SFY 2028 State Designated Rural Health Centers Support Grant

RFA Title: State Designated Rural Health Centers Support Grant 

Funding Agency Name: North Carolina Office of Rural Health (ORH)

RFA Opens: November 16, 2026

RFA Deadline: January 15, 2027, at 5:00 pm
Incomplete applications, or applications not completed in accordance with the following instructions, will not be reviewed.
Applicants must submit their application electronically through the Zengine portal. Visit the link to access electronic version of application.

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Purpose: These grant funds, supported through the North Carolina General Assembly, allow ORH to partner with local communities to provide funding to improve their ability to serve underserved populations who would otherwise be unable to access needed primary care services due to geographic, economic, or other barriers. State Designated Rural Health Centers have become an integral part of the health care safety net for North Carolina’s rural and underserved residents.

Funding Availability: Requests are contingent upon availability of program funding. ORH anticipates that approximately 15 applicants will receive funding. Successful applicants will be required to attend a grant award workshop.

Eligibilty:  The applicant organization must first assess if it can meet certain criteria. The purpose of the SDRHC program is to increase access to primary care for rural, uninsured, and underinsured residents. The following are specific requirements that must be met to be eligible for funding:

  • Rural Determination.
  • Health Professional Shortage Area determination and HPSA scores.
  • Demonstrated unmet need
  • County Distress Ranking – Tier 1 or 2 – County Distress Rankings.
  • Proof that the organization is not owned, controlled, or operated by another entity and holds an active 501 c3status. (Independent Rural Health Clinics, and Provider Based Clinics operated by Rural and Critical Access Hospitals are eligible to apply); Federally Qualified Health Centers with an access point not covered under the organization’s current Section 330 funding are eligible.
  • Provider of primary health care services to all individuals in the defined service area regardless of ability to pay.
  • Ability or plan to enroll eligible providers in Medicare and Medicaid reimbursement programs.
  • Documentation demonstrating that at least 10% of total patient volume are Medicaid beneficiaries (submitting reimbursement claims for eligible visits).

As a condition of receiving state funds, the SDRHC agrees to comply with the standards of the NC Office of the Controller, NC Office of Budget and Management standards, and NC ORH Operations Program. Requirements include (1) Compliance Standards (Completion of all NC DHHS Contract Approval Forms), (2) Contractual Agreement, and (3) Program Operations.

Award Information: Applicant awardees will be awarded for a one-year period. Awardees are required to attend a grant award workshop and participate in a site visit or desk review within three months of the awarded start date. Any remaining balances from Year 2 funds will not carry forward into the following year.  Future funding is contingent upon substantially meeting performance and financial goals as mutually agreed upon between ORH and the awardee.

Maximum Award Amount: Applicants may request up to $250,500.

Proposed Project Period or Contract Term: State Fiscal Year 2028: July 1, 2027 – June 30, 2028. All grantees must fully expend grant funds by June 30, 2028.   All invoices for completed and projected work must be submitted to ORH for reimbursement no later than June 7, 2028.

Grant Funding Description

A. Funding Level Definitions - There are two levels of funding for applicants to consider. Level 1 includes Capacity-Building sites who do not currently serve Medicaid and Medicare patients, but plan to do so within the first year of funding. If awarded, Capacity-Building sites will work with ORH and NC AHEC to complete their Medicaid application by the end of SFY 2028 to reach Level 2. Level 1 sites are eligible for Operational/ Infrastructure funds ONLY. Level 1 sites are eligible for awards up to $100,000. Level 2 includes State Designated Rural Health Centers who currently serve Medicaid and Medicare patients and meet the 10% Medicaid patient population threshold.  Level 2 sites are eligible for awards up to $250,500. All applicants applying for Level 2 status must have at least 10% Medicaid patient volume and currently billing Medicaid for those services. 

B. Health service delivery site: Primary Care Access Plan (PCAP) and/or Behavioral Health Access Plan (BHAP) –Proposal to provide a comprehensive package of healthcare services to rural uninsured/underinsured residents. These visits are reimbursable at a rate of $115.00 per PCAP encounter to the health center based on medically necessary, face-to-face provider encounters, which includes, but is not limited to the following: on-site x-rays, in-house labs (reimbursable if the organization owns and operates their own lab equipment and the patient labs are completed on site), minor surgical procedures, services performed by practice providers such as prophylaxis (annual physical/check-ups), and telehealth.  For purposes of this grant, a reimbursable telehealth encounter is defined as the use of two-way, real-time interactive audio and video where the healthcare provider and the patient can hear and see each other.

