Idaho to receive $182.7M in second year of federal rural health transformation grant

Federal authorities said on Monday Idaho will receive about $182.7 million in the second year of a grant designed to improve rural healthcare, marking a reduction from Idaho’s first-year award. 

The federal Rural Health Transformation grant was part of the 2025 One Big Beautiful Bill Act, in which Congress allocated $50 billion nationwide for the five-year program. The massive tax-and-spending bill also cut spending on Medicaid by about $1 trillion over 10 years — these reductions will start to take effect on Jan. 1, 2027. 

Idaho was awarded nearly $186 million on Dec. 30, 2025, for the first year of the program. 

“Where you live should not determine whether you can access quality, affordable health care,” Idaho Gov. Brad Little said in a press release. “That is especially important for families in rural Idaho, where distance and limited resources can create real barriers. This investment will help close those gaps, support local providers, and bring more care within reach for Idahoans across our state.”

On Oct. 28, Idaho and federal authorities announced the state had awarded all of its first-year funds on projects such as infrastructure improvements at rural hospitals, emergency medical equipment, healthcare workforce development, mobile clinics and others. 

The Centers for Medicare & Medicaid had been slated to announce the second-year grants on Oct. 31, but federal leaders told states on Oct. 30 that the announcement was delayed, KFF Health News reported. 

“This next $10 billion will expand access to care, strengthen the rural health workforce, improve prevention, and help states build solutions that fit the needs of their own communities,” Health and Human Services Secretary Robert F. Kennedy Jr. said in a press release Monday. “We are giving rural America the resources and flexibility to build stronger health systems that deliver better care and better outcomes.”

How are the rural health grant amounts decided? 

The federal funds were allocated in two parts. Half of the money is to be divided among states equally each year. The second half of the funds are awarded competitively, based on states’ proposed initiatives in their applications, rural population characteristics, healthcare facilities, policies that align with Trump administration priorities, and other requirements, according to CMS. 

For the second year, states’ progress reports submitted on Sept. 30 were evaluated to help determine their second-year grants. 

Idaho’s second-year award ranked at No. 40 compared to the rest of the state’s grant amounts. Texas received the most, at nearly $282 million. New Jersey received the least, at $142.3 million. 

Idaho Department of Health and Welfare Director Juliet Charron told the state’s program implementation task force in September that the Gem State’s low population density and low density of rural healthcare providers resulted in a lower score based on federal criteria for the first year of the program. 

Montana, which has a lower population than Idaho but shares many rural characteristics, received the third-highest award at $239.7 million. Alaska received the second-highest grant at $272.6 million.