Overview
- All 50 states secured first-year 2026 awards averaging about $200 million, ranging from $147 million for New Jersey to $281 million for Texas.
- $50 billion will be disbursed from 2026 to 2030 at $10 billion per year, with half split equally among states and half awarded based on CMS metrics and proposed initiatives; Washington, D.C., and U.S. territories are not eligible.
- CMS assigned project officers to each state, will require annual progress reports, and plans a rural health summit starting in 2026, with funding re-scored each year and potential clawbacks for noncompliance.
- State plans target expanded access, workforce strengthening, infrastructure and technology upgrades, and new care and payment models, with examples such as medication delivery by drones in Alaska and robotic ultrasound for remote maternal care.
- Experts and rural stakeholders warn the fund will not fully offset projected Medicaid reductions and note constraints such as a 15% cap on direct payments to providers and policy-linked incentives that may affect state awards.