A Closer Look at the $50 Billion Rural Health Transformation Program

On July 4, 2025, President Trump signed a budget reconciliation bill—once known as the “One Big Beautiful Bill”—into law that included significant reductions in federal health care spending, large tax cuts, and other changes. It was projected that the law would reduce federal Medicaid spending by $911 billion over ten years (based on estimates released shortly after enactment), including by an estimated $137 billion in rural areas, according to KFF analysis. To help mitigate the impact on rural areas, the law created the Rural Health Transformation Program (referred to here as the “rural health fund”), which will award $50 billion in state grants from 2026 to 2030 to support rural health care.

This brief provides an overview of the rural health fund. Key takeaways include the following:

• The $50 billion rural health fund represents a large investment in rural health care and is intended to transform the delivery of care through a wide variety of activities.
• The $50 billion fund could mitigate but will not fully offset estimated cuts to federal Medicaid spending in rural areas ($137 billion over ten years according to KFF analysis) included in the same law. Unlike most of the federal Medicaid spending cuts, the fund is also time limited.
• While the fund was established in part to address concerns about the impact of the reconciliation law on rural hospitals, the funding is being used for a much broader set of purposes, and there are restrictions on how hospitals can benefit.
• Half of the funding is being divided equally among approved states. The rest is being distributed based on measures of state need, state initiative scores, state policy, and other factors.
• All 50 states were approved, with first-year awards ranging from $147 million to $281 million. First-year awards per rural resident range from less than $100 in ten states to more than $500 in eight.
• It remains to be seen how the funding will be distributed within states across various activities and entities.

Structure

The rural health fund will provide $50 billion in grants to states over five years.

The rural health fund was added to the 2025 reconciliation law as a political compromise just prior to the law’s passage. The fund emerged during Senate negotiations in response to concerns about the impact of federal spending cuts on rural hospitals. Nonetheless, the program is not specific to rural hospitals but instead supports a much broader set of activities (see below). The law specifies that the Centers for Medicare & Medicaid Services (CMS) will oversee the program. It grants the agency substantial leeway to determine how to distribute funding across states and flexibility to expand the permitted uses of funding and determine the terms and conditions. CMS is administering the program through the new Office of Rural Health Transformation.

Under the rural health fund, CMS will award $10 billion in grants to approved states each year from fiscal years 2026 to 2030, a five-year period, for a total of $50 billion. States will be allowed to spend funds that they receive at a given point through the end of the following fiscal year, and CMS will redistribute any unused funds over time, but all funds must be spent by the end of fiscal year 2032. States will administer their programs, subject to terms agreed upon with CMS. However, the funding is occurring through a mechanism known as a “cooperative agreement,” which “require[s] substantial CMS project involvement after an award is made.”  

States had a one-time opportunity to apply for funding and all states were approved, meaning that they are eligible for funding for all five years of the program. However, CMS may withhold, reduce, eliminate, or recover funding over time if it determines that a state is not in compliance with program rules, the state has not made “satisfactory progress,” or that funding is no longer “in the government’s best interest.” The law indicates that there will be no administrative or judicial review of these and other funding decisions made by CMS.

The law and CMS established a fast-paced timeline for states to apply for funding and initiate programs during the first year of the program. CMS issued a Notice of Funding Opportunity in September 2025 with guidance on how to apply. States then had less than two months to prepare their applications. Those applications affect the scope of activities states can engage in and the amount of funding they receive for the life of the program. CMS announced first-year awards in December 2025. States were then given less than a year to finalize their plans through discussions with CMS, develop their own application process for entities within the state to receive funding, process applications, obligate funding, and submit their first annual progress reports (which will affect second-year awards). States likely differ in their capacity to manage procurement processes and have varied widely in terms of how quickly they have distributed funds during the first year.

Uses

The rural health fund is intended to transform the delivery of health care in rural communities and is being used to support a wide variety of activities.

The rural health fund is designed to help “support…rural communities to improve healthcare access, quality, and outcomes through system transformation” according to CMS. CMS also indicated that it “expects States to design initiatives that invest in long-term, sustainable improvements rather than temporary fixes or funding perpetual operating expenses.” States can use funding for eleven purposes detailed in law and through guidance from CMS, with certain restrictions (see textbox below and Appendix Table 1). CMS has also identified five strategic goals of the program that align with these uses: make rural America healthy again, sustainable access, workforce development, innovative care, and tech innovation (see Appendix Table 2).

