The Urban Health Transformation Act of 2026 establishes a new federal grant program to improve healthcare access and quality in large urban areas. The legislation provides $10 billion annually from fiscal years 2027 through 2031 to states with approved applications, distributed through the Centers for Medicare & Medicaid Services. States must submit detailed urban health transformation plans addressing hospital access, health outcomes, workforce recruitment, technology adoption, and financial stability of urban healthcare systems, and then implement at least three of ten specified activities including chronic disease management, technology solutions, workforce development, mental health services, and innovative care models. The funds will be allocated 50 percent equally among all approved states and 50 percent based on factors like urban population percentage and the number of urban health facilities in each state. States cannot use the funds to match other federal requirements, are limited to 10 percent for administrative costs, and must submit annual reports on fund usage, with any unspent money returned to the Treasury by October 1, 2033.