US Code

Public Law 119-88 (05/04/2026)

42 U.S.C. § 291b

State allotments

(a)

Computation for individual States; formulas for both new construction and modernization

(1)
section 291a(a) of this titlesection 291a(b) of this title Each State shall be entitled for each fiscal year to an allotment bearing the same ratio to the sums appropriated for such year pursuant to subparagraphs (1), (2), and (3), respectively, of , and to an allotment bearing the same ratio to the sums appropriated for such year pursuant to , as the product of—
(A)
the population of such State, and
(B)
the square of its allotment percentage,
bears to the sum of the corresponding products for all of the States.
(2)
section 291a(c) of this titlesection 291a of this title For each fiscal year, the Secretary shall, in accordance with regulations, make allotments among the States, from the sums appropriated for such year under , on the basis of the population, the financial need, and the extent of the need for modernization of the facilities referred to in paragraphs (a) and (b) of , of the respective States.
(b)

Minimum allotments

(1)
The allotment to any State under subsection (a) for any fiscal year which is less than—
(A)
$50,000 for the Virgin Islands, American Samoa, the Trust Territory of the Pacific Islands, or Guam and $100,000 for any other State, in the case of an allotment for grants for the construction of public or other nonprofit rehabilitation facilities,
(B)
$100,000 for the Virgin Islands, American Samoa, the Trust Territory of the Pacific Islands, or Guam and $200,000 for any other State in the case of an allotment for grants for the construction of public or other nonprofit outpatient facilities,
(C)
section 291a of this title $200,000 for the Virgin Islands, American Samoa, the Trust Territory of the Pacific Islands, or Guam and $300,000 for any other State in the case of an allotment for grants for the construction of public or other nonprofit facilities for long-term care or for the construction of public or other nonprofit hospitals and public health centers, or for the modernization of facilities referred to in paragraph (a) or (b) of , or
(D)
section 291a of this title $200,000 for the Virgin Islands, American Samoa, the Trust Territory of the Pacific Islands, or Guam and $300,000 for any other State in the case of an allotment for grants for the modernization of facilities referred to in paragraphs (a) and (b) of ,
shall be increased to that amount, the total of the increases thereby required being derived by proportionately reducing the allotment from appropriations under such subparagraph or paragraph to each of the remaining States under subsection (a) of this section, but with such adjustments as may be necessary to prevent the allotment of any of such remaining States from appropriations under such subparagraph or paragraph from being thereby reduced to less than that amount.
(2)
An allotment of the Virgin Islands, American Samoa, the Trust Territory of the Pacific Islands, or Guam for any fiscal year may be increased as provided in paragraph (1) only to the extent it satisfies the Surgeon General, at such time prior to the beginning of such year as the Surgeon General may designate, that such increase will be used for payments under and in accordance with the provisions of this part.
(c)

Allotment percentages; definitions; determination

For the purposes of this part—
(1)
The “allotment percentage” for any State shall be 100 per centum less that percentage which bears the same ratio to 50 per centum as the per capita income of such State bears to the per capita income of the United States, except that (A) the allotment percentage shall in no case be more than 75 per centum or less than 33⅓ per centum, and (B) the allotment percentage for the Commonwealth of Puerto Rico, Guam, American Samoa, the Trust Territory of the Pacific Islands, and the Virgin Islands shall be 75 per centum.
(2)
The allotment percentages shall be determined by the Surgeon General between July 1 and September 30 of each even-numbered year, on the basis of the average of the per capita incomes of each of the States and of the United States for the three most recent consecutive years for which satisfactory data are available from the Department of Commerce, and the States shall be notified promptly thereof. Such determination shall be conclusive for each of the two fiscal years in the period beginning July 1 next succeeding such determination.
(3)
The population of the several States shall be determined on the basis of the latest figures certified by the Department of Commerce.
(4)
The term “United States” means (but only for purposes of paragraphs (1) and (2)) the fifty States and the District of Columbia.
(d)

Availability of allotments in subsequent years

(1)
Any sum allotted to a State, other than the Virgin Islands, American Samoa, the Trust Territory of the Pacific Islands, and Guam for a fiscal year under this section and remaining unobligated at the end of such year shall remain available to such State, for the purpose for which made, for the next two fiscal years (and for such years only), in addition to the sums allotted to such State for such purposes for such next two fiscal years.
(2)
Any sum allotted to the Virgin Islands, American Samoa, the Trust Territory of the Pacific Islands, or Guam for a fiscal year under this section and remaining unobligated at the end of such year shall remain available to it, for the purpose for which made, for the next two fiscal years (and for such years only), in addition to the sums allotted to it for such purpose for each of such next two fiscal years.
(e)

