State Agencies · Policy & Compliance · 4 min read
What is a cooperative agreement, and why does RHTP use one?
RHTP awards are cooperative agreements (COAGs), a federal funding vehicle that, unlike a standard grant, requires substantial ongoing involvement from CMS. That means states don't just receive money and report at the end; CMS stays engaged in how the work proceeds, milestones are met, and outcomes are measured.
Grant vs. cooperative agreement
A grant is largely hands-off after award. A cooperative agreement keeps the funder substantially involved, which is why RHTP states should expect active CMS engagement throughout FY2026–FY2030.
What this means for sub-recipients
Because CMS holds states closely accountable, states pass rigorous monitoring and reporting expectations down to the providers and partners they fund.
Frequently asked questions
- Can CMS change requirements mid-program?
- Under a cooperative agreement, CMS remains substantially involved and can shape implementation within the award's terms.
Figures reflect the CMS Rural Health Transformation Program NOFO and the December 2025 award announcement. RHTP Tracker is an independent resource by Moodr Health and is not affiliated with CMS.