The Rural Health Transformation Program, created under the One Big Beautiful Bill Act, represents a $50 billion federal investment distributed as $10 billion annually from 2026-2030. All 50 states submitted applications in November requesting typically $1 billion each. CMS will announce awards by December 31, 2025, with half distributed equally among approved states and half awarded discretionally based on compelling initiatives and demonstrated need.

Fifteen governors launched a public health alliance to improve emergency preparedness and coordination across state lines, while CMS announced all 50 states applied for the $50 billion Rural Health Transformation Program. California enacted major healthcare transparency and PBM oversight legislation, Colorado proposed significant Medicaid spending cuts, and Massachusetts advanced prior authorization reforms.

CMS released guidance for states applying to the Rural Health Transformation Program's $50 billion in federal funding distributed between FY2026-FY2030. States like Mississippi, Oklahoma, North Dakota, and Washington are conducting stakeholder surveys and forming committees to develop applications focusing on workforce development, technology infrastructure, and healthcare access improvements. Applications are due November 5, 2025, with approvals by December 31.