Overview
- CMS confirmed every state met the Nov. 5 application deadline and said award notices will go out by Dec. 31, with funding distributed through cooperative agreements over the next five years starting in 2026.
- The program splits $50 billion into two tracks: $25 billion in equal baseline allocations to approved states and $25 billion awarded through a data-driven merit review that gives CMS broad latitude.
- States detailing requests include Arkansas seeking $1 billion, Arizona seeking $1 billion for behavioral and maternal-focused initiatives, Alabama proposing $500 million across 11 projects, and Texas requesting $1 billion for its Rural Texas Strong plan.
- Across submissions, governors emphasized telehealth buildouts, rural workforce pipelines, maternal and behavioral health services, EMS and trauma systems, and statewide data and interoperability efforts.
- Analysts say the fund will cover only a portion of projected rural Medicaid reductions, and Senate Democrats pressed GAO to investigate fairness and guardrails as questions persist over rules such as limits on direct provider payment use.