Overview

• States have a single chance to apply by Nov. 5, with award decisions due Dec. 31 and disbursements beginning in 2026.
• The fund provides $10 billion annually through 2030, with half split equally among approved states and half awarded at the CMS administrator’s discretion.
• States—not individual hospitals—must apply, funds cannot backfill routine operating costs or reimbursable services, and proposals must target prevention, provider sustainability, workforce, care-model innovation, or technology and cybersecurity.
• CMS says it can claw back or reallocate dollars if states underperform, denials are not appealable, and guidance notes money is not required to flow directly to rural hospitals.
• Officials promote bold, innovation-focused plans as analysts question accountability and note projected Medicaid reductions, with CMS hosting applicant webinars on Sept. 19 and Sept. 25.