In line with the broad scope of the rural health fund, states are implementing a wide variety of activities under the program. For example, states are using funds to promote prevention and chronic disease management interventions, support collaboration among rural health care facilities (such as by sharing administrative services) and between rural providers and regional health systems, recruit clinical workers to rural areas, promote technological advancements (such as by expanding telehealth or promoting AI diagnostic tools), invest in existing hospital buildings and infrastructure, help hospitals determine which services should and should not be maintained, and support the adoption of value-based care and alternative payment models.

Specific state examples include the following (each state is undertaking multiple initiatives):

• Alabama is funding the use of telerobotics to provide ultrasounds remotely.
• Alaska is funding the use of drones to deliver medications to remote areas.
• California is funding new provider collaboration networks, connecting regional hospitals with critical access hospitals, clinics, birthing centers, and other providers.
• Michigan is funding an initiative to bring “services closer to where people work and live,” such as by “expanding…home-based care for older adults to allow them to age in place.”
• North Carolina is increasing access to healthy foods, such as by “facilitat[ing] farm-to-hospital [programs], mobile food markets, and community-based food access.”
• Montana is helping rural hospitals “right size” their services, which could entail eliminating some service offerings to improve hospitals’ financial sustainability.
• Nevada is funding an expansion of its rural workforce, such as through provider recruitment incentives.

Uses for Hospitals

Rural health funds are not just for hospitals, and there are restrictions on how hospitals can benefit.

While the fund emerged in response to concerns about the impact of the reconciliation law on rural hospitals, the extent to which it will benefit these facilities is unclear. States can choose how much of the funds will go to hospitals versus other rural providers and various other entities, such as contractors providing technical assistance, universities participating in workforce initiatives, regional health systems in urban areas collaborating with rural providers, and vendors developing new health technologies. Of the dollars going to rural hospitals, it is not yet clear which specific facilities will receive funding and the extent to which states will target resources to particular types of hospitals, such as those that are isolated or in financial distress. Additionally, hospitals that are not in rural areas can also receive funding, as long as it is to the benefit of rural communities and residents.

Initiatives could benefit hospitals to varying degrees. For example, uses of the funds that could more directly benefit hospitals include investing in existing hospital infrastructure (permitted within limits), strengthening collaboration among rural facilities and other providers, and supporting alternative payment models. Other initiatives, such as programs to promote health literacy and healthy behaviors, may have less direct or no obvious benefits for hospitals. The benefit to rural hospitals—and to other providers, patients, and rural communities—will also depend on how effective state initiatives are, which is difficult to predict. 

While funding could benefit hospitals in a number of ways, there are also limitations on how it can do so. For example, CMS guidance indicates that rural health funds cannot be used for:

• Propping up struggling hospitals with temporary relief. The funds are not intended “to be used for perpetual operating expenses, but rather for investments…that will have sustainable impact beyond the end of the program,” according to CMS.
• Payments to providers for care that exceed 15% of a state award in a given budget period. Payments to providers must be related to the strategic goals of the program, such as bonus payments for providing high-quality care, and cannot be used to supplement or duplicate existing funding, including payments from Medicaid or private insurance.
• Construction, building expansion, or purchasing buildings, though they can be used for certain investments in existing rural health care facility buildings and infrastructure, not to exceed 20% of a state award in a given budget period.
• Replacements for previous HITECH-certified electronic medical record (EMR) systems that exceed 5% of a state award in a given budget period.
• Funds for gender-affirming care (a limitation that is not restricted to care for minors, as are many other federal measures) and reimbursement for most abortion services. There are also limitations related to “citizenship documentation requirements for payments made with respect to an individual.” Many hospitals do not currently collect patient immigration status but may need to do so to be reimbursed for patient care with rural health funds.

The rural health fund may help hospitals adapt to the loss of federal funding under the reconciliation law, though the extent to which it will do so is unclear. The reconciliation law made historic reductions in federal support for health care and is expected to result in an unprecedented increase in the number of people without health insurance. An increasing uninsured rate results in fewer patients with health coverage for hospital care, and an increase in the amount of uncompensated care hospitals provide. At the same time, the 2025 reconciliation law made significant changes to Medicaid financing that could result in major reductions to the rates Medicaid pays for hospital services in most states.

