The top gainer was a slow starter
North Dakota had 5.6% of its Year 1 award at work and gained $7.4 million, the most of any state. West Virginia had nothing at work and still gained $2.6 million.
RHTP Year 2 awards · Last updated November 10, 2026
RHTP Year 2 Report: Under 1% Variance From Year 1 Allocations
Year 2 looks a lot like Year 1. Progress in Budget Period 2 sets Year 3.
CMS awarded another $10 billion to all 50 states for the program's second budget period. Year 2 allocations differ from Year 1 by a combined $68.0 million, under 1% of the total. This report shows which states gained, why the changes were small, and what decides the Year 3 awards.
$10.0BYear 2 awards across all 50 states
$68.0MVariance from Year 1 allocations, 0.7% of the total
25 / 25States whose award went up / down
$20.0BAwarded so far of the $50 billion program
Change by state
Small changes from Year 1, from +$7.4M to −$6.1M
Half of every award is a fixed $100 million equal share, so scores can change only the other half. 13 states changed by less than $1 million from Year 1. Six changed by $5 million or more: North Dakota, Iowa, Montana and Virginia up, Florida and Vermont down. No state's award changed by as much as 4%.
| State | Year 1 | Year 2 | Change |
|---|---|---|---|
| North Dakota | $198.9M | $206.4M | +$7.4M |
| Iowa | $209.0M | $216.0M | +$7.0M |
| Montana | $233.5M | $239.7M | +$6.2M |
| Virginia | $189.5M | $195.7M | +$6.2M |
| Kansas | $221.9M | $225.9M | +$4.0M |
| North Carolina | $213.0M | $216.8M | +$3.8M |
| Oklahoma | $223.5M | $227.1M | +$3.6M |
| Louisiana | $208.4M | $211.9M | +$3.5M |
| Tennessee | $206.9M | $210.3M | +$3.5M |
| Delaware | $157.4M | $160.3M | +$2.9M |
| Georgia | $218.9M | $221.7M | +$2.9M |
| West Virginia | $199.5M | $202.1M | +$2.6M |
| Nevada | $179.9M | $182.4M | +$2.5M |
| Missouri | $216.3M | $218.5M | +$2.3M |
| Wyoming | $205.0M | $207.2M | +$2.2M |
| Rhode Island | $156.2M | $158.2M | +$2.0M |
| Indiana | $206.9M | $208.9M | +$2.0M |
| Hawaii | $188.9M | $189.6M | +$0.7M |
| Nebraska | $218.5M | $219.2M | +$0.7M |
| Texas | $281.3M | $282.0M | +$0.7M |
| Alaska | $272.2M | $272.7M | +$0.5M |
| Maine | $190.0M | $190.4M | +$0.4M |
| New Hampshire | $204.0M | $204.3M | +$0.3M |
| Maryland | $168.2M | $168.4M | +$0.2M |
| Wisconsin | $203.7M | $203.7M | $0.0M |
| Oregon | $197.3M | $197.3M | $0.0M |
| Ohio | $202.0M | $201.9M | −$0.1M |
| New Mexico | $211.5M | $211.0M | −$0.4M |
| Connecticut | $154.2M | $153.7M | −$0.6M |
| Arkansas | $208.8M | $207.8M | −$1.0M |
| Mississippi | $205.9M | $204.7M | −$1.2M |
| Kentucky | $212.9M | $211.3M | −$1.6M |
| South Dakota | $189.5M | $187.7M | −$1.8M |
| Arizona | $167.0M | $165.0M | −$2.0M |
| Minnesota | $193.1M | $190.8M | −$2.3M |
| Michigan | $173.1M | $170.6M | −$2.5M |
| California | $233.6M | $231.1M | −$2.5M |
| Pennsylvania | $193.3M | $190.7M | −$2.6M |
| Colorado | $200.1M | $197.2M | −$2.9M |
| Illinois | $193.4M | $190.5M | −$3.0M |
| Idaho | $186.0M | $182.7M | −$3.3M |
| Massachusetts | $162.0M | $158.4M | −$3.6M |
| Utah | $195.7M | $191.9M | −$3.8M |
| South Carolina | $200.0M | $196.0M | −$4.0M |
| Alabama | $203.4M | $199.3M | −$4.1M |
| Washington | $181.3M | $177.1M | −$4.2M |
| New York | $212.1M | $207.8M | −$4.3M |
| New Jersey | $147.3M | $142.3M | −$4.9M |
| Vermont | $195.1M | $190.0M | −$5.1M |
| Florida | $209.9M | $203.8M | −$6.1M |
Sorted by change, largest gain first. Year 2 amounts from the CMS announcement, November 9, 2026, rounded to the nearest $0.1 million. Changes are calculated from exact award amounts.
Gains and losses net to zero. 25 states gained a combined $68.0 million, and 25 states lost the same amount.
