On Monday, the administration of President Donald Trump announced the distribution of hundreds of millions of dollars to each state for this fiscal year. This funding is part of a significant $50 billion rural health initiative integrated into the Republicans’ comprehensive legislation, often referred to as a “big, beautiful” law.
The five-year Rural Health Transformation Program—which was authorized under the extensive tax and spending reform package signed into law by Trump in July—is aimed at mitigating budget challenges faced by rural regions due to the extensive cuts to Medicaid.
| State | Fiscal Year 2026 Allocation |
|---|---|
| Oregon | $197,271,578 |
| North Dakota | $198,936,970 |
| West Virginia | $199,476,099 |
| South Carolina | $200,030,252 |
| Colorado | $200,105,604 |
| Ohio | $202,030,262 |
| Alabama | $203,404,327 |
| Wisconsin | $203,670,005 |
| New Hampshire | $204,016,550 |
| Wyoming | $205,004,743 |
| Mississippi | $205,907,220 |
| Tennessee | $206,888,882 |
| Indiana | $206,927,897 |
| Louisiana | $208,374,448 |
| Arkansas | $208,779,396 |
| Iowa | $209,040,064 |
| Florida | $209,938,195 |
| New Mexico | $211,484,741 |
| New York | $212,058,208 |
| Kentucky | $212,905,591 |
| State | Fiscal Year 2026 Allocation |
|---|---|
| Washington | $181,257,515 |
| Nevada | $179,931,608 |
| Michigan | $173,128,201 |
| Maryland | $168,180,838 |
| Arizona | $166,988,956 |
| Massachusetts | $162,005,238 |
| Delaware | $157,394,964 |
| Rhode Island | $156,169,931 |
| Connecticut | $154,249,106 |
| New Jersey | $147,250,806 |
The Centers for Medicare and Medicaid Services (CMS) indicated that half of the $50 billion will be evenly allocated among all states from fiscal years 2026 to 2030.
The remaining $25 billion will be distributed over the same period, according to various criteria, including the initiatives states are implementing to enhance healthcare access in rural communities.
Texas is set to receive the highest first-year allocation, totaling $281.3 million, followed closely by Alaska at $272.2 million. California will receive $233.6 million, with Montana at $233.5 million and Oklahoma getting $223.5 million.
Conversely, New Jersey will receive the smallest award for the first year, amounting to $147.2 million. Maryland, with $168.2 million, ranks as the seventh lowest, primarily followed by other predominantly urban East Coast states. Among larger, largely rural states, Arizona’s allocation is also notably lower, at just under $167 million, based on CMS data.
“Thanks to Congress for establishing this funding and to President Trump for his leadership, states are moving forward with innovative and ambitious strategies to enhance rural healthcare access, strengthen their healthcare workforce, modernize health services, and support the communities that are essential to our nation’s functioning,” said CMS Administrator Dr. Mehmet Oz in a statement accompanying the announcement.
Dr. Oz further remarked that “CMS is eager to collaborate with each state to translate their ideas into enduring improvements for families living in rural areas.”
In a separate analysis, the nonpartisan health research organization KFF discovered that this program is only projected to compensate for slightly over one-third of the anticipated $137 billion reduction in federal Medicaid funding allocated to rural areas over the next decade.
Ashley Murray contributed to this article. The subheading was updated on December 30 to rectify the length of the program.
