Top 5 Most Interesting Moves
October 16, 2026 - Top 5 Insights
📊 GAO raises questions about RHTP progress deadlines
States had as little as four months to demonstrate progress before CMS began using that performance to inform Year 2 funding, according to a new GAO review.
Why it matters: Future RHTP allocations will depend partly on whether states can demonstrate satisfactory progress toward approved initiatives and policy actions.
What stands out: GAO found that revised Year 1 budget plans took an average of about 41 days to complete. Until those plans were fully approved, states were limited in their ability to use funding, leaving states between four and seven months before the August progress-reporting deadline.
The concern: Representatives from selected rural health and state government groups told GAO that the window was too short to demonstrate meaningful progress for Year 2 funding decisions. GAO notes those views are not generalizable to all stakeholders. GAO October 2026
What comes next: CMS plans to convert progress on initiatives and policy actions into numerical scores for future allocations. Monitoring will also include financial and performance reporting, site visits, and audits beginning in 2027.
The takeaway: Year 2 funding decisions may provide the first real test of how CMS balances measurable progress with the limited time states had to execute.
⏱️ States had obligated less than half of Year 1 RHTP funds
States reported obligating less than half of their first-year RHTP funding as of July 31, according to CMS' first implementation report.
Why it matters: Budget Period 1 ends Oct. 30, making the pace of obligation increasingly important as states close out Year 1 and move toward their next awards.
What stands out: The report covers activity from Dec. 29 through July 31 and tracks funding states had committed to agencies, providers, contractors, vendors, and other partners. CMS cautions that the initial data do not capture the full extent of state progress and plans another update in November.
The bigger picture: The numbers vary widely by state. Iowa, for example, says it has now fully obligated its $209 million Year 1 award, underscoring how differently implementation is progressing across the country.
Between the lines: Obligation rates provide one measure of execution, but they do not necessarily show how much care has changed on the ground yet.
The takeaway: The closing weeks of Year 1 will bring more clarity on which states were able to move from planning to committed funding fastest.
