Overview

• The application window opened Sept. 15 with most guidance setting a Nov. 5, 2025 deadline, award decisions due by Dec. 31, and disbursements starting in 2026.
• Half of the $50 billion will be divided equally among approved states while the other half will be awarded at CMS Administrator Mehmet Oz’s discretion, with authority to deny, reallocate, or claw back funds.
• States—not hospitals—must apply and manage funds, with eligible uses spanning prevention, provider payments, workforce, care-model innovation, and digital health across five stated priorities.
• Oz said a state’s rural population "definitely matters" for discretionary decisions and emphasized limiting awards that primarily benefit big tech vendors, according to new local interviews.
• Policy experts warn broad eligibility could steer dollars away from local providers and note the program’s five-year scope coincides with sizable Medicaid cuts projected to reduce rural funding, even as at least one report listed a later Nov. 15 deadline than CMS materials.