Overview
- Initial fiscal-year allocations total roughly $10 billion, with Texas ($281.3 million) the largest recipient followed by Alaska ($272.2 million), California ($233.6 million), Montana ($233.5 million) and Oklahoma ($223.5 million).
- Awards flow from a five-year, $50 billion program that splits funding between equal per-state disbursements and CMS-weighted grants tied to rural metrics and state proposals, with first-year awards starting near $147 million.
- The Office of Rural Health Transformation was established on Dec. 29 to manage grants, assign project officers, run annual audits and enforce performance-based reallocations or clawbacks if states miss commitments.
- States outline uses such as recruiting clinicians, expanding telehealth, building regional provider partnerships, integrating behavioral health, and funding prevention and chronic disease management within spending caps.
- Researchers and rural stakeholders warn the fund is limited relative to projected Medicaid reductions, with KFF estimating it covers a little over one-third of an anticipated $137 billion rural Medicaid shortfall over a decade.