States will share $10 billion for rural health care next year in a program that aims to offset the Trump administration’s massive budget cuts to rural hospitals, federal officials announced Monday.

But while every state applied for money from the Rural Health Transformation Program, it won’t be distributed equally. And critics worry that the funding might be pulled back if a state’s policies don’t match up with the administration’s.

Officials said the average award for 2026 is $200 million, and the fund puts a total of $50 billion into rural health programs over five years. States propose how to spend their awards, and the Centers for Medicare and Medicaid Services assigns project officers to support each state, said agency administrator Dr. Mehmet Oz.

“This fund was crafted as part of the One Big Beautiful Bill, signed only six months ago now into law, in order to push states to be creative,” Oz said in a call with reporters Monday.

Under the program, half of the money is equally distributed to each state. The other half is allocated based on a formula developed by CMS that considered rural population size, the financial health of a state’s medical facilities and health outcomes for a state’s population.

The formula also ties $12 billion of the five-year funding to whether states are implementing health policies prioritized by the Trump administration’s “Make America Healthy Again” initiative. Examples include requiring nutrition education for health care providers, having schools participate in the Presidential Fitness Test or banning the use of SNAP benefits for so-called junk foods, Oz said.

Several Republican-led states — including Arkansas, Iowa, Louisiana, Nebraska, Oklahoma and Texas — have already adopted rules banning the purchase of foods like candy and soda with SNAP benefits.

The money that the states get will be recalculated annually, Oz said, allowing the administration to “claw back” funds if, for example, state leaders don’t pass promised policies. Oz said the clawbacks are not punishments, but leverage governors can use to push policies by pointing to the potential loss of millions.

“I’ve already heard governors express that sentiment that this is not a threat, that this is actually an empowering element of the One Big Beautiful Bill,” he said.

Carrie Cochran-McClain, chief policy officer with the National Rural Health Association, said she’s heard from a number of Democratic-led states that refused to include such restrictions on SNAP benefits even though it could hurt their chance to get more money from the fund.

“It’s not where their state leadership is,” she said. Oz and other federal officials have touted the program as a 50% increase in Medicaid investments in rural health care. Rep. Don Bacon, a Republican from Nebraska who has been critical of many of the administration’s policies but voted for the budget bill that slashed Medicaid, pointed to the fund when recently questioned about how the cuts would hurt rural hospitals.

“That’s why we added a $50 billion rural hospital fund, to help any hospital that’s struggling,” Bacon said. “This money is meant to keep hospitals afloat.”

But experts say it won’t nearly offset the losses that struggling rural hospitals will face from the federal spending law’s $1.2 trillion cut from the federal budget over the next decade, primarily from Medicaid. Millions of people are also expected to lose Medicaid benefits.

Estimates suggest rural hospitals could lose around $137 billion over the next decade because of the budget measure. As many as 300 rural hospitals were at risk for closure because of the GOP’s spending package, according to an analysis by The Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill.

“When you put that up against the $50 billion for the Rural Health Transformation Fund, you know — that math does not add up,” Cochran-McClain said.

She also said there’s no guarantee that the funding will go to rural hospitals in need. For example, she noted, one state’s application included a proposal for healthier, locally sourced school lunch options in rural areas.

And even though innovation is a goal of the program, Cochran-McClain said it’s tough for rural hospitals to innovate when they were struggling to break even before Congress’ Medicaid cuts.

“We talk to rural providers every day that say, ‘I would really love to do x, y, z, but I’m concerned about, you know, meeting payroll at the end of the month,’” she said. “So when you’re in that kind of crisis mode, it is, I would argue, almost impossible to do true innovation.”

The Supreme Court is meeting in private Friday with a key issue on its agenda — President Donald Trump ’s birthright citizenship order declaring that children born to parents who are in the United States illegally or temporarily are not American citizens.

The justices could say as soon as Monday whether they will hear Trump’s appeal of lower court rulings that have uniformly struck down the citizenship restrictions. They have not taken effect anywhere in the United States.

If the court steps in now, the case would be argued in the spring, with a definitive ruling expected by early summer.

The birthright citizenship order, which Trump signed on the first day of his second term in the White House, is part of his administration’s broad immigration crackdown. Other actions include immigration enforcement surges in several cities and the first peacetime invocation of the 18th century Alien Enemies Act.

The administration is facing multiple court challenges, and the high court has sent mixed signals in emergency orders it has issued. The justices effectively stopped the use of the Alien Enemies Act to rapidly deport alleged Venezuelan gang members without court hearings, while they allowed the resumption of sweeping immigration stops in the Los Angeles area after a lower court blocked the practice of stopping people solely based on their race, language, job or location.

