On December 29, 2025, the Centers for Medicare & Medicaid Services (CMS) announced all 50 states will receive funding awards from the Rural Health Transformation (RHT) Program—a historic $50 billion investment aimed at redesigning rural health care systems across the nation. This program intends to assist states in remodeling rural health care delivery by expanding workforce capacity, modernizing health care infrastructure and deploying innovative technologies tailored to regional needs. Funding will be distributed over five fiscal years, with $10 billion available annually from fiscal year 2026 through fiscal year 2030.

Collectively, the 20 heartland states were awarded $4.12 billion of the $10 billion allocated for fiscal year 2026 in recognition of both the significant need for rural health care access and delivery across the heartland and the strength of the solutions heartland states put forward to address these gaps in their RHT applications. In the following four fiscal years, CMS will allocate the remaining $40 billion based on demonstrated outcomes, programmatic milestones and the effectiveness of implemented reforms. By identifying local needs and advancing innovative, state-tailored solutions, heartland states aligned with CMS priorities to develop, test and scale rural health care models, informing efforts to strengthen care delivery nationwide.

Within the $4.12 billion awarded to the heartland, the eight states represented in the Heartland Health Caucus—a non-partisan group of health policy officials committed to improving health outcomes across the heartland—received $1.7 billion to advance coordinated, state-led and locally-informed strategies to address persistent rural health challenges while strengthening local economies. 

States now transition towards the implementation phase of the RHT Program. Heartland states have indicated plans to establish dedicated RHT offices, or similar entities, to coordinate with subgrantees and partners, manage funds and serve as the primary point of contact with CMS throughout the life of the program. These structures are intended to support strong governance, accountability and transparency as the RHT Program moves from planning to execution.

States will continue to work closely with CMS as they finalize application submissions, develop program strategies and begin implementing the various programs outlined in their applications. Under their cooperative agreements, CMS will provide ongoing guidance and technical assistance, while states submit regular updates to monitor progress, assess program effectiveness and inform future rural health care policy. As this work moves forward, the RHT Program presents a significant opportunity for heartland states to lead in building resilient, innovative and accessible models of care to support community health and long-term economic competitiveness.

The RHT Program heartland state awards for Fiscal Year 2026 are listed below. 

State (With RHTP Website/Application Linked)	FY26 Award Amount	FY26 Award Per Rural Resident
Alabama	$203,404,327	$126
Arkansas**	$208,779,396	$159
Illinois	$193,418,216	$101
Indiana**	$206,927,897	$106
Iowa	$209,040,064	$139
Kansas**	$221,898,008	$191
Kentucky**	$212,905,591	$95
Louisiana**	$208,374,448	$188
Michigan	$173,128,201	$83
Minnesota	$193,090,618	$114
Mississippi	$205,907,220	$118
Missouri**	$216,276,818	$104
Nebraska	$218,529,075	$280
North Dakota	$198,936,970	$561
Ohio	$202,030,262	$69
Oklahoma**	$223,476,949	$142
South Dakota	$189,477,607	$379
Tennessee**	$206,888,882	$94
Texas	$281,319,361	$66
Wisconsin	$203,670,005	$95
Heartland Total Funding (All 20 States)	$4,177,479,915	N/A
**Heartland Health Caucus States Total Funding	$1,705,527,989	N/A