CMS Announces Rural Health Transformation Program Awards in All 50 States, Including Tribal Set-Asides and Initiatives in Several States
On December 29, 2025, the Centers for Medicare and Medicaid Services (CMS) announced all 50 states will receive awards under the Rural Health Transformation Program (RHTP), which was created in the One Big Beautiful Bill Act (OBBBA). In 2026, states will receive first-year awards from CMS averaging $200 million with awards ranging from $147 million to $281 million. Importantly, many states included Tribal-specific components within their RHTP application abstracts.
Annual Allocations and Tribal Mentions for States with UIOs
| State | Total Annual Allocation | Tribal Set Aside or Tribal Initiative1 |
| Arizona | $166,988,956 | |
| California | $233,639,308 | |
| Colorado | $200,105,604 | |
| Illinois | $193,418,216 | |
| Kansas | $221,898,008 | |
| Maryland | $168,180,838 | |
| Massachusetts | $162,005,238 | |
| Michigan | $173,128,201 | List Tribes or Tribal organizations as subrecipients of the state’s funding allocation. |
| Minnesota | $193,090,618 | Minnesota states that rural Tribal Nations are a potential subgrantee of its funding allocation. |
| Missouri | $216,276,818 | |
| Montana | $233,509,359 | List Tribes or Tribal organizations as subrecipients of the state’s funding allocation. |
| Nebraska | $218,529,075 | List Tribes or Tribal organizations as subrecipients of the state’s funding allocation. |
| Nevada | $179,931,608 | |
| New Mexico | $211,484,741 | Includes an initiative to “build and sustain a rural and Tribal health workforce by expanding local career pathways, strengthening clinical training pipelines and educational opportunities, and supporting long-term retention through housing, mentorship, and community-based incentives.” Also includes an initiative to “launch a competitive grant program that empowers rural, frontier, and Tribal communities in New Mexico to design and lead locally tailored health initiatives addressing unique challenges such as preventive care, behavioral health, non-medical drivers of health, and provider facility needs.” |
| New York | $212,058,208 | Includes information about partnering with Tribal Nations to implement their plans in the most effective way possible. |
| Oklahoma | $223,476,949 | Includes information about partnering with Tribal Nations to implement their plans in the most effective way possible. |
| Oregon | $197,271,578 | Oregon has a dedicated set-aside for the nine federally recognized Tribes in the state. |
| South Dakota | $189,477,607 | |
| Texas | $281,319,361 | |
| Utah | $195,743,566 | Includes information about partnering with Tribal Nations to implement their plans in the most effective way possible. |
| Washington | $181,257,515 | Washington states its initiatives will support, among other things, “increasing training capacity for Tribal providers, nurses and long-term care workers.” |
| Wisconsin | $203,670,005 | Includes information about partnering with Tribal Nations to implement their plans in the most effective way possible. |
Background on the RHTP
The RHTP’s $50 billion in funds will be allocated to approved states over five years, with $10 billion available each year from 2026 through 2030. As directed by the OBBBA:
- 50% of the funding is distributed equally among all approved states; and
- 50% is allocated based on factors as described in the Notice of Funding Opportunity.
NCUIH will continue to monitor how the allocations under the RHTP will be distributed.
1Hobbs, Straus, Dean & Walker, LLP., General Memorandum 26-001, (2026, January 6), https://hobbsstraus.com/general_memo/general-memorandum-26-001/.