultimately it will be the responsibility of the Regional Coalition and Committee to find consensus and submit a proposal that benefits rural residents within each region.

If not selected to be part of a regional committee, what will be the process for active participation in the application process and/or to provide input. Will someone from the region be reaching out to organizations?
All regional stakeholders should be part of the application process, even if they are not part of the Regional Committee. The MRIHA Regional Grant technical assistance providers will help facilitate this collaboration. More information about these providers will be posted to the GROW website soon.

Will the technical assistance team convene potential partners in our region soon, to begin the planning process?  The timeline is aggressive unless relationships already exist across the region.
Yes. Information about regional convenings will be available soon.

When will regional committee members be announced?
The Regional Committee members are expected to be announced in February.

What is the role of the regional committees?

Regional Committees are the governing and advisory group for each region, similar to a board of directors. Comprised of 11 appointed members, their role is to ensure diverse representation for the Regional Coalition, provide guidance, and receive regular updates on progress. They do not develop or implement the regional plan but provide oversight, help maintain alignment with regional priorities, and support transparent communication between the Coalition and the community.

Who are the T/A providers, what is their role, who are the contacts?
This information will be posted to the GROW website soon.

Whom do I reach out to with questions in my region?
See the GROW website for TA contact information for each of the eight rural health regions.

What types of costs are allowed and what are not allowed? Clearly identify and explain the parameters for Indiana Regional Coalitions spending GROW money.
In general, eligible costs must:

• Directly support access, technology innovation, workforce development, MRAHA, or innovative care
• Be tied to approved regional projects that advance KPOs
• Occur in and serve rural areas

Key parameters include:

• Capital costs: Capped at 20% of a region’s total budget
• EMR expenditures: Capped at 5% of a region’s total budget
• Program costs: Care delivery, workforce, technology, telehealth, transportation solutions, paraprofessional deployment, quality improvement, training, and evaluation are generally allowable when tied to approved projects
• Unallowable costs include : major construction, non-health-related infrastructure, food, general government uses, or activities outside the RHTP scope or service area.

Further details can be in the RFF.

What is the role of ineligible counties based on HRSA rural health funding? Can those counties still be a subgrantee?
Counties that do not meet the HRSA/FORHP rural definition cannot be the primary target of RHTP investments. However, entities in non-rural counties may participate as subrecipients if their activities clearly:

• Serve rural residents
• Support regional infrastructure or specialty access that rural patients rely on

All funded activities and services must still be rural-serving.

Do regions need to describe how subrecipients will select their contracts and hold those contractors accountable?
Yes. Regional applications must outline:

• Transparent procurement processes for sub-contractors
• How subrecipients will select and monitor vendors
• How performance, data, and compliance will be tracked
• How corrective action will occur if contractors underperform

The state will also impose reporting and audit requirements on subrecipients.

What is considered program duplication? Can funding be used to expand existing programs to include more communities and systems of care?
Program duplication occurs when a new project replicates an existing service or infrastructure without adding value, reach, or efficiency. GROW funds cannot be used to simply replace current funding streams or pay for the same service twice. However, funds can be used to:

• Expand successful programs to additional rural communities
• Add new populations, sites, or modalities (e.g., telehealth, home-based care)
• Integrate programs to reduce fragmentation and improve outcomes

Regions must clearly show how funding fills gaps, scales impact, or increases efficiency, not just continues the status quo.

Does the program limit funding to certain types of providers or facilities?
No single provider type is exclusively favored, but priority is placed on entities that are critical to rural systems, such as:

• CAHs, rural hospitals
• FQHCs and rural health clinics
• CMHCs and CCBHCs
• EMS and mobile integrated health
• Local health departments and CBOs

Proposed funding must support rural-serving entities and align with the required categories and KPOs.

Are regional grants able to fund healthcare services across state borders (e.g., Cincinnati Children’s clinics in Indiana), and how are subrecipient arrangements and lab samples handled when crossing state lines?
Funding may support care models and partnerships that cross state lines if:

• Services are delivered in or clearly serve Indiana rural communities, and
• The arrangement complies with federal and state rules on subawards, licensure and billing.

Cross-border labs, contracts, and subawards must be structured with formal agreements and must still meet all RHTP and Indiana requirements for allowable, rural-serving expenditures.

How should regions consider initiative sustainability after the GROW funding period?
Every regional proposal must include a sustainability plan that addresses:

• How programs will demonstrate ROI or cost savings
• How payers (Medicaid, Medicare, commercial) can support ongoing reimbursement
• How shared services, workforce, and infrastructure will be embedded into routine operations
• How partnerships will persist beyond the grant

Sustainability is a core scoring criterion, not an add-on.

Is the state responsible for issuing RFPs and purchasing resources for regional grants, and if so, how is ownership transitioning to the regions?
All contracts will come directly from the state. The state will:

• Issue state-level procurements for certain supports (e.g., evaluation, technical assistance, some statewide tools).
• Execute grant agreements directly with individual entities carrying out regional activities.

Subrecipients within each region will generally be responsible for their own procurements for needed services within state and federal rules. Ownership of equipment or systems purchased with GROW funds will be defined in the grant agreement but is typically vested in the subrecipient, with conditions for use, reporting, and disposition.

Define subgrantee, subrecipient, subaward, sub agreement.
The State of Indiana is the awardee for RHTP funds. The disbursement of these funds to other entities falls into these categories:

• Subrecipient / Subgrantee: An organization that receives GROW funds from the state to carry out a portion of the program (not just to provide goods/services).
• Subaward: The formal award of funds from the state (or primary grantee) to a subrecipient documented in a grant or contract.
• Sub agreement: The legal agreement (grant agreement or contract) that outlines the subrecipient’s scope, budget, reporting, and compliance obligations.

Subrecipients may further subaward or procure services via GROW funds, and all additional agreements are subject to state and federal rules.

Can this funding be used for any environmental issues since that impacts health as well?
RHTP funds are not designed to support broad environmental projects, but they can be used for environmental issues when there is a direct and demonstrable connection to rural health outcomes. Environmental activities may be allowable only when they clearly advance a health‑specific objective.

What the funding cannot support are broad environmental initiatives that fall outside the health that don’t have a a clear health impact.

Could neurodegenerative diseases, like Alzheimer's disease, be considered a focused chronic disease?
Yes, they can if the region can demonstrate a clear burden, a rural access gap, and a strategy that aligns with RHTP’s health‑system strengthening goals.

If you were to participate in the regional coalition, would your organization still be eligible to request a sub-award under the regional grant?
Yes.

Could these funds be applied to housing assistance in some capacity to rural areas?
Maybe. RHTP funds cannot be used for broad housing assistance, but they may support housing‑related activities when there is a clear and direct connection to rural health outcomes. Any housing‑focused use of funds must be tightly aligned with the region’s health priorities and must demonstrate a measurable impact on rural health, rather than serving as general housing support.

Will the initial Regional Grant applications cover the entire five-year grant period (similar to the state grant to CMS) or will new applications be submitted each year?
The applications will cover the entire five-year grant period with continuing applications to be submitted each year.