On November 9, 2026, CMS announced $10 billion in second-year (FY 2027) Rural Health Transformation awards. Every state keeps its $100 million baseline; only the workload half moved. Here is each state’s Year 2 award next to its Year 1 award, and what the change lines up with.
Rural Care Journey · Status as of November 10, 2026
$10 billion
Year 2 total, all 50 states
25 / 25
States up / down from Year 1
3.7%
Largest change in either direction
$142M–$282M
Range: New Jersey to Texas
How to Prepare for RHTP Year 2 Funding with Rural Care Journey
New or returning, start here: a step-by-step manual for RHTP Year 2 (Budget Period 2) with links straight to your state's readiness signals, state page, open rounds, alerts and application tools.
The same states sit at the bottom and top as in Year 1: New Jersey at $142,338,224 and Texas at $281,976,026. Because the total stayed at $10 billion, money only moved between states. The biggest gain was North Dakota (+$7,442,657); the biggest loss was Florida (−$6,110,124).
CMS says it re-scored two things for Year 2: progress on each state’s initiatives and progress on state policy actions, naming the Presidential Fitness Test and nutrition continuing medical education (CME) for physicians. CMS also says July 2026 obligation data “do not, by themselves” set a state’s award.
Change from Year 1
Largest gain at the top. Hover a bar for both amounts.
What the change lines up with
CMS’s State Data Maps list which of 19 state policy actions each state committed to. Of the 13 states with no commitments, 2 gained and 11 lost money. Of the 14 states with four or more, 12 gained. This is a pattern in the published numbers, not CMS’s formula: CMS hasn’t published how much each factor weighs.
| Policy commitments | States | Gained | Net change | States |
|---|---|---|---|---|
| No commitments | 13 | 2 | −$34,506,936 | CA CO FL ID IL KY MD ME MN NJ NY OR WA |
| 1 to 3 | 23 | 11 | −$4,803,247 | AL AZ CT GA HI IN LA MA MI MS NC NE OH OK PA SC SD TX UT VA VT WI WV |
| 4 or more | 14 | 12 | +$39,310,183 | AK AR DE IA KS MO MT ND NH NM NV RI TN WY |
Commitments as shown on CMS’s State Data Maps before the Year 2 announcement (RCJ snapshot, last checked November 9, 2026). Every state page on RCJ shows its own commitments.
Sorted by change, largest gain first.
| State | Year 1 (FY 2026) | Year 2 (FY 2027) | Change | % | Policy commitments |
|---|---|---|---|---|---|
| North Dakota | $198,936,969.55 | $206,379,627 | +$7,442,657 | +3.74% | 5 of 19 |
| Iowa | $209,040,063.71 | $216,007,657 | +$6,967,594 | +3.33% | 4 of 19 |
| Montana | $233,509,358.76 | $239,740,669 | +$6,231,310 | +2.67% | 6 of 19 |
| Virginia | $189,544,888.14 | $195,710,118 | +$6,165,230 | +3.25% | 2 of 19 |
| Kansas | $221,898,007.82 | $225,896,117 | +$3,998,109 | +1.80% | 4 of 19 |
| North Carolina | $213,008,356.47 | $216,824,573 | +$3,816,217 | +1.79% | 3 of 19 |
| Oklahoma | $223,476,948.62 | $227,097,543 | +$3,620,594 | +1.62% | 2 of 19 |
| Louisiana | $208,374,447.57 | $211,858,378 | +$3,483,931 | +1.67% | 2 of 19 |
| Tennessee | $206,888,882.11 | $210,344,524 | +$3,455,642 | +1.67% | 8 of 19 |
| Delaware | $157,394,963.86 | $160,294,521 | +$2,899,557 | +1.84% | 6 of 19 |
| Georgia | $218,862,169.63 | $221,731,766 | +$2,869,596 | +1.31% | 2 of 19 |
| West Virginia | $199,476,098.72 | $202,081,355 | +$2,605,256 | +1.31% | 3 of 19 |
| Nevada | $179,931,608.42 | $182,403,722 | +$2,472,114 | +1.37% | 4 of 19 |
| Missouri | $216,276,817.66 | $218,547,090 | +$2,270,273 | +1.05% | 5 of 19 |
