The Rural Health Transformation Program, created by Public Law 119-21, provides $50 billion over five years, $10 billion a year from 2026 through 2030. CMS announced awards to all 50 states on December 29, 2025 (CMS). The program's first budget period ran from December 31, 2025, to September 30, 2026 (U.S. Chamber of Commerce), and the final week of that period brought a burst of state announcements.
California
Primary recordCalifornia's fiscal year 2026 award is $233,639,308.46, administered by the Department of Health Care Access and Information through its CalRHT program; the notice of award is dated February 27, 2026 (HCAI). A March 2026 budget notice to the Legislature states that federal guidance requires the entire award to be encumbered, or legally committed, by October 30, 2026 (Joint Legislative Budget Committee). HCAI's Accelerator Partner grants carry an $8 million award ceiling for federal fiscal year 2026–27 and are paid on milestones (HCAI).
AnalysisThe questions for California are whether HCAI commits the full $233.6 million by October 30, how much reaches San Joaquin Valley providers, and what happens to any amount not committed. This tracker will record each California sub-award as it is announced, with a separate panel for Valley counties.
Recent state announcements
| State | Amount announced | Date | Purpose | Source |
|---|---|---|---|---|
| Colorado | $169,587,181 to 91 grantees (of a $200,105,604 fiscal year 2026 award) | September 28, 2026 | Telemedicine, mobile care, behavioral and maternal health, specialty care, workforce, records modernization; a prehospital whole-blood network reaching 39 counties. 112 applicants sought $250 million for 368 projects | Colorado Governor; Colorado Sun |
| Montana | $8.7 million | September 2026 | Rural EMS: ambulances, cardiac monitors, ventilators, transport systems | CMS |
| North Carolina | $1.25 million for children's preventive, acute and behavioral care, building on $10 million earlier | September 2026 | Fiscal year 2026 total award $213,008,356 | Fierce Healthcare tracker |
| New Mexico | $74 million | September 2026 | — | Fierce Healthcare tracker |
| Missouri | More than $45 million | September 2026 | — | Fierce Healthcare tracker |
| Hawaii | $58 million | September 1, 2026 | — | Fierce Healthcare tracker |
| Arkansas, Connecticut, Delaware, South Carolina, Texas | — | September 2026 | Named in CMS's September 30 roundup | Health IT Answers |
| California | $233,639,308.46 award; sub-awards to be listed as announced | Commitment deadline October 30, 2026 | CalRHT | HCAI |
How to read this tracker
Each state moves through five stages: awarded, notice of award, sub-awards announced, encumbered, disbursed. An announcement is not a payment. Amounts are shown only when a state or CMS release, or a named trade source, reports them, and the source is listed in the row.
Why it matters in the Valley
AnalysisWith the Kern County medical-school study and the community-college nursing degree pilot both vetoed in September 2026, rural-transformation money is now the main new public lever on physician and nursing supply in the San Joaquin Valley.