Just as it is unclear how much hospitals will benefit under the rural health fund, it is also hard to predict how much hospitals will lose due to spending cuts under the reconciliation law. As detailed below, the rural health fund is smaller than estimated cuts to federal Medicaid spending when looking at rural areas in aggregate, and most of the cuts will persist over time, in contrast to the rural health fund.

The hospital industry and some members of Congress have called for a greater focus on hospitals. The hospital industry has recommended that the rural health fund give greater priority to supporting rural hospitals, including by lifting restrictions on provider payments and capital investments. A group of Senators also recommended that the program focus more on rural hospitals and other rural providers and expressed concern that small rural providers will have a harder time vying with larger systems and organizations for funding. Increasing funding for rural hospitals would do more to address concerns about the financial standing of these facilities, an original motivation for the program, but would involve tradeoffs with competing initiatives.

Amount

The $50 billion rural health fund is smaller than the $137 billion in estimated cuts to federal Medicaid spending in rural areas included in the same law.

The $50 billion in new funding could offset a little over a third (37%) of the estimated cuts to federal Medicaid spending in rural areas ($137 billion over ten years) based on KFF analysis of CBO estimates from July 2025, or about 5% of the total estimated cuts to federal Medicaid spending ($911 billion over ten years). This does not account for other revenue losses related to the law, including cuts to federal spending for the ACA Marketplaces. Nor does it include revenue losses stemming from the increased number of people who will be uninsured because of the expiration of the enhanced ACA premium tax credits and the implementation of 2025 Marketplace integrity rules. The impact of all of these changes on rural areas, and the extent to which the rural health fund offsets losses, will vary across the country.  

Timing

Rural health funding will be available primarily from 2026 to 2030, while most of the federal Medicaid spending cuts will occur afterwards and persist over time.

While many of the major cuts related to Medicaid and the ACA Marketplaces under the law are not time limited, the rural health fund is temporary. The law provides $10 billion per year through the rural health fund for fiscal years 2026 through 2030, a five-year period. States will be allowed to spend funds that they receive at a given point through the end of the following fiscal year, and CMS will redistribute any unused funds over time, but all funds must be spent by the end of fiscal year 2032.  New legislation would be required to provide additional support to rural areas after the funds dry up.

Rural health funds will be made available before many of the health care spending cuts under the law are fully realized (Figure 2). The rural health fund was put in place to address concerns of lawmakers from rural states, and front-loading these dollars could allow rural communities to make progress in improving care delivery in advance of forthcoming cuts. As described above, funding will first be available for fiscal year 2026, with $10 billion dollars available per year over five years through fiscal year 2030, and all funds must be spent by the end of fiscal year 2032. Yet most of the health care spending reductions are backloaded and occur after fiscal year 2030. For example, based on KFF analysis of CBO estimates, nearly two thirds (64%) of the ten-year reductions in federal Medicaid spending would occur after fiscal year 2030.

Approach

CMS is distributing half of the funds equally across states, a quarter based on measures of state need, and a quarter based on state initiative scores, state policy, and other factors.

The reconciliation law requires that half ($25 billion) of the rural health fund be distributed equally among states with approved applications while providing CMS with substantial discretion over how to distribute the second half ($25 billion). CMS refers to the former as “baseline funding” and the latter as “workload funding.” CMS is distributing workload funding (the second $25 billion) across all approved states based on 23 factors, weighted to varying degrees (see Appendix Table 3). CMS announced state awards from the $10 billion available for funding in the first year based on this approach and will use the same general approach in subsequent years.

The $50 billion rural health fund is being distributed as follows across all 50 states (CMS will use the same approach but for fewer states if it rescinds funding for some later on) (Figure 3):

