GAO Reviews CMS Rollout of $50 Billion Rural Health Fund
In a new report, GAO reviews CMS's early implementation of the Rural Health Transformation program, established by the One Big Beautiful Bill Act to distribute up to $50 billion to states over five years for rural health activities. CMS has already awarded all 50 states a first round totaling $10 billion, with individual state allotments ranging from $147 million (New Jersey) to $281 million (Texas) based on rural characteristics and application strength. GAO found CMS's planned monitoring activities, including audits, site visits, and performance reviews, generally align with federal award oversight requirements. CMS plans to distribute the remaining $40 billion over the next four years based on states' progress, and may withhold or recover funds for noncompliance; notably, the authorizing law limits states' ability to appeal CMS funding decisions, and CMS is still determining how it will handle disputes.