Texas will receive $281,976,026 in the second year of the Rural Health Transformation Program, the most of any state. New Jersey will receive $142,338,224, the least. CMS announced the awards on November 9, 2026, $10 billion in all, split across all 50 states.
The program was created by the Working Families Tax Cut legislation in 2025 and runs 5 years at $10 billion a year, from fiscal year 2026 through 2030. With year 2, CMS has awarded $20 billion of the $50 billion total. The press release lists each state’s award, and a fact sheet explains how the amounts are set.
Half the money is the same for every state
Each year’s $10 billion is divided into 2 equal halves. The baseline half is split evenly, so every approved state receives $100 million a year regardless of size. The workload half is allocated by factors in the program’s funding notice, including the state’s rural population and health facilities, the initiatives in its transformation plan, certain state policy actions and other technical factors.
That structure explains why the awards cluster tightly. Every state starts at $100 million, so the spread comes entirely from the workload half. In year 2 the gap between the largest and smallest award is about $140 million.
The workload half can change every year. CMS said year 2 amounts were informed by each state’s progress on its approved plan, measured partly through a checkpoint model covering governance, project plan approval, launches, milestones, measurement methods and sustainability planning. All 50 states submitted year 1 annual reports. The press release named progress on 2 policies among the factors, the Presidential Fitness Test and continuing medical education for physicians on nutrition.
Half the states gained and half lost
Comparing the year 2 table with CMS’s year 1 awards from December 29, 2025 shows how much the formula moved. By our count, 25 states received more in year 2 and 25 received less. No state’s award changed by more than 3.8%.
| State | Year 1 award | Year 2 award | Change |
|---|---|---|---|
| North Dakota | $198,936,970 | $206,379,627 | +$7,442,657 |
| Iowa | $209,040,064 | $216,007,657 | +$6,967,593 |
| Montana | $233,509,359 | $239,740,669 | +$6,231,310 |
| Virginia | $189,544,888 | $195,710,118 | +$6,165,230 |
| Kansas | $221,898,008 | $225,896,117 | +$3,998,109 |
| Washington | $181,257,515 | $177,060,212 | -$4,197,303 |
| New York | $212,058,208 | $207,750,071 | -$4,308,137 |
| New Jersey | $147,250,806 | $142,338,224 | -$4,912,582 |
| Vermont | $195,053,740 | $189,996,036 | -$5,057,704 |
| Florida | $209,938,195 | $203,828,071 | -$6,110,124 |
The table shows the 5 largest increases and the 5 largest decreases, computed from the 2 CMS tables. Because the $100 million baseline does not move, the swings are larger as a share of the workload half. North Dakota’s workload share rose from about $98.9 million to about $106.4 million, roughly 7.5%.
The top of the list barely changed. Texas, Alaska, Montana, California and Oklahoma received the 5 largest awards in both years, though Montana moved ahead of California in year 2.
A state’s award can rise or fall each year, and CMS says a decrease does not set its course for the remaining years.
CMS cautioned against reading too much into a single year. It said a lower year 2 amount does not determine a state’s funding in later years. It also said year 1 spending data through July 31, 2026 is a point-in-time snapshot that was not used to set year 2 awards.
The money has to be spent by 2032
States must use the funds on at least 3 approved purposes. The list includes prevention and chronic disease management, rural workforce recruitment and retention, technology-enabled care and health IT, behavioral health and substance use services, new care and payment models and right-sizing delivery systems. The money may not replace existing federal funding.
Timeline
Rural Health Transformation Program milestones
6 dates · July 4, 2025 to September 30, 2032
Working Families Tax Cut legislation signed
Creates the $50 billion, 5-year program.
Year 1 obligation snapshot
CMS says it was not used to set year 2 awards.
Year 2 awards announced Announced
Another $10 billion, informed partly by implementation progress.
- Today
Last annual allocation
Fiscal year 2030 is the final year of new awards.
Spending deadline Deadline
Unspent funds return to the Treasury.
Dates come from CMS press releases and the year 2 fact sheet.
Funds must be obligated within the budget period and generally stay available through the end of the next fiscal year. Money a state does not spend is redistributed to other states using the same method as the original allocation. CMS monitors the cooperative agreements through annual and quarterly reports, financial oversight and assigned project officers, with more detailed quarterly reporting starting this month.
For health plans and providers in rural markets, the money arrives through state programs, and each state’s transformation plan decides where it goes. The checkpoint model means states have a financial reason to show launches and milestones each year. Partners that can document what a project delivered, in terms a state can put in its quarterly report, will be easier for a state to fund again.