CMS will decide which states to fund by the end of the year, and how to allocate the first year of funding across states. It is not yet clear how states will distribute funds across rural hospitals, other providers, and other state initiatives (9/9)

The analysis could not factor in the $12.5 billion that will be distributed based on CMS’s discretionary scoring of state policy, state initiatives, and other factors (8/9).

TX, CA, NM, MT, and AK are estimated to receive the largest amounts from the $37.5 billion. Most of the extra dollars they're estimated to receive are due to their large land area, one of several factors used to allocate funds based on state need (7/9).

Additionally, of the $12.5 billion based on measures of need, only 20% is directly based on total rural population (6/9).

This in part reflects the fact that estimated state awards vary much less than differences in rural populations, principally due to the equal distribution of the first $25 billion across all states with approved applications (5/9).

Estimated awards from the $37.5B are partially, but not closely, tied to rural population. E.g., TX has the most rural residents in the nation (4.3M) but is estimated to only receive about twice as much as RI, which has the fewest (about 25,000) (4/9)

Estimated awards from the $37.5B range from $550 million in Rhode Island to just over $1 billion in Texas over five years if all states are approved for funding (3/9).

The analysis examines $37.5B of the $50B fund: $25B to be distributed equally across states with approved applications (as required by law) and an additional $12.5B to be distributed based on measures of state need (as specified primarily by CMS) (2/9).

As well as the implications of the reconciliation bill for spending and coverage, including in rural areas (7/7):
www.kff.org/medicaid/iss...
www.kff.org/affordable-c...
www.kff.org/policy-watch...

Recent work from KFF provides a deeper dive on rural hospitals, Medicaid and hospitals, and the implications of the reconciliation bill (6/7):
www.kff.org/health-costs...
www.kff.org/medicaid/iss...
www.kff.org/medicaid/iss...

While the fund could help prop up rural hospitals, it doesn't address concerns about the millions of individuals who could lose Medicaid or ACA Marketplace coverage in rural and other areas, many of whom would also be at risk of losing SNAP benefits (5/7)
www.kff.org/medicaid/iss...

Urban hospitals that serve a large share of Medicaid patients have been left out of the conversation and without support from the fund, though many are already in the red. These hospitals could also have a hard time absorbing any losses under the bill (4/7)

The relief for hospitals and other providers would also be temporary, while major Medicaid and ACA cuts would be permanent (3/7).

It's unclear:
* How much of this fund would be used for hospitals,
* Which hospitals would be targeted, and
* Whether the fund would be enough to offset any losses for hospitals and other providers under the bill. (2/7).