• Equal distribution. Half of the funding (50% or $25 billion) is being distributed equally across states, as required by law.
• Measures of state need. A quarter of the funding (25% or $12.5 billion) is being distributed across states based on measures of state need, as specified by CMS (Appendix Figure 2 and Appendix Table 3).  Multiple measures have a rural focus, such as the size of the state’s rural population and the number of rural health facilities (a blend of hospitals and other facilities) in the state. Other measures are not explicitly focused on rural areas, such as hospitals’ uncompensated care as a percent of operating expenses and the share of hospitals in the state that receive Medicaid disproportionate share hospital payments (which are payments for hospitals that serve disproportionate numbers of people who are uninsured or enrolled in Medicaid). These factors were calculated once and will be used in all subsequent allocation periods (i.e., will not reflect changes over time, such as in uncompensated care).
• State proposed initiatives. About one sixth of the funding (16% or $8.0 billion) is being distributed based on how state initiatives are scored. This reflects a qualitative review of the state’s plan and, in later years, the state’s progress in implementing the plan. Not all of the initiatives allowed under the rural health fund are being considered for the allocation, but CMS has laid out those that are being taken into account, such as initiatives related to population health clinical infrastructure, health and lifestyle, rural provider strategic partnerships, and talent recruitment.
• Make America Health Again (MAHA) and other state policies. Eight percent of the funding ($3.8 billion) is being distributed based on whether a state has adopted, committed to adopting, or made progress towards adopting certain policies that are priorities of the Trump administration. Each of these policies reflect state-wide changes that are not specific to rural areas. Some of the policies are tied to the administration’s MAHA agenda, including requiring schools to reestablish the Presidential Fitness Test; prohibiting SNAP spending on non-nutritious items, like soda or candy; and requiring that nutrition be included in continuing medical education for physicians. Most other policies aim to promote competition among health care providers, such as by not having certificate of need (CON) laws, making it easier for providers to practice in multiple states, and providing an expansive scope of practice for nurse practitioners and other non-physicians.
• Other factors. The remaining funds (1% or $0.7 billion) are being distributed based on other factors, such as the share of dual eligibles (people who have both Medicare and Medicaid) that are enrolled in plans integrating Medicare and Medicaid benefits and the quality of Medicaid and Children’s Health Insurance Program (CHIP) data reporting to CMS.

Amount

All 50 states were approved for funding, with first-year awards ranging from $147 million in New Jersey to $281 million in Texas.

States had a one-time opportunity to apply for funding and all states were approved, meaning that they are eligible for funding for all five years of the program. However, as noted above, CMS may choose to scale back, withhold, reduce, eliminate, or recover funding from a given state over time.

State awards for 2026, the first of five years, average $200 million, ranging from $147 million in New Jersey to $281 million in Texas (Figure 4). Differences in total awards across states in the first year (and most likely in future years) are modest relative to large differences in rural populations and rural health needs more generally. For example, Texas has about thirty times as many rural residents as New Jersey (4.3 million versus about 140,000) but is only receiving about twice as much funding in the first year ($281 million versus $147 million). Differences in total awards across states are relatively modest primarily because half of the rural health fund (50%) is being distributed equally across approved states, regardless of need. Because all states have been approved for funding, each is slated to receive $100 million from this half of the fund in 2026 and in each year from 2027 through 2030.

Texas, Alaska, and California are receiving the largest total awards in the first year. While Texas and California have the largest and fourth-largest rural populations in the country respectively, Alaska has the fifth-smallest rural population. Alaska received a relatively large award, at least in part, because a portion of the fund is being distributed to the five largest states based on land area. Alaska also received the largest award from the pool based on state initiatives, state policy, and other funding factors according to estimates from the UNC Sheps Center (see Appendix Figure 3). New Jersey, Connecticut, and Rhode Island are receiving the smallest awards in the first year. These are all states with relatively small rural populations.

Amount per Rural Resident

First-year awards per rural resident vary widely, ranging from less than $100 in ten states to more than $500 in eight.

State awards are partially, but not closely, tied to rural population, meaning that first-year awards per rural resident are generally relatively small among states with the largest rural populations (Figure 5). For example, Texas has the largest rural population in the country—and the largest total award in the first year—but received the smallest award per rural resident ($66 in 2026). In contrast, states like Rhode Island, New Jersey, and Alaska, with far fewer rural residents, received substantially higher amounts per rural resident ($6,305, $1,069, and $990 respectively, with Rhode Island being an extreme outlier).

Distribution Within States

It remains to be seen how states will distribute funding across various entities and activities. 

CMS is tracking the flow of state funding to different entities and activities and will have information about all first-year state obligations to direct recipients towards the end of 2026. CMS is collecting information from states about the distribution of funding across entities and permitted uses (see above) as part of states’ annual and quarterly reporting process. Recipients of state funding will be categorized into standardized groups, including different types of health care providers, state and local government agencies, tribal entities, educational organizations, health IT vendors, other consultants, and other entity types. Beginning with the first quarterly report, CMS will begin tracking the flow of dollars downstream (e.g., if a state pays a contractor to manage a program, and the contractor then sends a portion of the funds to a rural hospital). States are required to obligate first-year funding by October 30, 2026, meaning that all first-year obligations to direct recipients of the funding should be captured in the first quarterly report, due November 29, 2026.

