NC Rural Health Transformation Program Frequently Asked Questions

The North Carolina Rural Health Transformation Program (NCRHTP) is a statewide program led by NCDHHS. It aims to improve health care in rural communities, help people get better care and make sure rural health services are available for years to come.

The program will serve more than 3.4 million people in rural North Carolina. It is funded for five years by the U.S. Centers for Medicare & Medicaid Services (CMS).

The federal government created the Rural Health Transformation Program to help states improve health care in rural communities. States can use the funding to improve technology, build partnerships, strengthen the health care workforce and develop new ways to provide care.

North Carolina has the second-largest rural population in the country. Many rural communities face challenges such as:

• Not enough health care providers
• Hospital closures
• High rates of long-term health conditions
• Differences in access to care and health outcomes

NCDHHS applied for the federal funding in November 2025. In December 2025, CMS awarded North Carolina over $213 million for the first year. Future funding will depend on the program's progress and results.  

NCRHTP has three main goals:

• Improve how health care providers work together to care for people in rural communities.
• Make it easier for people to get medical care, behavioral health care and other support close to home.
• Build a rural health care system that can last. This includes training and keeping health care workers and finding better ways to pay rural health care providers. 

North Carolina's plan includes six main areas of work:

• NC ROOTS Hubs: Local and regional networks that connect medical care, behavioral health care and social services.
• Expanded Primary Care and Prevention: Better access to primary care, help managing long-term health conditions, maternal health services and nutrition support.
• Behavioral Health and Substance Use Services: More mental health and substance use services, including crisis care and school-based services.
• Workforce Development: More training and retention programs to prepare and retain people to work in rural health care.
• Value-Based Payment Models: New ways to pay health care providers that focus on the quality and results of care.
• Digital Health and Technology: Better use of health information, digital tools and new technology. 

NCDHHS’ plan was developed with input from communities and partners across North Carolina. This included:

• More than 400 public comments
• A town hall with more than 600 participants
• Conversations with communities and state lawmakers

NCDHHS also considered federal priorities, research on what works in rural communities and whether the programs could continue over time.  

Together, they are the building blocks of a stronger rural health care system. 

NC Rural Organizations Orchestrating Transformation for Sustainability (ROOTS) Hubs are regional networks that bring together health care providers and community partners. They will help carry out NC Rural Health Transformation Program activities based on the needs of each region.

Hubs work with local partners to improve primary care, behavioral health care, the health care workforce, digital health and other services that support rural communities.

Learn more about the NC ROOTS Hub Leads. 

NCDHHS selected five organizations to lead NC ROOTS Hubs across North Carolina's six Medicaid regions:

• Region 1: Impact Health
• Regions 2 and 5: Trillium Health Resources
• Region 3: Vaya Health
• Region 4: UNC Health
• Region 6: Access East, Inc.

The Hub Leads were chosen through a competitive application process. Each Hub Lead brings together local partners and help carry out NC Rural Health Transformation Program activities in its region.

Each ROOTS Hub Lead will have a Governing Body that will set priorities and make decisions about ROOTS Hub work. The Governing Body must represent the geographic region and rural populations.

NC ROOTS Hubs will meet together and regularly share what is working, what they are learning and where improvements are needed.

NCDHHS is also developing ways for the Hubs to share data and successful approaches. This will help regions learn from each other and improve outcomes over time. 

NCDHHS has an online map that shows which NC ROOTS Hub serves each county. The webpage also provides information about each Hub Lead.

Find your NC ROOTS Hub.

Organizations interested in working with an NC ROOTS Hub should start by finding the Hub that serves their region.

Hub Leads are building regional networks of health care providers, community organizations and other partners. Opportunities may be different in each region based on local needs and program activities.

North Carolina defines “rural” using the Rural Health Grants Eligibility Analyzer and Federal Office of Rural Health Policy (FORHP) designations implemented by the Health Resources and Services Administration (HRSA). For the purposes of this application, these include counties of at least one census tract designated as rural. Under this approach, any county with at least one federally designated rural census tract was considered rural, resulting in 85 of North Carolina’s 100 counties being designated rural for program purposes.  

In applying this definition to determine whether subrecipients were considered rural, the State also evaluated:

• Type of recipient – Entities did not need to be physically located in a rural county; eligibility depended on whether the organization serves rural residents, regardless of headquarters location.
• Type of service delivered – For initiatives intended to expand or strengthen services in rural communities, subrecipients needed to demonstrate that their work aligned with and directly benefited a rural county, based on the census tract definition.

