CMS awards a second $10 billion in rural health funds; Texas gets the most and New Jersey the least
Second-year awards run from $142 million to $282 million. By our comparison, 26 states get more than in year one and 24 get less, all within 4%.
By States Desk · · 4 min read
What it means for you
- CMS announced $10 billion in second-year Rural Health Transformation Program awards to all 50 states on November 9, bringing the total awarded to $20 billion.
- Each state receives $100 million in equal baseline funding a year; the rest depends on factors such as rural population, state plans and certain state policy actions, CMS says.
- Texas ($282.0 million), Alaska ($272.7 million) and Montana ($239.7 million) receive the most; New Jersey ($142.3 million) receives the least.
- By our comparison with first-year awards, 26 states get more and 24 get less. North Dakota's award rose most, by 3.7%; New Jersey's fell most, by 3.3%.
- States reported putting about $4.0 billion of first-year money to work by July 31, 2026, by our count. CMS says that figure is not a full measure of progress.
The Centers for Medicare & Medicaid Services announced $10 billion in second-year awards to all 50 states under the Rural Health Transformation Program on November 9. The program, created by the law CMS calls the Working Families Tax Cuts Act, provides $50 billion over five years, with $10 billion awarded each fiscal year from 2026 through 2030. With this round, CMS says it has awarded $20 billion, and $30 billion remains for the last three years.
The second-year awards, listed in CMS's announcement, run from $142.3 million for New Jersey to $282.0 million for Texas. Alaska ($272.7 million), Montana ($239.7 million) and California ($231.1 million) follow Texas. Half of the 50 awards are above $202 million, by our calculation. The five smallest go to New Jersey, Connecticut, Rhode Island, Massachusetts and Delaware.
How the money is divided
Congress split each year's $10 billion in two, according to CMS's fact sheet. Half is shared equally, which gives every state $100 million. The other half is allocated using factors set out in the program's funding notice, including the makeup of a state's rural population and health facilities, the initiatives in its transformation plan, certain state policy actions and other technical factors.
This year, CMS says, awards also reflected in part each state's progress on its approved plan, judged from annual reports all 50 states submitted. Its announcement names two of the state policies it considered: the Presidential Fitness Test and continuing medical education for physicians on nutrition. States must spend all program money by September 30, 2032, or return it to the Treasury, and will begin more detailed quarterly reporting in November 2026.
States have already put these resources to work bringing better care closer to home for their rural communities.
Year two against year one
We compared the second-year figures with each state's first-year award in CMS's obligated funds report. By that comparison, 26 states receive more than in the first year and 24 receive less, and no award moved by more than 4%. North Dakota gained the most in percentage terms, 3.7%, followed by Iowa and Virginia at 3.3% each. Florida lost the most in dollars, about $6.1 million, while New Jersey had the largest percentage cut, 3.3%. CMS says a state's total can rise, fall or stay similar from year to year, and that one decrease does not set its course for the rest of the program.
| State | Year 1 award | Year 2 award | Change |
|---|---|---|---|
| Alabama | $203.4 million | $199.3 million | −2.0% |
| Alaska | $272.2 million | $272.7 million | +0.2% |
| Arizona | $167.0 million | $165.0 million | −1.2% |
| Arkansas | $208.8 million | $207.8 million | −0.5% |
| California | $233.6 million | $231.1 million | −1.1% |
| Colorado | $200.1 million | $197.2 million | −1.5% |
| Connecticut | $154.2 million | $153.7 million | −0.4% |
| Delaware | $157.4 million | $160.3 million | +1.8% |
| Florida | $209.9 million | $203.8 million | −2.9% |
| Georgia | $218.9 million | $221.7 million | +1.3% |
| Hawaii | $188.9 million | $189.6 million | +0.4% |
| Idaho | $186.0 million | $182.7 million | −1.8% |
| Illinois | $193.4 million | $190.5 million | −1.5% |
| Indiana | $206.9 million | $208.9 million | +1.0% |
| Iowa | $209.0 million | $216.0 million | +3.3% |
| Kansas | $221.9 million | $225.9 million | +1.8% |
| Kentucky | $212.9 million | $211.3 million | −0.7% |
| Louisiana | $208.4 million | $211.9 million | +1.7% |
| Maine | $190.0 million | $190.4 million | +0.2% |
| Maryland | $168.2 million | $168.4 million | +0.1% |
| Massachusetts | $162.0 million | $158.4 million | −2.2% |
| Michigan | $173.1 million | $170.6 million | −1.5% |
| Minnesota | $193.1 million | $190.8 million | −1.2% |
| Mississippi | $205.9 million | $204.7 million | −0.6% |
| Missouri | $216.3 million | $218.5 million | +1.0% |
| Montana | $233.5 million | $239.7 million | +2.7% |
| Nebraska | $218.5 million | $219.2 million | +0.3% |
| Nevada | $179.9 million | $182.4 million | +1.4% |
| New Hampshire | $204.0 million | $204.3 million | +0.1% |
| New Jersey | $147.3 million | $142.3 million | −3.3% |
| New Mexico | $211.5 million | $211.0 million | −0.2% |
| New York | $212.1 million | $207.8 million | −2.0% |
| North Carolina | $213.0 million | $216.8 million | +1.8% |
| North Dakota | $198.9 million | $206.4 million | +3.7% |
| Ohio | $202.0 million | $201.9 million | −0.1% |
| Oklahoma | $223.5 million | $227.1 million | +1.6% |
| Oregon | $192.3 million | $197.3 million | +2.6% |
| Pennsylvania | $193.3 million | $190.7 million | −1.3% |
| Rhode Island | $156.2 million | $158.2 million | +1.3% |
| South Carolina | $200.0 million | $196.0 million | −2.0% |
| South Dakota | $189.5 million | $187.7 million | −1.0% |
| Tennessee | $206.9 million | $210.3 million | +1.7% |
| Texas | $281.3 million | $282.0 million | +0.2% |
| Utah | $195.7 million | $191.9 million | −2.0% |
| Vermont | $195.1 million | $190.0 million | −2.6% |
| Virginia | $189.5 million | $195.7 million | +3.3% |
| Washington | $181.3 million | $177.1 million | −2.3% |
| West Virginia | $199.5 million | $202.1 million | +1.3% |
| Wisconsin | $203.7 million | $203.7 million | +0.01% |
| Wyoming | $205.0 million | $207.2 million | +1.1% |
How much of the first year's money is in use
The obligated funds report, which covers December 29, 2025, through July 31, 2026, shows what each state said it had committed to state agencies, contractors, community partners, hospitals and others. Across the 50 states, those "funds put to work" add up to about $4.0 billion, roughly 40% of first-year awards, by our count. Georgia, Hawaii and New Hampshire reported their whole first-year award as put to work; New York and West Virginia reported none.
CMS cautions that the report is a point-in-time look and not a full view of state progress, and that the figures do not by themselves determine a state's second-year award. It plans to update the data after states submit their November 30, 2026, quarterly reports.
Sources
- Trump Administration Announces $10 Billion in Second Year of Rural Health Transformation Awards to All 50 States Centers for Medicare & Medicaid Services, November 9, 2026
- Rural Health Transformation Program: Year 2 Awards (fact sheet) Centers for Medicare & Medicaid Services, November 9, 2026
- RHTP Obligated Funds Report, reporting period December 29, 2025 - July 31, 2026 Centers for Medicare & Medicaid Services (Medicaid.gov)
Researched and drafted with AI assistance, then checked against the 3 sources above in a separate fact-check on November 14, 2026. Spotted an error? Tell us.