PlainBillCongress, translated.Legislation. Context. Public interest.Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Congressional Research Service
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People & committees
Rep. Waters, Maxine [D-CA-43] · D–CA
Legislative record
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Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Introduced in House
Introduced in House
Primary sources
Text links open the official source. We also preserved the text version used in the PlainBill explanation below.
No related bills are listed in this snapshot. This does not establish whether the proposal has appeared in earlier Congresses.
Source last updated: Oct 13, 2026. Consult Congress.gov for the current record.
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PlainBill explanation
Based on the full Introduced in House · 2026-10-01 text. This explanation has not received human editorial review. This overview describes the proposal’s major provisions; it does not establish what its real-world effects would be.
The proposed Urban Health Transformation Act of 2026 would fund state-led changes to health care in metropolitan areas with at least 1 million people. Participating states would choose at least three activities, such as improving chronic disease care, paying health care providers, recruiting clinicians, or supporting mental health treatment. The bill would provide $10 billion annually for fiscal years 2027–2031. These are proposed funding and program requirements, not evidence of enacted law or demonstrated improvements in care.
This Act may be cited as the Urban Health Transformation Act of 2026.
The term urban area means a metropolitan statistical area with a population of 1,000,000 or more.
Amounts allotted to a State under this section shall be used for 3 or more of the following health-related activities:
(1) Promoting evidence-based, measurable interventions to improve prevention and chronic disease management. (2) Providing payments to health care providers for the provision of health care items or services, as specified by the Administrator.
(5) Recruiting and retaining clinical workforce talent to urban areas, with commitments to serve urban communities for a minimum of 5 years.
(8) Supporting access to opioid use disorder treatment services (as defined in section 1861(jjj)(1)), other substance use disorder treatment services, and mental health services.
(A) $10,000,000,000 for fiscal year 2027; (B) $10,000,000,000 for fiscal year 2028; (C) $10,000,000,000 for fiscal year 2029; (D) $10,000,000,000 for fiscal year 2030; and (E) $10,000,000,000 for fiscal year 2031.
Source snapshot updated 2026-10-13T16:45:14Z. 2026-10-01: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
The bill would add an Urban Health Transformation Program to the Social Security Act, administered by the Centers for Medicare & Medicaid Services. It would directly appropriate $50 billion in total for state allocations over fiscal years 2027–2031, rather than merely authorize possible future funding.
Part A of title XI of the Social Security Act (42 U.S.C. 1301 et seq.) is amended by inserting after section 1150C the following new section: 1150D. Urban Health Transformation Program
There are appropriated, out of any money in the Treasury not otherwise appropriated, to the Administrator of the Centers for Medicare & Medicaid Services (in this section referred to as the Administrator), to provide allotments to States for purposes of carrying out the activities described in subsection (f)— (A) $10,000,000,000 for fiscal year 2027; (B) $10,000,000,000 for fiscal year 2028; (C) $10,000,000,000 for fiscal year 2029; (D) $10,000,000,000 for fiscal year 2030; and (E) $10,000,000,000 for fiscal year 2031.
All 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa could apply. The program would define an urban area as a metropolitan statistical area with at least 1 million people; its definition of a health care provider requires enrollment under one of three specified Social Security Act titles.
The 50 States, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa shall be eligible for an allotment under this section
(1) Health care provider The term health care provider means a provider of services or supplier who is enrolled under title XVIII, title XIX, or title XXI. (2) Urban area The term urban area means a metropolitan statistical area with a population of 1,000,000 or more.
A state's application would need a detailed plan addressing access to care, health outcomes, prevention and chronic disease technology, partnerships among providers, clinician recruitment and training, and care close to patients' homes. These are required planning goals, not established program results.
(A) a detailed urban health transformation plan— (i) to improve access to hospitals, other health care providers, and health care items and services furnished to urban residents of the State; (ii) to improve health care outcomes of urban residents of the State; (iii) to prioritize the use of new and emerging technologies that emphasize prevention and chronic disease management; (iv) to initiate, foster, and strengthen local and regional strategic partnerships between urban hospitals and other health care providers in order to promote measurable quality improvement, increase financial stability, maximize economies of scale, and share best practices in care delivery; (v) to enhance economic opportunity for, and the supply of, health care clinicians through enhanced recruitment and training; (vi) to prioritize data and technology driven solutions that help urban hospitals and other urban health care providers furnish high-quality health care services as close to a patient's home as is possible;
The application would also need strategies for urban hospitals' long-term ability to meet financial obligations and operate. It would have to identify causes of stand-alone urban hospitals becoming at risk of closure, conversion, or service reductions.