This approach ensures that impact is measured at the rural county level, while allowing participation from organizations that effectively reach rural residents where they actually receive care, not only where they are physically located.  

Yes. Organizations located outside designated rural counties may participate if they serve rural populations or support NCRHTP goals. This includes health systems, academic institutions, nonprofits and statewide organizations. 

Activities and investments may vary by region based on local needs, ROOTS Hub design and available funding. 

The program uses North Carolina's six Medicaid regions.

Five organizations serve as NC ROOTS Hub Leads because Trillium Health Resources leads both Region 2 and Region 5.

NCDHHS has an online map where people can find their county, region and NC ROOTS Hub Lead. 

North Carolina received about $213 million for the first year of the Rural Health Transformation Program.

The federal program will run for five years. CMS asked North Carolina to plan for $213 million for year 2. The actual amount may change based on North Carolina's progress and future federal funding decisions. 

Funding will reach communities in several ways.

NC ROOTS Hubs will help support local and regional projects. Funding will also be available through statewide programs and competitive grants.

Projects may support primary care, chronic disease prevention, behavioral health, the rural health workforce, technology and other efforts to improve rural health care.

New funding opportunities will be available as different parts of the NC Rural Health Transformation Program begin.

Current opportunities, eligibility requirements, deadlines and application instructions are posted on the program's Grant Opportunities page.

Organizations should check this page regularly because opportunities will change throughout the five-year program.  

NCDHHS will continue to announce funding opportunities as the program moves forward.

One upcoming opportunity is the Rural Health Innovation Fund, which will help rural health care providers improve technology and digital systems. The fund is expected to provide up to $20 million each year for up to five years.

The first competitive application process is planned for Sept. 30, 2026.

Organizations should check the Grant Opportunities page for the latest information and deadlines. 

Yes. Technical assistance is available across initiative priority areas. 

Medicaid is an important partner, but the NC Rural Health Transformation Program is not only for people with Medicaid.

For example, NC Medicaid is moving to pay providers based on health results and how they care for patients, rather than the number of services they provide. Lessons learned will be used to develop new ways to pay health care providers (outside of Medicaid) that reward better health and quality of care.

The program is designed to strengthen rural health care for communities, including people with Medicaid, other insurance and people who are uninsured or do not have enough insurance.

NCRHTP will build on health care services and programs that already serve North Carolina communities.

Partners may include hospitals, health systems, community health centers, behavioral health providers, rural hospitals, local health departments and other organizations.

NC ROOTS Hubs will help these groups work together. The goal is to strengthen programs that are already working and avoid creating the same services twice.  

The program will make it easier for people in rural communities to get mental health and substance use care.

This may include:

• Mental health and substance use treatment
• Crisis services
• Mobile services that bring care into communities
• School-based services
• Treatment for opioid use disorder
• Better connections between behavioral health and primary care

NCDHHS is already investing in some of these services through the NCRHTP. 

The program will help train and keep more health care workers in rural communities.

Investments may include:

• Rural residency and fellowship programs
• Training centers
• Simulation labs where health care workers can practice skills
• Programs that prepare students for health care careers
• Support for new types of rural health care teams

The goal is to build a stronger health care workforce that can meet the needs of rural communities.

Technology is an important part of the NC Rural Health Transformation Program.

Current efforts include:

• Expanding NC HealthConnex so providers can securely share health information across electronic health record platforms
• Improving telehealth and other digital systems
• Helping people learn how to use digital health tools
• Helping rural providers understand and safely use artificial intelligence and other new technology
• Investing in technology through the Rural Health Innovation Fund

The Rural Health Innovation Fund will help rural health care providers improve their technology and digital systems.

Funding may support projects such as telehealth, electronic health records, cybersecurity, artificial intelligence and other health technologies.

NCDHHS plans to provide up to $20 million each year for up to five years. The first competitive application process is planned for Sept. 30, 2026. 

Metrics include access to care, chronic disease outcomes, maternal and child health, behavioral health access, workforce recruitment and retention, and technology adoption. Continued funding is tied to demonstrated progress. 

Visit NCDHHS' Rural Health Transformation Program webpage for updates, documents and engagement opportunities. Sign up for the NCDHHS Rural Health Transformation Program newsletter.