Pace and awards
Faster states did a little better, but pace was not the score
We compared each state's Year 2 change with how much of its Year 1 award was at work on July 31, 2026, from the Year One Report. Faster states did slightly better on average, but the link is weak. CMS scores initiative progress and policy actions, not how fast money is put to work.
Fast starts did not guarantee gains
California had 93.8% at work and lost $2.5 million. Connecticut had 98.4% at work and lost $0.6 million.
Faster states gained a little on average
The eight states with 90% or more at work gained $1.2 million on average, and six of them went up. The 15 states under 10% lost $0.5 million on average, and six of them went up.
How CMS scores progress
Half the money is fixed. The rest is earned.
The law provides $10 billion a year from FY 2026 to FY 2030. Half is split equally among approved states. CMS allocates the other half using rural population, rural health facilities, hospital factors and each state's scores (CMS). Each budget period, CMS recalculates two scores: initiative progress and state policy actions. Data-driven factors, such as rural population, stay fixed (CMS webinar).
| Stage | Name | Weight |
|---|---|---|
| Stage 0 | Planning | 10% |
| Stage 1 | Project preparation | 10% |
| Stage 2 | Early implementation | 20% |
| Stage 3 | Midway implementation | 25% |
| Stage 4 | Preparation for completion | 20% |
| Stage 5 | Full implementation | 15% |
CMS tracks each initiative through 17 checkpoints in six stages. Weights from the CMS reporting and rescoring webinar, shared as a draft that may change. CMS shows each state's stage on its State Data Maps.
Stages 3 to 5 carry 60% of the weight. Initiatives still in planning and preparation have most of their progress credit ahead of them.
Rules for Year 2 money
Six rules that shape what states do next
CMS set these rules in its post-award FAQ in September 2026. They apply to every state and decide how fast Year 2 money can reach providers.
Unobligated money goes to other states
States must obligate each year's funds during that budget period. Money left uncommitted is redistributed by CMS to other states.
Year 1 money must be spent by September 2027
Obligated funds can be spent until the end of the next federal fiscal year. For Year 1, that is September 30, 2027.
Overhead and provider payments are capped
No more than 10% of an award can go to administration, and no more than 15% to provider payments.
Policy promises come due in 2027
Most policy commitments are due by the end of 2027, and factors B.2 and B.4 by the end of 2028. CMS recovers funds tied to commitments that are not met.
Every initiative needs four metrics
Each initiative must track at least four metrics, including at least one at the county or community level.
States reapply every year
States file a Non-Competing Continuation application each year, and can use it to adjust their budget.
What this means
What to watch before Year 3 awards
The November 29 quarterly report and the August 30, 2027 annual report will show which initiatives are moving through the stages. Those reports feed the Year 3 rescoring in September and October 2027.
For rural hospitals
Year 2 money reaches providers through state funding rounds, not CMS. Each state's lead agency announces its own rounds and deadlines. Check your state's guide for what is open and what is coming.
For partners and vendors
Each state has a new year of funds to obligate, under the same 10% cap on administration. Money a state does not commit in time goes to other states, which favors work that is ready to sign.
For state teams
Progress now feeds Year 3 directly. Moving initiatives into later stages and closing policy commitments before the end of 2027 are what protect future awards.
Key dates
The Year 2 calendar
The dates that matter for Year 2 money and for the Year 3 award. Reporting dates come from CMS draft materials and may change.
| Date | What happens | Source |
|---|---|---|
| Oct 30, 2026 | Budget Period 1 ends | Source |
| Oct 31, 2026 | Budget Period 2 (Year 2) spending begins | Source |
| Nov 9, 2026 | CMS announces $10 billion in Year 2 awards | Source |
| Nov 29, 2026 | First quarterly report due to CMS | Source |
| Aug 30, 2027 | Annual Report #2 due; it feeds the next rescoring | Source |
| Sep 30, 2027 | Deadline to spend Year 1 (Budget Period 1) funds | Source |
| Sep to Oct 2027 | CMS rescores states to set Year 3 awards | Source |
| Dec 31, 2027 | Deadline for most state policy commitments | Source |
| Dec 31, 2028 | Deadline for policy factors B.2 and B.4 | Source |
| Feb 27, 2031 | Final program report due | Source |
Reading the data
Read the awards as scores, not spending
Year 2 awards show how CMS rated each state's first year. They do not show what states have done with the new money.
Awards are not spending
Year 2 money is not yet in CMS data on funds put to work. The Year One Report covers Year 1 dollars put to work through July 31, 2026.
The scoring model is a draft
CMS shared the checkpoint stages and weights as a draft that is not yet approved by OMB and may change.
Pace is a point in time
Shares of Year 1 funds at work are state-reported as of July 31, 2026. CMS refreshes them after the quarterly report.
Oversight
What federal reviewers are watching
Independent reviews of how CMS runs the program and what it asks states to report.
