States with approved plans would receive money for urban health care

Congress would set aside $10 billion a year for approved state health plans. All states, Washington, D.C., and five U.S. territories could apply to serve metro areas with at least 1 million people. Federal officials would have to approve a plan before a state could receive money. Funding would cover fiscal years 2027–2031. Federal officials would approve or deny applications by December 31, 2026.

Federal officials would split half the funding equally among approved states. States would not have to contribute their own money. At least one-quarter of approved states would receive some of the remaining half. For that half, officials would consider the share of each state's residents living in metro areas with at least 1 million people, among other factors. This formula would apply in fiscal years 2027–2031.

States would use grants for at least three allowed health activities and report spending each year. Allowed work includes preventing illness and helping people manage long-term diseases. States could spend no more than 10% of each year's grant on administration. States could not use the money for required state contributions under other laws. Federal officials could withhold, reduce, or recover payments used outside an approved plan.