This edition focuses on the Rural Health Transformation Program, the $50 billion fund established by H.R. 1 and distributed across all 50 states from FY26 through FY30
- Year 1’s compressed timeline has produced wide variation in how states are distributing funds, both across states and across initiatives within states. Approaches range from open grant rounds (Kansas) to third-party grant intermediaries (Alaska) to regional fiduciary leads (North Carolina) to traditional RFP procurement (Texas, Nevada).
- Texas, Alaska, California, Montana, and Oklahoma received the five largest workload funding awards. However, when adjusted for rural population size, their per-resident rankings ranged from 2nd (Alaska, at $626 per rural resident) to 46th (Texas, at $42 per rural resident).
- 27 states submitted increased budgets following their award announcements, while 23 submitted decreased budgets, reflecting the gap between the $200 million hypothetical in initial applications and actual award amounts.