GAO review
On October 6, 2026, the Government Accountability Office found CMS's monitoring plans generally consistent with federal award rules, but said it is too early to judge them. Some stakeholders raised concerns about how little time states had to show progress before Year 2. GAO made no recommendations.
Reporting requirements
CMS's proposed reporting templates for states, including the quarterly and annual reports, were published for comment in 2026. KFF Health News posted the proposed requirements.
State data from CMS
CMS posts each state's funding, policy commitments and initiative progress on its State Data Maps, with the full detail in the State Programmatic Snapshots.
Year 2 announcements
How states announced Year 2
Announcements from CMS, state governments and the press. We add state announcements as they come out.
| Date | Announcement | Source |
|---|---|---|
| Nov 10, 2026 | N.H. awarded $204 million for second year of the Rural Health Transformation Program | Concord Monitor |
| Nov 10, 2026 | West Virginia awarded $202M for second year of Rural Health Transformation | News and Sentinel |
| Nov 9, 2026 | CMS announces $10 billion in second year of awards to all 50 states | CMS |
| Nov 9, 2026 | Feds award $10B to states in second year of rural health grants | Stateline |
| Nov 9, 2026 | Rural Health Transformation Year 2 awards stay near Year 1 | HealthSystemCIO |
| Nov 9, 2026 | Maryland Department of Health receives $168 million in Year 2 funding | Maryland Governor's Office |
| Nov 9, 2026 | Delaware secures $160,294,521 in Year 2 funding | State of Delaware |
| Nov 9, 2026 | North Dakota receives $206 million in second year of the program | North Dakota congressional delegation |
| Nov 2, 2026 | North Carolina launches a Rural Health Transformation Program dashboard | North Carolina Governor's Office |
FAQ
RHTP Year 2 FAQs
Short answers to the questions we hear most about Year 2 awards.
How much is the Rural Health Transformation Program Year 2 award?
CMS awarded $10 billion for Year 2 (fiscal year 2027) to all 50 states on November 9, 2026. Awards range from $142.3 million in New Jersey to $282.0 million in Texas. With Year 2, CMS has awarded $20 billion of the program's $50 billion.
How much did Year 2 awards change from Year 1?
Year 2 awards changed very little from Year 1: 25 states gained a combined $68.0 million and 25 states lost the same amount, under 1% of the $10 billion. North Dakota (+$7.4 million) and Iowa (+$7.0 million) gained the most. Florida (−$6.1 million) and Vermont (−$5.1 million) lost the most. No state's award changed by as much as 4%.
How did CMS decide each state's Year 2 award?
Half of each year's $10 billion is split equally among approved states, $100 million each. CMS allocates the other half using factors such as rural population and rural health facilities, plus each state's scores. For Year 2, CMS recalculated scores for initiative progress and state policy actions using each state's annual report. Data-driven factors were not recalculated.
Did states that put Year 1 money to work faster get more in Year 2?
On average, states that put Year 1 money to work faster got slightly more in Year 2, but the link is weak. The eight states with 90% or more of Year 1 funds at work gained $1.2 million on average. The 15 states under 10% lost $0.5 million on average. North Dakota had 5.6% at work and gained the most of any state. CMS scores initiative progress and policy actions, not how fast money is put to work.
What happens if a state does not keep a policy commitment?
Most policy commitments must be in place by the end of 2027, and factors B.2 and B.4 by the end of 2028. If a state does not implement a commitment, CMS will recover payments tied to it. If a state abandons one, its points revert to the baseline right away.
Can hospitals and providers apply for Year 2 funds?
Hospitals and providers apply to their state for Year 2 funds, not to CMS. CMS awards the money to states, and each state runs its own funding rounds for providers, community groups and other partners. Check your state's guide for open and upcoming opportunities.
When will CMS decide Year 3 awards?
States file Annual Report #2 by August 30, 2027. CMS rescores states in September and October each year, and those scores set the next year's award. CMS plans to award $30 billion more over the last three years of the program, through 2030.
Original sources
Read the CMS documents behind these numbers
This report summarizes the Year 2 award amounts CMS announced on November 9, 2026, and the program rules and scoring materials CMS has published for states. Pace figures come from the CMS RHTP Obligated Funds Report used in the Year One Report.
PDF
2026 State Programmatic Snapshots
CMS · Each state's Year 1 and Year 2 awards, initiatives and policy commitments
| Document | What it covers | Published on |
|---|---|---|
| Post-award FAQ, September 2026 | Rules for spending, reporting and policy commitments | Medicaid.gov |
| Reporting and rescoring webinar | Checkpoints, stage weights and reporting dates (draft) | CMS.gov |
| State Data Maps | Funding, policy commitments and initiative progress by state | Medicaid.gov |
| Year 2 award announcement | Press release with every state's Year 2 award, November 9, 2026 | CMS.gov |