Transfer of allotments

(1)
Upon the request of any State that a specified portion of any allotment of such State under subsection (a) for any fiscal year be added to any other allotment or allotments of such State under such subsection for such year, the Secretary shall promptly (but after application of subsection (b)) adjust the allotments of such State in accordance with such request and shall notify the State agency; except that the aggregate of the portions so transferred from an allotment for a fiscal year pursuant to this paragraph may not exceed the amount specified with respect to such allotment in clause (A), (B), (C), or (D), as the case may be, of subsection (b)(1) which is applicable to such State.
(2)
In addition to the transfer of portions of allotments under paragraph (1), upon the request of any State that a specified portion of any allotment of such State under subsection (a), other than an allotment for grants for the construction of public or other nonprofit rehabilitation facilities, be added to another allotment of such State under such subsection, other than an allotment for grants for the construction of public or other nonprofit hospitals and public health centers, and upon simultaneous certification to the Secretary by the State agency in such State to the effect that—
(A)
it has afforded a reasonable opportunity to make applications for the portion so specified and there have been no approvable applications for such portion, or
(B)
in the case of a request to transfer a portion of an allotment for grants for the construction of public or other nonprofit hospitals and public health centers, use of such portion as requested by such State agency will better carry out the purposes of this subchapter,
the Secretary shall promptly (but after application of subsection (b)) adjust the allotments of such State in accordance with such request and shall notify the State agency.
(3)
section 291a of this title In addition to the transfer of portions of allotments under paragraph (1) or (2), upon the request of any State that a specified portion of an allotment of such State under paragraph (2) of subsection (a) be added to an allotment of such State under paragraph (1) of such subsection for grants for the construction of public or other nonprofit hospitals and public health centers, and upon simultaneous certification by the State agency in such State to the effect that the need for new public or other nonprofit hospitals and public health centers is substantially greater than the need for modernization of facilities referred to in paragraph (a) or (b) of , the Secretary shall promptly (but after application of subsection (b) of this section) adjust the allotments of such State in accordance with such request and shall notify the State agency.
(4)
After adjustment of allotments of any State, as provided in paragraph (1), (2), or (3) of this subsection, the allotments as so adjusted shall be deemed to be the State’s allotments under this section.
(f)

Request by State to transfer portion of allotment

In accordance with regulations, any State may file with the Surgeon General a request that a specified portion of an allotment to it under this part for grants for construction of any type of facility, or for modernization of facilities, be added to the corresponding allotment of another State for the purpose of meeting a portion of the Federal share of the cost of a project for the construction of a facility of that type in such other State, or for modernization of a facility in such other State, as the case may be. If it is found by the Surgeon General (or, in the case of a rehabilitation facility, by the Surgeon General and the Secretary) that construction or modernization of the facility with respect to which the request is made would meet needs of the State making the request and that use of the specified portion of such State’s allotment, as requested by it, would assist in carrying out the purposes of this subchapter, such portion of such State’s allotment shall be added to the corresponding allotment of the other State, to be used for the purpose referred to above.

July 1, 1944, ch. 373 Pub. L. 88–443, § 3(a)78 Stat. 448 Pub. L. 90–574, title IV, § 402(b)82 Stat. 1011 Pub. L. 91–296, title I84 Stat. 338 (, title VI, § 602, as added , , ; amended , , ; , §§ 103(a), (b), 104, 116(a), 119(a)–(c), 122, , , 341, 343, 344.)

Editorial Notes

Prior Provisions

act July 1, 1944, ch. 373, title VI, § 612 Aug. 13, 1946, ch. 958, § 2 60 Stat. 1041 Pub. L. 88–443A prior section 291b, , as added , , related to a State application for funds, its requirements and its approval, prior to the general amendment of this subchapter by .

act July 1, 1944, ch. 373, title VI, § 624 Aug. 13, 1946, ch. 958, § 2 60 Stat. 1941 Pub. L. 88–443A prior section 291c, , as added , , related to subject matter similar to this section, prior to the general amendment of this subchapter by .