(vii) that outlines strategies to manage long-term financial solvency and operating models of urban hospitals in the State; and (viii) that identifies specific causes driving the accelerating rate of stand-alone urban hospitals becoming at risk of closure, conversion, or service reduction;
States would have to certify that program money would not finance a legally required nonfederal share of spending—the portion that must come from sources other than the federal government. The prohibition expressly includes transfers between governments and certified public expenditures used for that purpose. The Administrator could require additional application information.
(B) a certification that none of the amounts provided under this section shall be used by the State for an expenditure that is attributable to an intergovernmental transfer, certified public expenditure, or any other expenditure to finance the non-Federal share of expenditures required under any provision of law, including under the State plan established under title XIX, the State plan established under title XXI, or under a waiver of such plans; and (C) such other information as the Administrator may require.
The Administrator would set the application period, which must end by December 31, 2026, and approve or deny all applications by that same date. One approval would establish eligibility for allocations in each fiscal year from 2027 through 2031, subject to the bill's payment remedies for misuse.
a State shall submit to the Administrator during an application submission period to be specified by the Administrator (but that ends not later than December 31, 2026) an application in such form and manner as the Administrator may specify
(2) Deadline for approval Not later than December 31, 2026, the Administrator shall approve or deny all applications submitted for an allotment under this section. (3) One-time application If an application of a State for an allotment under this section is approved by the Administrator, the State shall be eligible for an allotment under this section for each of fiscal years 2027 through 2031, except as provided in subsection (a)(2)(D).
For each fiscal year from 2027 through 2031, half the program funding would be divided equally among states with approved applications. The Administrator would distribute the other half under the bill's allocation criteria, with at least one-quarter of approved states receiving a share of that second half.
from the amounts appropriated under subsection (a)(1) for each of fiscal years 2027 through 2031, the Administrator shall allot— (A) 50 percent of the amounts appropriated for each such fiscal year equally among all States with an approved application under this section; and (B) 50 percent of the amounts appropriated for each such fiscal year among all such States in an amount to be determined by the Administrator in accordance with paragraph (3).
ensure that not less than 1/4 of the States with an approved application under this section for a fiscal year are allotted funds from amounts that are to be allotted under subparagraph (B) of such paragraph
For the second half of funding, the Administrator would have to consider each state's percentage of residents in qualifying urban areas and its share of the nation's defined urban health facilities. The Administrator could also consider other factors deemed appropriate; the bill does not assign fixed weights to these factors.
(B) consider— (i) the percentage of the State population that is located in an urban area; (ii) the proportion of urban health facilities (as defined in paragraph (4)) in the State relative to the number of urban health facilities nationwide; and (iii) any other factors that the Administrator determines appropriate.
Hospitals counted for that allocation factor would include the referenced statutory category of disproportionate share hospitals, hospitals with approved medical residency training, and a specified hospital category meeting a 75th-percentile service criterion for two referenced patient groups. They would also include hospitals in qualifying urban areas that the state determines serve many low-income, uninsured, or title XIX medical-assistance patients. Several underlying statutory definitions are not reproduced.
(4) Urban health facility defined For the purposes of paragraph (3)(B), the term urban health facility means the following: (A) A facility defined as a disproportionate share hospital under section 1923(a)(1)(A). (B) A hospital with an approved medical residency training program (as defined in section 1886(h)(5)(A)). (C) A subsection (d) hospital (as defined in section 1886(d)(1)(B)) that is in the 75th percentile with respect to inpatient hospital services furnished to— (i) individuals dually eligible under titles XVIII and XIX; or (ii) subsidy eligible individuals (as defined in section 1860D–14(a)(3)). (D) A hospital that is located in an urban area and, based upon the determination of the State, serves a large number of residents who are low-income, uninsured, or receiving medical assistance under a State plan (or a waiver of such plan) under title XIX.