The justices also are weighing the administration’s emergency appeal to be allowed to deploy National Guard troops in the Chicago area for immigration enforcement actions. A lower court has indefinitely prevented the deployment.

Birthright citizenship is the first Trump immigration-related policy to reach the court for a final ruling. Trump’s order would upend more than 125 years of understanding that the Constitution’s 14th Amendment confers citizenship on everyone born on American soil, with narrow exceptions for the children of foreign diplomats and those born to a foreign occupying force.

In a series of decisions, lower courts have struck down the executive order as unconstitutional, or likely so, even after a Supreme Court ruling in late June that limited judges’ use of nationwide injunctions.

While the Supreme Court curbed the use of nationwide injunctions, it did not rule out other court orders that could have nationwide effects, including in class-action lawsuits and those brought by states. The justices did not decide at that time whether the underlying citizenship order is constitutional.

But every lower court that has looked at the issue has concluded that Trump’s order violates or most likely violates the 14th Amendment, which was intended to ensure that Black people, including former slaves, had citizenship.

The administration is appealing two cases.

The U.S. Court of Appeals for the 9th Circuit in San Francisco ruled in July that a group of states that sued over the order needed a nationwide injunction to prevent the problems that would be caused by birthright citizenship being in effect in some states and not others.

Madagascar President Andry Rajoelina left the country after an elite military unit turned against the government in an apparent coup that followed weeks of youth-led protests, an opposition lawmaker in the Indian Ocean country said Monday.

The lawmaker’s comments came shortly before Rajoelina was due to appear on national television and radio to make a speech to the people of Madagascar. The president’s office said his speech was scheduled to be broadcast at 7 p.m. local time (1600 GMT), but was delayed after a group of soldiers attempted to take over the state broadcaster.

His office didn’t say if he was still in Madagascar amid reports he had fled on Sunday on a French military plane.

The anti-government protests, which were initially led by Gen-Z demonstrators, began on Sept. 25 but reached a turning point on Saturday when soldiers from the elite CAPSAT military unit accompanied protesters to a square in the capital, Antananarivo, and called for Rajoelina and several government ministers to step down.

The unit, which helped Rajoelina first come to power as transitional leader in a military-backed coup in 2009, said that it had taken charge of all the armed forces in Madagascar.

Siteny Randrianasoloniaiko, the leader of the opposition in parliament, said that Rajoelina “ran away” from the country after soldiers turned against him.

Rajoelina’s office had said Sunday that “an attempt to seize power illegally and by force” was underway in the nation of 31 million off the east coast of Africa. He has not appeared in public since the revolt by soldiers and his current whereabouts are unknown.  A spokesperson for the president didn’t respond to phone calls and messages.

Following a report that France had flown Rajoelina and his family out of Madagascar on one of its military planes, French Foreign Ministry spokesperson Pascal Confavreux declined to comment.

Madagascar is a former French colony. Rajoelina reportedly has French citizenship, a source of discontent among Madagascans.

Madagascar’s former prime minister under Rajoelina and one of the president’s closest advisors had left the country and arrived in the nearby island of Mauritius in the predawn hours of Sunday, the Mauritian government said, adding it was “not satisfied” that the private plane had landed on its territory.

Rajoelina hasn’t identified who was behind the attempted coup, but the CAPSAT military unit appeared to be in a position of authority and on Sunday appointed a general as the new head of Madagascar’s armed forces, which was accepted by the defense minister.

A commander of CAPSAT, Col. Michael Randrianirina, said that his soldiers had exchanged gunfire with security forces who were attempting to quell weekend protests, and one of his soldiers was killed. But there was no major fighting on the streets, and soldiers riding on armored vehicles and waving Madagascar flags were cheered by people in Antananarivo.

Randrianirina said that the army had “responded to the people’s calls,” but denied there was a coup. Speaking at the country’s military headquarters on Sunday, he told reporters that it was up to the Madagascan people to decide what happens next, and if Rajoelina leaves power and a new election is held.

The U.S. Embassy in Madagascar advised American citizens to shelter in place because of a “highly volatile and unpredictable” situation. The African Union urged all parties, “both civilian and military, to exercise calm and restraint.”

Madagascar has been shaken by three weeks of the most significant unrest in years. The anti-government protests, which erupted over water and electricity outages, were led by a group calling itself “Gen Z Madagascar.” The United Nations says the demonstrations left at least 22 people dead and dozens injured. The government has disputed this number.

The protests snowballed into larger dissatisfaction with the government and the leadership of Rajoelina. The demonstrators have brought up a range of issues, including poverty and the cost of living, access to tertiary education, and alleged corruption and embezzlement of public funds by government officials, as well as their families and associates.