Some information about how states plan to distribute funding are available through approved plans and budgets, but with much less detail.

Some groups have called for greater transparency around funding streams. CMS will release progress reports to the public upon request but does not plan to do so proactively. Obtaining information through a Freedom of Information Act (FOIA) request, if required, could be a long and arduous process. The Bipartisan Policy Center recommended that CMS make key information easily available to the public, such as through an online dashboard. The hospital industry has also recommended greater public reporting as well as collecting additional information, such as existing hospital identifiers, which could facilitate oversight of the types of hospitals receiving funding.

Transparency around state funding will likely be of interest for policymakers, journalists, and researchers as they seek to track where funds are going, who is benefiting, and how effective they are.

Changes Over Time

The distribution of funding across and within states will change over time.

CMS has broad leeway to change the distribution of funding across states in later years, though it is unclear how much it will use its discretion. As described, CMS has broad discretion to withhold, reduce, eliminate, or recover funding over time as it sees fit (e.g., if a state has not made satisfactory progress). If CMS does not do so, changes in state awards in later years could be modest, given that most of the funding is locked in place over time based on statute and CMS guidance (see above).

Funding priorities may shift over time as states learn what does and does not work. The head of CMS, Dr. Mehmet Oz, indicated that states were given room to be creative with their applications, and that the expectation is that states will learn from both program successes and failures over time. States may adjust the details of their work plans but cannot significantly change their underlying strategy according to guidance from CMS. However, it is possible that CMS could reduce funding for states with less successful initiatives over time (see above) or work with states to shift their funding towards more successful programs.

Distribution of Funding by Factor

This brief identifies the share of the $50 billion rural health fund that is being distributed based on an equal distribution across states; measures of state need, initiatives, and policies; and other factors (Figure 3). The reconciliation law specifies that half of the fund ($25 billion) must be distributed equally across states, while CMS has indicated that it is distributing the second half ($25 billion) among approved states based on a set of 23 factors, weighted to varying degrees (see Appendix Table 3). CMS refers to the former as “baseline funding” and the latter as “workload funding.” While CMS considers all 23 factors in each year, its calculations for 2 of the 23 factors change beginning in the second year of the program; this brief describes the distribution of funding as of the second year of the program.

The distribution of workload funding ($25 billion) across different categories of factors was calculated based on CMS weights. CMS is scoring some factors (health and lifestyle, individuals dually eligible for Medicare and Medicaid, remote care services, and data infrastructure)—representing $3.75 billion of the $50 billion rural health fund—by evaluating how states rank based on a weighted average of measures from two buckets. For example, health and lifestyle factors are being evaluated based on the state rank of a weighted average of their score on certain state initiatives (75%) and the adoption of a certain policy (25%). The contribution of each bucket in those cases cannot be fully disentangled because of the structure of the calculation, which involves a ranking of a weighted average. In those cases, funding based on these factors was apportioned to each bucket based on the weights used to generate the weighted average (e.g., 75% or 25%).

First-Year State Awards

First-year state awards from the rural health fund (Figure 4) were obtained from the HHS Tracking Accountability in Government Grants System (TAGGS). First-year awards per rural resident (Figure 5) were calculated based on the HRSA definition of “rural”, which CMS uses to allocate a portion of the rural health funds. This definition includes all nonmetropolitan areas as well as some parts of metropolitan areas. Rural population, as defined by HRSA, by state was obtained from the UNC Sheps Center Rural Facility and Population Score Estimates by State, as updated on October 24, 2025.

This brief also describes the estimated first-year awards based on each of the seven measures of state need (Appendix Figure 1), which CMS refers to as “rural facility and population factors.” Appendix Table 3 includes details about these factors. We obtained estimated scores by state for each of these factors and their weighted total by state from the Sheps Center Rural Facility and Population Score Estimates by State. The Sheps Center generated these estimates based on their interpretation of CMS’s Notice of Funding Opportunity (NOFO) and available data. We converted estimated scores for a given factor into a dollar amount by: (1) calculating the share of workload funding in the first year distributed based on that factor (i.e., multiplying $5 billion by the weight for that factor) and (2) multiplying the result by the state share of the distribution based on that factor (i.e., the score divided by 100). Each state’s total distribution from the $2.5 billion based on state need in the first year is the sum of the factor allocations calculated in (2).