The allocation factor would also count federally qualified health centers, community mental health centers, and health centers receiving section 330 grants. Opioid treatment programs, substance use disorder treatment programs, and certified community behavioral health clinics would count when located in qualifying urban areas. The listed health-center and community mental-health-center clauses do not expressly impose that location condition.
(E) A Federally qualified health center (as defined in section 1861(aa)(4)). (F) A community mental health center (as defined in section 1861(ff)(3)(B)). (G) A health center that is receiving a grant under section 330 of the Public Health Service Act. (H) An opioid treatment program (as defined in section 1861(jjj)(2)) that is located in an urban area. (I) A substance use disorder treatment program that is located in an urban area. (J) A certified community behavioral health clinic (as defined in section 1905(jj)(2)) that is located in an urban area.
Approved states would not have to contribute matching money as a condition of receiving program payments.
(d) No matching payment A State approved for an allotment under this section for a fiscal year shall not be required to provide any matching funds as a condition for receiving payments from the allotment.
The Administrator would set program terms and conditions. Each state would have to submit a spending plan covering at least three permitted activities and annual reports on its use of funds. Administrative expenses could consume no more than 10 percent of a state's allocation for a fiscal year.
(e) Terms and conditions The Administrator shall specify such terms and conditions for allotments to States provided under this section as the Administrator deems appropriate, including the following: (1) Each State shall submit to the Administrator (at a time, and in a form and manner, specified by the Administrator)— (A) a plan for the State to use its allotment to carry out 3 or more of the activities described in subsection (f); and (B) annual reports on the use of allotments, including such additional information as the Administrator determines appropriate. (2) Not more than 10 percent of the amount allotted to a State for a fiscal year may be used by the State for administrative expenses.
Permitted activities would include evidence-based prevention and chronic disease management, payments to providers for health care items or services specified by the Administrator, and consumer-facing technology for preventing and managing chronic diseases.
(1) Promoting evidence-based, measurable interventions to improve prevention and chronic disease management. (2) Providing payments to health care providers for the provision of health care items or services, as specified by the Administrator. (3) Promoting consumer-facing, technology-driven solutions for the prevention and management of chronic diseases.
States could fund training and technical assistance for urban hospital technologies, including remote monitoring, robotics, and artificial intelligence. They could also fund technical assistance, software, and hardware for information technology improvements designed to strengthen efficiency, cybersecurity, and patient outcomes.
(4) Providing training and technical assistance for the development and adoption of technology-enabled solutions that improve care delivery in urban hospitals, including remote monitoring, robotics, artificial intelligence, and other advanced technologies.
(6) Providing technical assistance, software, and hardware for significant information technology advances designed to improve efficiency, enhance cybersecurity capability development, and improve patient health outcomes.
Funding for recruiting and retaining clinical workers in urban areas would include commitments to serve urban communities for at least five years.
(5) Recruiting and retaining clinical workforce talent to urban areas, with commitments to serve urban communities for a minimum of 5 years.
States could help urban communities identify the mix of health services they need, including preventive care, care without hospital admission, pre-hospital and emergency services, inpatient care, and care after an acute illness or hospital stay.
(7) Assisting urban communities to right size their health care delivery systems by identifying needed preventative, ambulatory, pre-hospital, emergency, acute inpatient care, outpatient care, and post-acute care service lines.
States could support access to opioid use disorder treatment, other substance use disorder treatment, and mental health services.
(8) Supporting access to opioid use disorder treatment services (as defined in section 1861(jjj)(1)), other substance use disorder treatment services, and mental health services.
States could develop projects using new care and payment arrangements, including arrangements described as value-based care and alternative payment models. The bill does not define those arrangements. The Administrator could also permit additional uses designed to sustain access to high-quality urban health care.
(9) Developing projects that support innovative models of care that include value-based care arrangements and alternative payment models, as appropriate. (10) Additional uses designed to promote sustainable access to high quality urban health care services, as determined by the Administrator.
A state's allocation would generally remain available to spend through the end of the following fiscal year. Redistributed money would have the same general spending window, but any money redistributed in fiscal year 2033 would have to be spent by September 30, 2033.
