States had obligated about $4 billion of nearly $10 billion in first-year Rural Health Transformation Program funds as of July 31, according to a CMS report based on state-reported data.
The 105-page report covers Dec. 29, 2025, through July 31, 2026. It details funds states obligated to state agencies, contractors and vendors, community partners, hospitals and facilities, and others. CMS noted the document “is not a full view of state progress.” It plans to update the data after states submit their Nov. 30 quarterly reports and refresh it quarterly after that.
Here are seven things to know:
1. Across 50 states, first-year awards total $9.995 billion. States reported $4 billion in obligated funds, or about 40%.
2. Line items in nine states, or 18%, specifically describe funds going to hospitals or to named hospitals: California, Connecticut, Georgia, Illinois, Indiana, Nebraska, North Dakota, Oklahoma and Pennsylvania. Hospitals are mentioned in some way in 18 states’ line items or initiative titles, or 36%, including projects where hospitals are one of several participants.
The report generally describes what funds will be used for rather than who will receive them. Line items accounting for more than half of obligated dollars do not name a recipient type.
Some of the largest line items focus on hospitals.
- California obligated $35 million in grants for “Transformative Payments for Strategically Located Hospitals.”
- Oklahoma obligated $33.9 million for “building joint resiliency for rural hospitals through a rural-focused provider collaborative.”
- Georgia obligated $26 million for robotic surgical equipment for rural hospitals.
- Connecticut obligated $20.4 million for rural hospital infrastructure improvements, right-sizing, facility upgrades and minor renovations. It also obligated $15.2 million for EMR replacement and hospital system modernization.
- Kansas obligated $10.2 million for its Anchor Hospital Advancement Program.
3. Pace varies widely. Ten states reported obligating at least 75% of their first-year award: Georgia, Hawaii, New Hampshire, Maryland, Connecticut, Indiana, California, Iowa, Illinois and North Carolina. Georgia, Hawaii and New Hampshire reported obligating 100%.
4. Fifteen states reported obligating less than 10%. New York and West Virginia reported $0 obligated. Idaho, New Mexico, Florida, Wyoming and Nevada each reported less than 2%. By comparison, Texas, which received the largest award at $281.3 million, reported $53.3 million obligated, or 18.9%.
5. In six slower-moving states, all reported obligations so far went to program operations, such as staffing, administration and grant management.
- Alabama obligated $5.4 million, including about $5.2 million for a grant management contract.
- Arkansas obligated $6.2 million, including $6 million for contractual agreements.
- Florida obligated $1.8 million, mostly for personnel costs and fringe benefits.
- Idaho obligated $430,414 for administrative expenses.
- New Mexico obligated $754,754, including $512,549 for a grants management platform subscription and implementation.
- Wyoming obligated $1.9 million for salaries and supplies for employees supporting the program.
6. States are also directing funds toward priorities such as workforce, technology and prevention.
- California obligated $65.7 million in grants to expand rural workforce capacity and support provider retention and relocation.
- Washington obligated about $42 million for critical technology infrastructure and maintenance needs.
- Texas obligated $24.8 million for community-based prevention, wellness and nutrition programs or services.
7. Several states are funding readiness for value-based and alternative payment models, and some are routing funds through hospital associations.
- Georgia obligated $75.6 million for AHEAD hospital and primary care assessments, technical assistance and risk mitigation.
- Delaware obligated $9.6 million for a value-based care transformation initiative to strengthen readiness for alternative payment models.
- Rhode Island obligated $15.8 million to the Hospital Association of Rhode Island to assess needs for a rural hospital-at-home program.
- Nebraska obligated $3.5 million to the Nebraska Hospital Association to support critical access hospitals evaluating a transition to the Rural Emergency Hospital model.
Becker’s 3rd Annual Fall Chief Pharmacy Officer Summit is the top tier event that the people leading the future of pharmacy convene. This 3-day event is built specifically for Chief Pharmacy Officers and senior pharmacy leaders. The sessions examine the workforce, financial and clinical priorities shaping pharmacy today. Becker’s is where candid discussions flourish and new ideas thrive. Becker's 3rd Annual Fall Chief Pharmacy Officer Summit