| Wyoming | $205,004,742.95 | $207,231,931 | +$2,227,188 | +1.09% | 6 of 19 |
| Rhode Island | $156,169,931.19 | $158,171,967 | +$2,002,036 | +1.28% | 5 of 19 |
| Indiana | $206,927,896.80 | $208,908,591 | +$1,980,694 | +0.96% | 1 of 19 |
| Hawaii | $188,892,439.75 | $189,615,723 | +$723,283 | +0.38% | 1 of 19 |
| Nebraska | $218,529,075.01 | $219,247,775 | +$718,700 | +0.33% | 2 of 19 |
| Texas | $281,319,360.67 | $281,976,026 | +$656,665 | +0.23% | 2 of 19 |
| Alaska | $272,174,855.72 | $272,653,149 | +$478,294 | +0.18% | 10 of 19 |
| Maine | $190,008,051.09 | $190,358,993 | +$350,942 | +0.18% | 0 of 19 |
| New Hampshire | $204,016,550.20 | $204,312,551 | +$296,001 | +0.15% | 6 of 19 |
| Maryland | $168,180,837.61 | $168,410,112 | +$229,274 | +0.14% | 0 of 19 |
| Wisconsin | $203,670,005.21 | $203,695,089 | +$25,084 | +0.01% | 1 of 19 |
| Oregon | $197,271,577.67 | $197,254,520 | −$17,058 | -0.01% | 0 of 19 |
| Ohio | $202,030,262.02 | $201,926,470 | −$103,792 | -0.05% | 3 of 19 |
| New Mexico | $211,484,740.89 | $211,044,635 | −$440,106 | -0.21% | 6 of 19 |
| Connecticut | $154,249,105.53 | $153,652,078 | −$597,028 | -0.39% | 2 of 19 |
| Arkansas | $208,779,396.02 | $207,788,910 | −$990,486 | -0.47% | 4 of 19 |
| Mississippi | $205,907,220.16 | $204,677,190 | −$1,230,030 | -0.60% | 2 of 19 |
| Kentucky | $212,905,590.56 | $211,330,599 | −$1,574,992 | -0.74% | 0 of 19 |
| South Dakota | $189,477,607.26 | $187,653,446 | −$1,824,161 | -0.96% | 2 of 19 |
| Arizona | $166,988,955.92 | $165,014,474 | −$1,974,482 | -1.18% | 2 of 19 |
| Minnesota | $193,090,618.14 | $190,833,571 | −$2,257,047 | -1.17% | 0 of 19 |
| Michigan | $173,128,201.02 | $170,613,270 | −$2,514,931 | -1.45% | 1 of 19 |
| California | $233,639,308.47 | $231,105,823 | −$2,533,486 | -1.08% | 0 of 19 |
| Pennsylvania | $193,294,053.98 | $190,730,492 | −$2,563,562 | -1.33% | 1 of 19 |
| Colorado | $200,105,604.17 | $197,164,933 | −$2,940,671 | -1.47% | 0 of 19 |
| Illinois | $193,418,216.21 | $190,458,454 | −$2,959,762 | -1.53% | 0 of 19 |
| Idaho | $185,974,367.81 | $182,698,377 | −$3,275,991 | -1.76% | 0 of 19 |
| Massachusetts | $162,005,238.13 | $158,392,692 | −$3,612,547 | -2.23% | 1 of 19 |
| Utah | $195,743,566.29 | $191,923,052 | −$3,820,514 | -1.95% | 1 of 19 |
| South Carolina | $200,030,252.32 | $195,986,033 | −$4,044,219 | -2.02% | 2 of 19 |
| Alabama | $203,404,326.54 | $199,278,801 | −$4,125,525 | -2.03% | 1 of 19 |
| Washington | $181,257,515.06 | $177,060,212 | −$4,197,303 | -2.32% | 0 of 19 |
| New York | $212,058,207.80 | $207,750,071 | −$4,308,137 | -2.03% | 0 of 19 |
| New Jersey | $147,250,805.85 | $142,338,224 | −$4,912,581 | -3.34% | 0 of 19 |
| Vermont | $195,053,740.44 | $189,996,036 | −$5,057,704 | -2.59% | 1 of 19 |
| Florida | $209,938,194.50 | $203,828,071 | −$6,110,124 | -2.91% | 0 of 19 |
Year 2: CMS press release, November 9, 2026, table “Year 2 Rural Health Transformation Awards”, in whole dollars. CMS has since added Budget Period 2 funding to its State Data Maps to the cent (sums to $10,000,000,000.00, each state matching the press release when rounded); this report uses those figures and shows them rounded to the dollar. How annual amounts are set: CMS Year 2 fact sheet.
Year 1 and policy commitments: CMS RHTP State Data Maps, Budget Period 1 funding to the cent (sums to $10,000,000,000.00). RCJ captures the maps weekly; the figures here are from the capture last confirmed on November 9, 2026, before the Year 2 announcement. If CMS updates the maps, the commitments shown may change.