States are approaching a federal deadline to commit the first year of a $50 billion rural health fund, and progress has been uneven enough that some are still building the administrative machinery to distribute money awarded at the end of last year.
The Rural Health Transformation Program, created in the 2025 reconciliation law, allocates $10 billion a year from fiscal 2026 through fiscal 2030. All 50 states received first-year awards ranging from about $147 million in New Jersey to about $281 million in Texas, according to the Centers for Medicare and Medicaid Services, with an average near $200 million. The District of Columbia and U.S. territories are not eligible.