C. BHAP funds are available for behavioral health and mental health counseling services. The visits are reimbursable at a rate of $80.00 per encounter to the health center based on face-to-face behavioral health provider encounters. Eligible providers include but are not limited to licensed clinical social workers, advanced practice registered nurses, psychologists, and psychiatrists.    

D. Quality Improvement - Applicant awardees are required to complete a work plan and identify mutually agreed upon activities for execution with an NC AHEC Practice Support Coach. Awardees should ensure activities prioritize identified operational performance needs, quality of care gaps, HIT optimization (EHR, telehealth, HIE), clinical and administrative workflow redesign, community health worker optimization, behavioral health integration development, etc. where applicable.

Funding preferences: Preference will be given to applicants based on the criteria listed below: 

  • Demonstrate a need for health care services for rural and underserved residents in the community. 
  • Demonstrate capacity to effectively address barriers to care for rural residents and provide quality services. 
  • Demonstrate capacity to provide a healthcare home and link to specialty care, dental, and behavioral health services and to respond to additional needs if/when necessary. 
  • Propose a plan to incorporate rural community and patient feedback into its service delivery approach or quality improvement efforts. 
  • Propose a plan to integrate SDOH screening questions and assist patients with unmet needs using NCCARE360.  
  • Describe the approach to meet the ORH requirements and expectations outlined in the application.

E. Operational/Infrastructure Funds – An organization applying for funds in this category must describe how operating funds will support access to primary care for the population in the service area. The organization must demonstrate the ability to create systems and processes that promote sustainability of the organization being funded or how the funds will supplement the primary care services provided through PCAP and/or BHAP. Level 1 Capacity Building sites are eligible for Operational/ Infrastructure funding only.

Funding preferences: Preference will be given to applicants based on responses to the criteria below: 

  • Propose the creation and implementation of sustainable staff and technological infrastructure that enhances access to health care and improves quality.  
  • Demonstrate capacity to effectively carry out COVID-19, flu and other prevention and response efforts. 
  • Propose an efficient strategy that uses local resources and collaborates with partners to respond to health care gaps in the community, specifically leveraging the use of PCAP and BHAP funds.
  • Propose a plan to blend behavioral health and/or primary care telehealth services fully or partially within the primary care practice involving the use of Community Health Workers or other members of the health care team.

How to Obtain Further Information: Questions regarding the application can be sent to Kim McNeil at kimberly.r.mcneil@dhhs.nc.gov 

Scoring Criteria: Grant awards will be based on the criteria listed below. Failure to fully complete all sections will affect the funding amount, up to disqualification. Applications will be reviewed and scored according to all the following criteria regardless of the funding categories requested. Applications will be funded based on the application score, with the highest scoring applicants receiving all or most of their funding requests.

Organization Overview – 5 Points
Community Need – 20 Points
Improve Access to Care – 25 Points
Community Collaboration – 15 Points
Work Plan/Performance Measures – 20 Points
Budget – 15 Points
Total Points Awarded - 100 Points

Access electronic version of application.

Applicants are required to include the following attachments:

  • Organizational Chart and description of Quality Improvement (QI) Team. The QI Team is group of health professionals working collaboratively to improve patient care, safety and operational efficiency. This team could consist of clinicians, administrators, and specialists.
  • Proof or copy of sliding fee scale currently in use by the applicant organization
  • Budget Template (Note: this will be a separate Excel attachment with multiple tabs)
    • Purchases for equipment over $500.00 are considered Capital expenses and should not be included in this RFA.
  • Annual Provider Certification Documents
  • Capacity building sites transitioning to SDRHC status are required to include the following attachments as well: 
    • Documentation of a completed Medicaid application and Provider enrollment before RFA submission is acceptable. 
  • EHR patient panel report by Insurance (report should not include PHI)
  • Proof of eProcurement registration: Vendor Search eVP (nc.gov)
  • Am I Rural Tool – Attach proof of rural status

Documents

Budget Template

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