This part sets up a rural health fund of $50 billion. It runs $10 billion a year from 2026 to 2030. States must apply by the end of 2025. Each must pick three or more listed uses.
The document says “shall”Who acts: Administrator of the Centers for Medicare & Medicaid ServicesHow: statuteSec. 71401 in the PDF
What the document says
“$10,000,000,000 for fiscal year 2026;”
The section adds a new subsection (h) to section 2105 of the Social Security Act (42 U.S.C. 1397ee) appropriating $10,000,000,000 for each of fiscal years 2026 through 2030 to the Administrator of the Centers for Medicare & Medicaid Services for allotments to States. Money unspent or unobligated as of October 1, 2032 returns to the Treasury, an allotment is available through the end of the following fiscal year, and the Administrator must decide each year from March 31, 2028 through March 31, 2032 what money is free to redistribute.
What the document actually says
“$10,000,000,000 for fiscal year 2026;”
That sentence, in plain words
Ten billion dollars goes out in fiscal year 2026.
What this is about
The same sum follows in each of the next four years. That runs through 2030. Money left over after October 1, 2032 goes back.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
The document says “can”Who acts: Administrator of the Centers for Medicare & Medicaid ServicesHow: statuteSec. 71401 in the PDF
What the document says
“the Administrator may withhold payments to, or reduce payments to, or recover previous payments from, the State under this subsection as the”
The section lets the Administrator, on finding a State is not using its money in a way consistent with its approved application, withhold, reduce or recover payments as the Administrator thinks fit, with anything so held back or recovered returned to the Treasury. There is no administrative or judicial review of allotments, redistributions, payments withheld or reduced, or payments recovered.
What the document actually says
“the Administrator may withhold payments to, or reduce payments to, or recover previous payments from, the State under this subsection as the”
That sentence, in plain words
The Administrator may hold back money from a state. It may also cut or claw back money.
What this is about
That follows a finding the state went off plan. The money then goes back to the Treasury. No court or agency may review it.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
“a State shall submit to the Administrator during an application submission period to be specified by the Administrator (but that ends not later than December 31, 2025) an application in such form and manner as the Administrator may specify, that includes--”
The section requires a State seeking an allotment to apply within a period the Administrator sets that ends no later than December 31, 2025, enclosing a detailed rural health transformation plan covering access, health outcomes, new technology, local partnerships, clinician recruitment and training, data driven care close to home, long term financial solvency, and the causes putting stand-alone rural hospitals at risk. The State must also certify that none of the money will finance the non-federal share of other spending. The Administrator must approve or deny every application by December 31, 2025, approval covers all five years, and only the 50 States may apply.
What the document actually says
“a State shall submit to the Administrator during an application submission period to be specified by the Administrator (but that ends not later than December 31, 2025) an application in such form and manner as the Administrator may specify, that includes--”
That sentence, in plain words
The state must send in an application. The window closes no later than December 31, 2025. The list that follows says what goes in it.
What this is about
A detailed rural health plan is required. It must cover access, outcomes and staffing. The state must also promise not to use the money as a match.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
The document says “shall”Who acts: Administrator of the Centers for Medicare & Medicaid ServicesHow: statuteSec. 71401 in the PDF
What the document says
“50 percent of the amounts appropriated for each such fiscal year equally among all States with an approved application under this subsection; and”
The section requires the Administrator, for each of fiscal years 2026 through 2030, to allot half the money equally among States with an approved application and the other half in amounts the Administrator sets, making sure at least a quarter of those States get some of the second half and weighing the share of the State population in a rural census tract, the State's share of rural health facilities nationwide, the situation of its hospitals, and any other factors. A State needs no matching funds.
What the document actually says
“50 percent of the amounts appropriated for each such fiscal year equally among all States with an approved application under this subsection; and”
That sentence, in plain words
Half the money is split evenly. Every state with an approved plan shares in it.
What this is about
The other half is set by the boss of the agency. Rural people and rural clinics are weighed. At least a quarter of states must get some of it.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
“Promoting evidence-based, measurable interventions to improve prevention and chronic disease management.”
The section requires a State to use its allotment for three or more listed activities: promoting evidence-based prevention and chronic disease management; paying providers for items or services; consumer facing technology for chronic disease; training and technical help for remote monitoring, robotics, artificial intelligence and similar tools; recruiting and keeping clinicians with a five year rural commitment; information technology and cybersecurity; right sizing local care delivery; supporting opioid, other substance use and mental health treatment; value based care models; and other uses the Administrator sets. No more than 10 percent may go to administration.
What the document actually says
“Promoting evidence-based, measurable interventions to improve prevention and chronic disease management.”
That sentence, in plain words
One listed use is backing steps that can be measured. They must improve prevention and long-term care.
What this is about
The state must pick three or more listed uses. They cover provider pay and new tools. No more than a tenth may go to running costs.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
The document says “shall”Who acts: Administrator of the Centers for Medicare & Medicaid ServicesHow: statuteSec. 71401 in the PDF
What the document says
“$200,000,000 for fiscal year 2025, to remain available until expended.”
The section requires the Administrator to implement the section by program instruction or other forms of program guidance, and appropriates $200,000,000 for fiscal year 2025, to remain available until expended, to carry it out.
What the document actually says
“$200,000,000 for fiscal year 2025, to remain available until expended.”
That sentence, in plain words
Two hundred million dollars is set aside for fiscal year 2025. The money stays there until it is spent.
What this is about
It pays to run the new program. The Administrator works by program guidance. No rulemaking is called for.
No action is recorded against this proposal. That is not evidence that none has been taken, and nobody has yet read it against the record. See what the tracker does not yet cover.
Each distinct thing the section does: appropriate $10,000,000,000 a year for five years, set the rules for unspent money, require an application with a rural health plan by December 31, 2025, split the money half evenly and half by need, waive any state match, cap administrative spending at 10 percent, require three or more of the listed uses, bar review of the allotments, and appropriate $200,000,000 to run the program.
The twelve kinds of rural health facility, the ten listed uses of funds and the conforming amendments to title XXI, which are carried in summaries.
The section works by amending sections 2101, 2105 and 2106 of the Social Security Act and points to sections 1861, 1886, 1902 and 1905 of that Act, none of which is indexed here.