act July 1, 1944, ch. 373, title VI, § 624 Aug. 13, 1946, ch. 958, § 2 60 Stat. 1041 June 29, 1948, ch. 728, § 1 62 Stat. 1103 Oct. 25, 1949, ch. 722 63 Stat. 899 Aug. 1, 1956, ch. 852, § 19(c) 70 Stat. 911 Pub. L. 87–688, § 4(a)(3)76 Stat. 587 Pub. L. 88–443A prior section 291g, , as added , ; amended , ; , §§ 3(b), 7, , 901; , ; , , , related to subject matter similar to this section, prior to the general amendment of this subchapter by .

act July 1, 1944, ch. 373, title VI, § 631 Aug. 13, 1946, ch. 958, § 2 60 Stat. 1041 June 19, 1948, ch. 544 62 Stat. 531 Aug. 1, 1956, ch. 852, § 19(a) 70 Stat. 911 Pub. L. 86–70, § 31(c)73 Stat. 149 Pub. L. 86–624, § 29(d)74 Stat. 419 Pub. L. 87–688, § 4(a)(2)76 Stat. 587 Pub. L. 88–443A prior section 291i(a) to (d), , as added , ; amended , ; , (b), ; , , ; , , ; , , , related to subject matter similar to this section, prior to the general amendment of this subchapter by .

act July 1, 1944, ch. 373, title VI, § 637 July 12, 1954, ch. 471, § 3 68 Stat. 463 Pub. L. 86–158, title II, § 20173 Stat. 349 Pub. L. 88–443A prior section 291n–1, , formerly § 654(c), as added , , renumbered and amended , , , related to subject matter similar to this section, prior to the general amendment of this subchapter by .

act July 1, 1944, ch. 373, title VI, § 648 July 12, 1954, ch. 471, § 2 68 Stat. 462 Pub. L. 88–443A prior section 291r, , as added , , related to subject matter similar to this section, prior to the general amendment of this subchapter by .

act July 1, 1944, ch. 373, title VI, § 652 July 12, 1954, ch. 471, § 3 68 Stat. 462 Aug. 1, 1956, ch. 852, § 19(c) 70 Stat. 911 Pub. L. 87–395, § 3(b)75 Stat. 825 Pub. L. 87–688, § 4(a)(3)76 Stat. 587 Pub. L. 88–443A prior section 291t, , as added , ; amended , ; , , ; , , , related to subject matter similar to this section, prior to the general amendment of this subchapter by .

act July 1, 1944, ch. 373, title VI, § 654 July 12, 1954, ch. 471, § 3 68 Stat. 463 Pub. L. 88–443A prior section 291v(b), , as added , , related to subject matter similar to this section, prior to the general amendment of this subchapter by .

Amendments

Pub. L. 91–296, § 103(a)section 291a(b) of this title1970—Subsec. (a)(1). , substituted “sums appropriated for such year” for “new hospital portion of the sums appropriated for such year” and struck out provision setting out a formula for determining new hospital portion of sums appropriated pursuant to .

Pub. L. 91–296, § 103(a)section 291a(c) of this titlesection 291a(b) of this titlesection 291a of this titleSubsec. (a)(2). , substituted “Secretary” for “Surgeon General”, and substituted reference to sums appropriated for such year under for reference to remainder of sums appropriated pursuant to (which portion was to be available for grants for modernization of facilities referred to in paragraphs (a) and (b) of ).

Pub. L. 91–296Subsec. (b)(1)(A). , §§ 103(b)(1), 119(a)(1), substituted “$50,000” and “$100,000” for “$25,000” and “$50,000”, respectively, and inserted reference to Trust Territory of the Pacific Islands.

Pub. L. 91–296Subsec. (b)(1)(B). , §§ 103(b)(2), 116(a), 119(a)(1), substituted “$100,000” and “$200,000” for “$50,000” and “$100,000”, respectively, substituted “outpatient facilities” for “diagnostic or treatment centers”, and inserted reference to Trust Territory of the Pacific Islands.

Pub. L. 91–296Subsec. (b)(1)(C). , §§ 103(b)(3), 119(a)(1), substituted “$200,000” and “$300,000” for “$100,000” and “$200,000”, respectively, and inserted reference to Trust Territory of the Pacific Islands.

Pub. L. 91–296, § 103(b)(4)Subsec. (b)(1)(D). , added subpar. (D).

Pub. L. 91–296, § 119(a)(2)Subsecs. (b)(2), (c)(1). , (b), inserted reference to Trust Territory of the Pacific Islands.