(C) Availability of funds (i) In general Amounts allotted to a State under this section for a year shall be available for expenditure by the State through the end of the fiscal year following the fiscal year in which such amounts are allotted. (ii) Availability of amounts redistributed Amounts redistributed to a State under subparagraph (B) with respect to a fiscal year shall be available for expenditure by the State through the end of the fiscal year following the fiscal year in which such amounts are redistributed (except in the case of amounts redistributed in fiscal year 2033 which shall only be available for expenditure through September 30, 2033).
By March 31, 2029, and annually through March 31, 2033, the Administrator would have to identify prior-year funds that remain unspent or uncommitted and are no longer available to a state under the spending deadlines. Although this clause is titled redistribution, its operative text requires identifying the amount and does not specify a redistribution formula.
(B) Redistribution of unexpended or unobligated funds In carrying out paragraph (1), the Administrator shall, not later than March 31, 2029, and annually thereafter through March 31, 2033, determine the amount of funds, if any, that are available under such paragraph for a previous fiscal year, are unexpended or unobligated with respect to such fiscal year, and will not be available to a State in the current fiscal year, pursuant to subparagraph (C).
Program appropriation money that remained unspent or not legally committed as of October 1, 2033, would have to return to the Treasury.
Any amounts appropriated under paragraph (1) that are unexpended or unobligated as of October 1, 2033, shall be returned to the Treasury of the United States.
If a state used allocated or redistributed money inconsistently with its approved application, the Administrator could withhold or reduce payments or recover earlier payments. Money withheld, remaining after a reduction, or recovered under this provision would have to return to the Treasury.
(D) Misuse of funds If the Administrator determines that a State is not using amounts allotted or redistributed to the State under this section in a manner consistent with the description provided by the State in its application approved under subsection (b), the Administrator may withhold payments to, or reduce payments to, or recover previous payments from, the State under this section as the Administrator deems appropriate, and any amounts so withheld, or that remain after any such reduction, or so recovered, shall be returned to the Treasury of the United States.
The Administrator would implement the bill through program instructions or other guidance. Separately from state program funding, the bill would appropriate $200 million for implementation in fiscal year 2026, available until spent.
(b) Implementation The Administrator of the Centers for Medicare & Medicaid Services shall implement this section, including the amendments made by this section, by program instruction or other forms of program guidance. (c) Implementation funding For the purposes of carrying out the provisions of, and the amendments made by, this section, there are appropriated, out of any monies in the Treasury not otherwise appropriated, to the Administrator of the Centers for Medicare & Medicaid Services, $200,000,000 for fiscal year 2026, to remain available until expended.
The supplied action snapshot, updated October 13, 2026, records introduction in the House on October 1, 2026, and referral that day to the Energy and Commerce and Ways and Means committees. This snapshot does not establish subsequent progress or enactment.
Source snapshot updated 2026-10-13T16:45:14Z. 2026-10-01: Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
2026-10-01: Introduced in House
A closer look
Reviewed version: Introduced in House · 2026-10-01. These findings describe provisions and who may benefit; they are not judgments of waste, corruption, or motive.
This review covers the supplied bill text. “None identified” does not rule out provisions in later versions or accompanying reports and disclosures.
Provisions outside the bill’s main subject, or policy changes attached to appropriations.
None identified in the reviewed text
No unrelated provision or separate policy rider was identified in the complete supplied introduced text. Its funding and operating rules form one program. This conclusion is limited to this text version and does not establish absence in other versions or accompanying materials.
Spending directed to particular recipients or places outside ordinary competitive or formula-based allocation.
None identified in the reviewed text
No earmark was identified in the complete supplied introduced text. The program's general allocation structure does not itself establish congressionally directed spending for particular recipients or places. This conclusion is limited to this version; accompanying disclosure and report materials are absent.
Narrow exceptions, exemptions, or preferential treatment that warrant a closer look.
None identified in the reviewed text
No materially narrow special exemption or preferential carve-out was identified in the complete supplied introduced text. The program's geographic scope, covered provider categories, and intended beneficiaries define its main policy rather than a separate special benefit. This conclusion is limited to this version and does not establish absence in other versions or accompanying materials.
Full text preserved for this analysis. Legislative record snapshot: Oct 13, 2026. How PlainBill uses AI