Rural Health Workforce Transformation

How do the ROOTS Hubs determine workforce investments?

All ROOTS Hubs must invest in rural residency programs and supports that help health care workers live and work in rural communities. Beyond those two requirements, Hubs are using needs assessments to inform what to fund. Hubs may invest directly or offer funding through competitive application processes (RFA or RFP). Funding may support education, clinical site capacity, professional development, recruitment and retention.

How much funding is available for ROOTS hub-led workforce initiatives?

Each of the ROOTS Hubs has $5.79 million for workforce initiatives in the first year. In addition, other initiatives, like behavioral health, have workforce components. North Carolina has only been awarded funds for Year One. States need to apply for funding each of the five years.

Do all workforce funds flow through ROOTS Hubs?

No, investments that strengthen the rural workforce are part of all NCRHTP programs. There are three statewide workforce initiatives that are outside the ROOTS Hubs:

Social Work Rural Scholars Program:
Trains and retains a new generation of social workers to serve rural and frontier NC communities.

Rural Behavioral Health Workforce Development Certification Program:  
Expands the Qualified Professional Initiative, which strengthens the behavioral health workforce in rural and underserved counties through development of stackable credentials. It is a partnership with the NC Community College System.

EMS Mobile Integrated Health Program:
The NCRHTP Mobile Integrated Health Program funds licensed North Carolina EMS agencies to bring care directly into people’s homes and connect people with the right care and resources in their communities. The program also supports the workforce needed to provide these services, improving access to behavioral health and preventive care while reducing unnecessary ambulance transports and emergency department visits.

What health professions does the NCRHTP focus on?

The ROOTS hub can support many types of health care jobs. This includes clinical roles and other jobs, such as medical billing or care coordination, that help deliver health services in rural communities. Each region has different needs, so its workforce priorities may be different. To decide which professions to focus on, Hubs will consider local health needs, the needs of older adults and families, access to primary care and behavioral health care, maternal health care access and other local priorities.

What investments does NCRHTP make into community health workers and doulas?

NCRHTP will support community health workers and doulas through the provision of training, capacity building, and support. Training and professional development for Community Health Workers and doulas are supported throughout the program.

How do NCRHTP investments complement other workforce investments by the Office of Rural Health?  

NCRHTP workforce funding builds on, rather than duplicates, existing workforce programs offered by the Office of Rural Health. Rural workforce needs are significant and funding is limited. NCRHTP investments are intended to catalyze efforts and expand what is already working.

What can NCRHTP workforce funds be used for?

The Centers for Medicare and Medicaid Services, the federal agency that funds NCRHTP, lists Allowed Workforce Uses of Funds including:

• Training and Development: Funds can support training programs and resources such as partnerships with local universities to create rural health career training tracks. Funds can also help people take part in early exposure programs; "grow your own" programs and education and training programs. These programs can provide a clear path to a new degree, certification or clinical job in a rural area.  
• Residency Programs: Funds can support new State-developed residency training programs, fellowships, or combined programs in rural communities. They can also help rural clinics and hospitals expand clinical training capacity, and provide residents with housing support, salaries and stipends.  
• Provider Recruitment and Retention Incentives: Funds can support sign-on bonuses and other bonuses that help recruit and keep providers.  
• Relocation, Travel Allowance and Other Incentives: Funds can help cover provider relocation expenses, travel between an approved work location and family home, transit costs (per diem) and childcare vouchers.  

What obligations apply to individuals who receive NCRHTP-funded workforce support?

Under CMS Rural Health Transformation Program rules, some workforce funding requires a five-year commitment to work in a rural area. This rule applies when funding directly benefits a person, such as tuition assistance, stipends, housing support or recruitment and retention incentives. It applies when the funding helps a person earns a degree or enter a clinical role.

To meet this commitment, providers must work in a rural area in the same state. They may complete the five years at more than one rural site within the state. ROOTS Hubs may set their own policies for managing this commitment, but those policies must follow CMS and NCDHHS guidelines.

Funding that strengthens the broader workforce system does not require the five-year service commitment. This includes expanding training capacity, supporting faculty or making facility improvements.

What restrictions apply to how NCRHTP funds can be used for workforce and related facility investments?

• NCRHTP funds may not be used for clinician salaries or wage support in facilities that require clinicians to sign non‑compete agreements. Salary or wage support is allowed only when the clinician is not subject to a non‑compete and the funding is part of an approved initiative.
• Renovations or changes to buildings can be allowed when they directly support program goals and follow rules for spending on buildings and equipment. For example, funds may not be used to build a new simulation lab. But they may be used for minor building changes or simulation equipment if part of an approved initiative.
• Investment in student loan repayment is not permitted.

How does RHTP strengthen North Carolina's human services and social work workforce?

Rural Health Transformation funds will expand education and training, support partnerships between schools and communities, and prepare the next generation of human services and social work professionals. These investments will be made through the Social Work Rural Scholars program, which is an expansion of North Carolina’s Public Service Leadership Program. They will focus on building a workforce that can meet long-term needs, increasing access to behavioral health services and addressing workforce shortages, particularly in underserved rural communities. 

What is the Social Work Rural Scholars Program?

The Social Work Rural Scholars Program is a statewide initiative designed to train and retain the next generation of social workers serving North Carolina’s rural communities. The program builds on the foundation of PSLP. It gives undergraduate and graduate social work students more opportunities to prepare for careers in rural behavioral health, substance use and aging services. These opportunities include paid field placements, tuition reimbursement, specialized training and mentorship. Participants receive training in areas such as rural practice, tele-behavioral health and workforce resiliency. The program aims to increase the pipeline for licensed clinical social workers and improve access to behavioral health services in high-need rural communities.

The Social Work Rural Scholars Program builds on the PSLP with a focus on North Carolina's rural social work workforce. The program invests in education, training, mentorship and workforce development. These investments help social work students move into rural practice and help recruit, prepare and retain social workers in rural and underserved communities.