Pub. L. 91–296Subsec. (d)(1). , §§ 119(c), 122, inserted reference to Trust Territory of the Pacific Islands and substituted two years for one year as the time span following a year in which allotted sums remaining unobligated at the end thereof during which such unobligated funds remain available.

Pub. L. 91–296, § 119(c)Subsec. (d)(2). , inserted references to Trust Territory of the Pacific Islands.

Pub. L. 91–296, § 104Subsec. (e). , authorized any State to make transfers of any amount up to the minimum amount allotted to any state for a particular category and authorized all amounts above such minimums to be transferred from one category of assistance to another without restriction on the amounts with the exception that no funds could be transferred from rehabilitation facilities category or to new hospital construction category and that all transfers be justified on the basis that either there are no approvable applications in the category from which funds are transferred or, in case of transfers from new hospital construction category, the purposes of the program would be better served by the transfer, and authorized transfers to new hospital construction from modernization category if need is greater.

Pub. L. 90–574, § 402(b)(1)1968—Subsec. (a)(1). , inserted provision for two-thirds of the sums appropriated in the case of the fifth fiscal year thereafter.

Pub. L. 90–574, § 402(b)(2)Subsec. (e)(2)(E). , added subpar. (E).

Statutory Notes and Related Subsidiaries

Change of Name

section 509(b) of Pub. L. 96–88section 3508(b) of Title 20“Secretary of Health and Human Services” substituted for “Secretary of Health, Education, and Welfare” in subsecs. (a)(2), (e), and (f) pursuant to , which is classified to , Education.

Effective Date of 1970 Amendment

Pub. L. 91–296, title I, § 103(a)84 Stat. 338 section 291a of this title, , , provided that the amendment made by that section is effective with respect to appropriations made pursuant to for fiscal years beginning after .

Pub. L. 91–296, title I, § 103(b)84 Stat. 338 section 291a of this title, , , provided that the amendment made by that section is effective with respect to allotments from appropriations made pursuant to for fiscal years beginning after .

Pub. L. 91–296, title I, § 10484 Stat. 338 section 291a of this title, , , provided that the amendment made by that section is effective with respect to allotments made pursuant to for fiscal years beginning after .

Pub. L. 91–296, title I, § 119(e)84 Stat. 343

o42 U.S.C. 291a42 U.S.C. 291j–1“The amendments made by this section [amending this section and section 291 of this title] shall apply with respect to allotments (and grants therefrom) under part A of title VI of the Public Health Service Act [ et seq.] for fiscal years ending after , and with respect to loan guarantees and loans under part B of such title [ et seq.] made after .”
, , , provided that:

Pub. L. 91–296, title I, § 12284 Stat. 344 section 291a of this title, , , provided that the amendment made by that section is effective with respect to allotments made from appropriations under for fiscal years beginning after .

Availability of Funds for Obligation From Allotment for Administration of Plan

Pub. L. 93–641, § 5(b)88 Stat. 2274 , , , provided that any State having in the fiscal year ending or the next fiscal year funds available for obligation from its allotments under section 291a et seq. of this title, may in such fiscal year use for the proper and efficient administration during such year of its State plan an amount of such funds not exceeding 4 percentum of such funds or $100,000, whichever is less.

Allotment Study; Report to Congress

Pub. L. 91–296, title I, § 103(c)84 Stat. 338 , , , directed Secretary to study effects of the formula specified in subsec. (a)(1) of this section for allotment among the States for construction of health facilities, with results of such study together with recommendations for change to be reported to Congress on .

Approval of Application for Modernization Prior to , or Before Approval of a State Plan

Pub. L. 88–443, § 3(b)(5)78 Stat. 462 section 291 of this title, , , providing that no application for modernization of any facility may be approved for purposes of receiving funds before the approval of a State plan, as well as other requirements, is set out as an Effective Date note under .

Executive Documents

Transfer of Functions

80 Stat. 1610 section 202 of this titleOffice of Surgeon General abolished by section 3 of Reorg. Plan No. 3 of 1966, eff. , 31 F.R. 8855, , and functions thereof transferred to Secretary of Health, Education, and Welfare by section 1 of Reorg. Plan No. 3 of 1966, set out as a note under . Office of Surgeon General reestablished within the Office of the Assistant Secretary for Health, see Notice of Department of Health and Human Services, Office of the Assistant Secretary for Health, , 52 F.R. 11754.

Termination of Trust Territory of the Pacific Islands

section 1681 of Title 48For termination of Trust Territory of the Pacific Islands, see note set out preceding , Territories and Insular Possessions.