Finally, the brief describes estimated first-year awards based on state initiatives, state policy, and other factors (Appendix Figure 3). These numbers were pulled directly from the Sheps Center Funding Amounts and State Policy Actions, as updated on January 8, 2026. The Sheps Center estimated this amount for each state by starting with a given state’s first-year award and subtracting out the allocation distributed equally across states ($100 million per state) and the estimated allocation based on measures of state need.

First-Year Awards by Factor

The five states with the largest land areas received the largest estimated awards in the first year from the pool based on measures of state need.

These five states (Texas, California, New Mexico, Montana, and Alaska) received an estimated $88 to $105 million in the first year from the quarter of funding based exclusively on measures of state need compared to the $50 million states received on average from this pool (Appendix Figure 1). Most of the extra dollars that these five states are estimated to have received relative to other states reflects the fact that a portion of funding is earmarked for them based on their large land area (see below). CMS intends to use the same data and measures for distributing funding based on state need over time.

Based on criteria published by CMS, the funding tied to measures of need ($2.5 billion in the first year and $12.5 billion in total) is being distributed as follows (Appendix Figure 2):

• Rural population and rural facilities. 40% of the $12.5 billion is based on the rural population and number of rural health care facilities in a state (20% each). CMS has published how it defines “rural” for purposes of distributing these dollars, though there are many potential ways of doing so. For example, CMS uses a broad definition of “rural hospitals” that includes all hospitals in areas classified as rural by the Health Resources & Services Administration (HRSA) (which itself is broader than some definitions) as well as any other hospital that receives certain Medicare rural payment designations or that is classified by Medicare as urban but reclassified as rural for certain payment purposes.
• Uncompensated care as a percent of hospital operating expenses. 20% of the $12.5 billion is based on this measure, which is among all hospitals (i.e., not just those in rural areas). Uncompensated care tends to be higher in states that have not expanded Medicaid under the Affordable Care Act, such as Texas and Georgia. Further, CMS is using data from 2021; uncompensated care may have dropped over time among states that have recently expanded Medicaid (like Oklahoma and Missouri in 2021 and North Carolina and South Dakota in 2023).
• Percent of population in rural areas and percent in frontier regions. 24% of the $12.5 billion is based on these measures (12% each). These factors do not account for the total size of the population in each state or the size of rural health care systems (which is also the case for three other factors, like land area). As a result, states with a relatively large share of the population living in rural and frontier areas but relatively small rural populations and few rural hospitals may still receive a greater than average share of these dollars (e.g., as is the case for Alaska, North Dakota, and Wyoming) while the reverse may be true for states with large rural populations and many rural hospitals (e.g., as is the case for California, Florida, and Texas). Nonetheless, as noted above, 20% of the $12.5 billion is based directly on rural population and 20% on rural facilities.
• Land area. 10% of the $12.5 billion is based on land area and is only going to the five largest states. These five states will each receive large allocations from this pool (ranging from an estimated $240 to $260 million if all five continue to receive funding), while states just outside of the top five and all other states will not receive funds based on land mass.
• Percent of hospitals receiving Medicaid disproportionate share hospital (DSH) payments. 6% of the $12.5 billion is based on this measure, which is among all hospitals (not just those in rural areas). Medicaid DSH status is based in part on the extent to which hospitals care for Medicaid and other low-income patients but also on specific criteria that vary across states.

Estimated awards in the first year based on state initiatives, state policies, and other factors ranged from $21 million in New Mexico to $84 million in Alaska.

Alaska, Texas, Nebraska, New Hampshire, and Hawaii received the largest estimated awards from this pool in the first year, ranging from $65 million to $84 million compared to the $50 million states received on average. This is a diverse group of states. For example, Alaska has the fifth-smallest rural population in the country (about 275,000) while Texas has the largest (about 4.3 million), and President Trump carried three of these states in the 2024 presidential election (Alaska, Nebraska, and Texas) but lost two (Hawaii and New Hampshire). The distribution of these dollars will change over time, for example, based on states’ progress on their proposed initiatives and on fulfilling policy commitments made in their applications.

Appendix Tables