North Dakota posted the largest gain in competitive Rural Health Transformation Program funding in the program’s second year, adding about $7.4 million, while Florida saw the steepest drop, losing about $6.1 million, according to a Becker’s analysis of CMS award data.
CMS awarded $10 billion to all 50 states Nov. 9 for fiscal 2027. Each state receives an equal $100 million baseline each year. The remaining $5 billion is distributed competitively based on factors such as rural population and facility characteristics, state policy actions and, new this round, implementation progress as reported in states’ annual progress reports.
Becker’s subtracted the $100 million baseline from each state’s fiscal 2026 and 2027 awards to isolate the competitive portion, then ranked states by the dollar change.
Notable patterns include:
- An even split. Exactly 25 states gained competitive funding and 25 lost it. Because the competitive pool stayed fixed at $5 billion, every dollar gained came from another state.
- Swings were modest. Changes ranged from a gain of $7.4 million to a loss of $6.1 million. Eight states moved by less than $500,000 in either direction, and the overall ranking of awards largely held.
- Rural Plains and Mountain West states led gains. North Dakota, Iowa, Montana and Kansas were among the top five. Montana now has the third-largest competitive allocation in the country, behind Texas and Alaska.
- Northeast and large-population states lost ground. New Jersey’s competitive funding fell 10.4%, the biggest percentage drop, and its total award remains the smallest at about $142.3 million. New York, Massachusetts, Vermont, Pennsylvania, Illinois, California and Washington each lost more than $2.5 million.
- Florida had the biggest dollar decline despite ranking 14th in competitive funding in year one.
Here are all 50 states ranked by change in competitive funding from fiscal 2026 to 2027:
1. North Dakota: +$7.44 million (+7.5%)
2. Iowa: +$6.97 million (+6.4%)
3. Montana: +$6.23 million (+4.7%)
4. Virginia: +$6.17 million (+6.9%)
5. Kansas: +$4 million (+3.3%)
6. North Carolina: +$3.82 million (+3.4%)
7. Oklahoma: +$3.62 million (+2.9%)
8. Louisiana: +$3.48 million (+3.2%)
9. Tennessee: +$3.46 million (+3.2%)
10. Delaware: +$2.9 million (+5.1%)
11. Georgia: +$2.87 million (+2.4%)
12. West Virginia: +$2.61 million (+2.6%)
13. Nevada: +$2.47 million (+3.1%)
14. Missouri: +$2.27 million (+2%)
15. Wyoming: +$2.23 million (+2.1%)
16. Rhode Island: +$2 million (+3.6%)
17. Indiana: +$1.98 million (+1.9%)
18. Hawaii: +$723,283 (+0.8%)
19. Nebraska: +$718,700 (+0.6%)
20. Texas: +$656,665 (+0.4%)
21. Alaska: +$478,293 (+0.3%)
22. Maine: +$350,942 (+0.4%)
23. New Hampshire: +$296,001 (+0.3%)
24. Maryland: +$229,274 (+0.3%)
25. Wisconsin: +$25,084 (<0.1%)
26. Oregon: −$17,058 (<0.1%)
27. Ohio: −$103,792 (−0.1%)
28. New Mexico: −$440,106 (−0.4%)
29. Connecticut: −$597,028 (−1.1%)
30. Arkansas: −$990,486 (−0.9%)
31. Mississippi: −$1.23 million (−1.2%)
32. Kentucky: −$1.57 million (−1.4%)
33. South Dakota: −$1.82 million (−2%)
34. Arizona: −$1.97 million (−2.9%)
35. Minnesota: −$2.26 million (−2.4%)
36. Michigan: −$2.51 million (−3.4%)
37. California: −$2.53 million (−1.9%)
38. Pennsylvania: −$2.56 million (−2.7%)
39. Colorado: −$2.94 million (−2.9%)
40. Illinois: −$2.96 million (−3.2%)
41. Idaho: −$3.28 million (−3.8%)
42. Massachusetts: −$3.61 million (−5.8%)
43. Utah: −$3.82 million (−4%)
44. South Carolina: −$4.04 million (−4%)
45. Alabama: −$4.13 million (−4%)
46. Washington: −$4.2 million (−5.2%)
47. New York: −$4.31 million (−3.8%)
48. New Jersey: −$4.91 million (−10.4%)
49. Vermont: −$5.06 million (−5.3%)
50. Florida: −$6.11 million (−5.6%)
