Article
Two states, two structures
In Mississippi, Gov. Tate Reeves announced a new office in his administration to oversee nearly $206 million the state received in December from the federal program, along with a public website to track initiatives and funding. The state’s plan includes a rural health assessment, care coordination, workforce support, a statewide health information exchange, expanded telehealth and infrastructure. CMS is still reviewing the state’s budget, and application details have not been posted. The rollout comes after the governor vetoed a legislative oversight bill, and some lawmakers have complained that they have little input.
New Hampshire took a different route. Its GO-NORTH office, created by executive order and housed in the governor’s office, expects about $200 million a year through 2030. Rather than award all funds centrally, it will route money through five hubs: about $283 million through the Foundation for Healthy Communities for primary, behavioral and specialty access; $223.2 million through the state’s community development finance authority for capital projects including rural hospitals, EMS and telehealth; $132 million for community mental health; and $96.9 million and $37.8 million to the university and community college systems for workforce training.
The bigger picture
The $50 billion, five-year program was created during the 2025 budget debate to cushion rural providers from Medicaid reductions. It is small relative to those cuts, which KFF estimates at roughly $991 billion over a decade. Mississippi’s officials also note a spending deadline: CMS says the state’s first award must be used by September 2027 or be redistributed.
How rural hospitals should engage
- Find the right door. In hub-based states, the hub, not the governor’s office, may be the place to bring a capital or workforce proposal.
- Bring shovel-ready projects. Tight spending deadlines favor proposals with budgets, partners and timelines already in place.
- Align with state priorities. Telehealth, care coordination, data exchange and workforce pipelines appear repeatedly in state plans.
- Plan for the end of the grant. Fund projects that can sustain themselves once federal dollars stop.
Archive entry for May 4, 2026, added Nov. 11, 2026.