You guys know I have been interested in the rural health transformation efforts and whether things will be truly transformational. Well, CMS just dropped its first obligated funds report for the Rural Health Transformation Program, showing how each state has obligated RHTP funds (as reported by the states themselves) between December 29, 2025 through July 31, 2026. Year One officially closes on October 30 so there's more reporting to come. CMS plans to refresh the numbers once states submit their November 30 quarterly reports, then quarterly after that. Here's how I broke down the first report card in Tuesday's issue of Hospitalogy (for a look at some notable spending examples, check out the full article here: 1. How much has been obligated So far, states have obligated roughly $4B of the almost $10B awarded across all 50 states for Year One. 2. Pace varies widely by state 10 states had obligated at least 75% of their award by July 31; Georgia, Hawaii, and New Hampshire had committed 100%; and 15 states had obligated less than 10%, including New York and West Virginia at exactly $0. Texas, which received the largest Year One award ($281.3M), had obligated just 18.9% ($53.3M), a reminder that award size and obligation pace move independently. Six of the slowest states — Alabama, Arkansas, Florida, Idaho, New Mexico, and Wyoming — reported that every obligated dollar so far went to program operations (staffing, administration, grant management) rather than to any of their actual initiatives. 3. Where the money is going Technology-related categories (IT Advances, Consumer Tech Solutions, and the technology-relevant share of Innovative Care) account for roughly 22% of obligated dollars (about $876M), making technology the single largest theme in Year One spending so far, just ahead of workforce (about $651M, 16%). Within the technology bucket, three sub-areas stand out: • Telehealth and virtual care, approx. $143M obligated, with 20 states reporting activity • EHR/EMR modernization, approx. $154M obligated, with 15 states reporting activity • HIE and interoperability, approx. $141M obligated, with 18 states reporting activity Chronic disease prevention and management (about $481M, 12%) and capital expenditures/infrastructure (about $280M, 7%) round out the largest named categories. Meaningful obligated dollars also sit under categories like Appropriate Care Availability, Behavioral Health, and Program Administration. More than half of obligated dollars sit in line items that describe a use rather than naming a recipient type (state agency, contractor, hospital, etc.). Hospitals show up in some states' line items (38%), but very few name specific hospitals. 4. What's next Up to $40 billion more is scheduled to flow over the next 4 years of this 5-year, up-to-$50B program. But, per a companion GAO review of CMS's implementation, each state's share depends on demonstrating 'satisfactory progress' toward its approved initiatives, and CMS may withhold, reduce, or recover funding for noncompliance. States have limited ability to appeal those decisions under the program's authorizing legislation. CMS report PDF: