Overview
- CMS published 2026 allocations for all 50 states, with first-year awards averaging about $200 million and ranging from $147 million for New Jersey to $281 million for Texas.
- $10 billion will be disbursed each year from 2026 through 2030, split between equal baseline shares and a scored pool that factors rurality, existing infrastructure, and proposed state initiatives.
- Each state was assigned a CMS project officer and must file annual progress reports, with awards re-scored yearly and funds subject to clawback for noncompliance; Washington, D.C., and U.S. territories were not eligible.
- Grants target workforce expansion, facility and technology modernization, and expanded preventive, primary, maternal, and behavioral health services, with pilots of new care and payment models.
- Experts and provider groups warn the fund may not offset larger Medicaid reductions in the same law and may not reach the most financially distressed rural hospitals, with some funding conditioned on policy priorities.