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Page 28 – CMCS Informational Bulletin Appendix B. Opportunities for Additional Financial Support for States Section Provision Description of Financial Support Section 71119 Requirement for States to Establish Medicaid Community Engagement Requirements for Certain Individuals What is Available? • Government Efficiency Grants to states • Grant funding is to be used for state implementation of this provision and others in same chapter of the WFTC legislation related to eligibility determinations or redeterminations. How Much is Available? • $200 million When Are Grants Available? • Beginning Fiscal Year 2026 and available until expended. How Will Grants be Disbursed? • $100 million to be distributed equally across states. • $100 million in an amount for each state reflecting the ratio of individuals subject to the community engagement requirement to the total number of such individuals residing in all states as of March 31, 2025. Section 71121 Making Certain Adjustments to Coverage of Home or Community-Based Services under Medicaid What is Available? • Payments to states to support state systems to deliver HCBS under section 1915(c) waivers or section 1115 demonstrations. How Much is Available? • $100 million When Are Payments Available? • Beginning Fiscal Year 2027, and available until expended. How Will Payments be Disbursed? • Payments will be made to a state based on the proportion of the state’s population that is receiving section 1915(c) or section 1115 HCBS, as compared to all states. Section 71401 Rural Health Transformation Program What is Available? • Allotments to states to be used for specified rural health-related activities, subject to approval and terms of state applications. How Much is Available? • $10 billion for each fiscal year 2026 through 2030. When Will Allotments be Available? • Fiscal Years 2026 through 2030. • States have two years to expend funds provided for a fiscal year (e.g., FY 2027 funds are available for FY 2027 and FY 2028). • Unexpended or unobligated funds may be redistributed. • The Administrator has the authority to withhold, reduce, or recover payments if a state has not expended funds consistent with its approved application. • Unexpended or unobligated funds as of October 1, 2032 return to the Treasury. How Will Allotments be Disbursed? • States except DC and territories can apply. • The Administrator must approve applications by December 31, 2025.