The Centers for Medicare & Medicaid Services (CMS) announced that all 50 states will receive first-year awards in 2026 through the Rural Health Transformation (RHT) Program, a federal initiative totaling $50 billion over five years (FY 2026–FY 2030). CMS said the first-year state awards will average about $200 million, with amounts ranging from $147 million to $281 million, and that the funding is intended to support access, workforce capacity, infrastructure modernization, and new care models in rural communities.
CMS describes the RHT Program as a multi-year effort in which $10 billion is available each fiscal year from 2026 through 2030, with states implementing plans that CMS will monitor through ongoing reporting and program support.
Policy And Administrative Context
CMS stated the program was established in federal law and is being implemented through a competitive grantmaking process governed by a Notice of Funding Opportunity and standard HHS review practices, including conflict-of-interest screening for reviewers.
Public reporting around the announcement has also highlighted broader policy context. For example, national coverage has described the program as part of a wider legislative and administrative agenda, and noted that some program funding and scoring considerations may be linked to adoption of certain policy priorities by states.
How Awards Are Distributed
CMS outlined a two-part structure for allocating the annual funding. One portion is distributed equally among states that receive awards, while another portion is distributed based on factors described by CMS in program materials and the funding opportunity documents. These factors include measures of rurality, the condition of a state’s rural health system, state policy actions related to access and quality, and the projected scale and potential impact of proposed initiatives.
Independent analyses have begun comparing first-year award amounts across states using per-rural-resident or similar lenses, underscoring that the same dollar amounts can represent different levels of investment depending on a state’s rural population and health system structure.
Implementation Priorities Highlighted By CMS
CMS said the awards are intended to support state-led strategies that strengthen rural care delivery and improve health outcomes. In its announcement and program overview, CMS emphasized several recurring focus areas that states may pursue.
Expanding Access To Core Services
CMS described planned activities that include expanding preventive, primary, maternal, and behavioral health services, as well as building additional “access points” so that care is available closer to where rural residents live. CMS also referenced approaches aimed at chronic disease prevention and management, including efforts that address nutrition and other upstream drivers of illness.
Strengthening Rural Emergency Response
Another stated objective is supporting rural emergency care capacity. CMS indicated that states may invest in improved EMS communications, coordinated transfers, and related operational changes designed to stabilize emergency response in low-resource areas.
Supporting The Rural Health Workforce
CMS also framed the program as a workforce investment, referencing training, residencies, recruitment and retention incentives, and pathways intended to help clinicians begin and sustain careers in rural communities.
Modernizing Facilities, Technology, And Data Infrastructure
CMS said states may use funding to modernize facilities and equipment, improve interoperability and cybersecurity, and expand telehealth and remote patient monitoring. The agency also referenced workflow-support tools, including emerging digital documentation aids, as examples of approaches states are exploring to reduce administrative burden.
Payment And Delivery Reform
CMS described the RHT Program as supporting experimentation with new models, including primary care-focused approaches and value-based care initiatives. The program materials also describe state efforts such as hub-and-spoke networks, clinically integrated rural networks, and data-sharing platforms, framed as mechanisms to coordinate services and keep care local where feasible.
State Awards And Public Documentation
CMS published a state-by-state list of FY 2026 first-year award amounts in its press release, with the highest reported award at $281.3 million (Texas) and the lowest reported award at $147.3 million (New Jersey). The full list is available through CMS’s newsroom materials and related program pages.
CMS also linked to additional program documentation, including a program overview page and a Frequently Asked Questions document describing application timelines and administrative requirements.
Oversight, Reporting, And Cross-State Learning
CMS stated it will assign project officers to states and conduct program kickoff meetings, provide technical assistance, and require regular updates to track implementation and progress. CMS also said states will convene annually at a Rural Health Summit held during the CMS Quality Conference in 2026 to share lessons learned and highlight effective models.
Key Questions Raised By Observers
While CMS and the administration described the awards as a major investment, some reporting and commentary have raised implementation questions. National coverage has pointed to debates about whether the funding is sufficient relative to broader pressures on rural hospitals and whether policy-linked conditions could affect how states participate or perform under program benchmarks.
As states move from award announcements to operational plans, much of the program’s near-term impact will likely depend on how funds are translated into staffing, service availability, technology upgrades, and care coordination in rural settings, as well as how CMS measures progress over the five-year period.
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Written by Nare Hovhannisyan, MD