State Designated Rural Health Center Request for Applications

RFA TITLE: State Designated Rural Health Centers Support Grants 
FUNDING AGENCY NAME: North Carolina Office of Rural Health (NC ORH) 
FUNDING AGENCY ADDRESS: 311 Ashe Avenue, Raleigh, NC 27603 
RFA OPENS: February 21, 2022 
RFA DEADLINE: March 21, 2022, 5:00 p.m. 
RFA TECHNICAL ASSISTANCE WEBINAR: March 1, 2022, 11:30 a.m. – 12:30 p.m.
Please contact Beth Blaise at for the recording.

HOW TO OBTAIN FURTHER INFORMATION: Questions regarding the application can be sent to Beth Blaise at (919) 801-1642 or you may reach out to your regional operations specialist member based on the appropriate Medicaid Region. Map of Regions.

Kim McNeil, Rural Health Operations Specialist - Regions 4 & 6  

Beth Blaise, Rural Health Operations Specialist - Regions 3 & 5   

Caroline Collier, Rural Health Operations Specialist - Regions 1 & 2   

Dorothea Brock, Program Manager


NC ORH assists underserved communities and populations with developing innovative strategies for improving access, quality, and cost-effectiveness of health care.  Distribution of primary care providers in North Carolina has historically been skewed toward cities and larger towns.  Rural residents, who often face transportation issues, find accessing primary care services difficult.  Through the establishment of State Designated Rural Health Centers (SDRHC), NC ORH partners with local communities to provide funding to improve ability to serve underserved populations who would otherwise be unable to access needed primary care services due to geographic, economic, or other barriers. Thus, SDRHCs have become an integral part of the health care safety net for North Carolina’s rural and underserved residents.  

The primary purpose of the state designation is to support new access points and stabilize current access in care sites that do not already receive support through the Federally Qualified Health Center (FQHC) designation. However, funding is available to support and sustain access to care in rural areas that may face sufficient challenges without the SDRHC funding. Recognizing the need for access to healthcare as the demographics of NC, as well as access points, change (due to FQHC growth and multi-site practice locations) is necessary for incubating and supporting the growth of new access points for health care in rural NC.

The SDRHC Guide is available as a resource for more detailed information about NC ORH’s work to increase access to quality care in rural and underserved communities. The Guide outlines the process for receiving State Designation as Rural Health Center and the activities the funds support. Link to guide.


NC ORH is accepting applications for continuing and new SDRHCs. The purpose of grants awarded under this program is to support SDRHCs. 
These grant funds, supported through the North Carolina General Assembly, are for assuring access to primary and preventive care to meet the health needs of rural, underserved and medically indigent patients in North Carolina.  An important component of this work is to stabilize and strengthen the safety net through increased levels of collaboration and integration of services to sustain and meet the needs of those served more effectively. 
The SFY 2023 RFA supports the state mission of improving health, safety and well-being of all North Carolinians while being good stewards of resources. The RFA seeks to develop sustainable models of care as well as address the conditions in which people live that directly impact health, known as “social determinants of health.” The initial focus encourages partnering with community-based organizations to ensure access to transportation, food, housing, and personal violence resources.


New Rural Health Center Applicants:  An organization that is not currently funded through the NC ORH SDRHC grant and seeks to serve an underserved service area and uninsured target population with one or more permanent service delivery site(s).  
The organization may have received funds from other NC ORH programs but not as an SDRHC.      
Rural Health Center Continuing Applicants: NC ORH seeks to continue serving its current service area and target population. Continuing applicants are required to provide details in the application that their site is currently offering primary care services, has an established board of directors, is actively using an identified EHR system, and follows the State of North Carolina requirements. Continuing applicants seeking to serve a different service access point or service area must include justification in the application narrative. This request is subject to approval.

Go here to access the application. 

Grant Funding Descriptions

A. Health service delivery site: Medical Access Plan (MAP) and/or Behavioral Health (BH) – Proposal to provide a comprehensive package of healthcare services to rural uninsured/underinsured residents. These visits are reimbursable at a rate of $100.00 per MAP encounter to the health center based on medically necessary on-site face-to-face provider encounters, as follows: onsite x-rays, in-house labs, surgical procedures, services performed by practice providers, prophylaxis, and telemedicine.  BH funds are available for behavioral health and mental health counseling services. The visits are reimbursable at a rate of $75.00 per encounter to the health center based on on-site face-to-face behavioral health provider encounters. Eligible providers include licensed clinical social workers, advanced practice registered nurses, psychologists, and psychiatrists.    

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

  • Demonstrates a need for increased health care services for rural and underserved residents in their community 
  • Demonstrates capacity to effectively address barriers to care for rural residents and provide quality services 
  • Demonstrates capacity to provide a healthcare home and link to primary, dental, and behavioral health services and to respond to additional needs 
  • Proposes a plan to incorporate rural community and patient feedback into their service delivery approach or quality improvement efforts 
  • Proposes a plan to integrate SDOH screening questions and assist patients with unmet needs utilizing NCCARE360  
  • Describes the capacity to meet the NC ORH requirements and expectations outlined in the application

B. Operating/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 MAP and/or BH.

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

  • Propose the creation and implementation of sustainable staff and technological infrastructure that enhances access to health care and improves quality.  
  • Propose innovative strategies to promote healthcare equity and inclusion 
  • Demonstrates capacity to effectively carry out COVID-19 prevention and response efforts 
  • Proposes an efficient strategy that utilizes local resources and collaborates with other partners to respond to health care gaps in their community 
  • Proposes a plan to blend behavioral health services fully or partially within the primary care practice


Applicants must demonstrate readiness to fulfill the requirements of an SDRHC. Applications must document the need for primary health care services in the service area and propose a comprehensive plan that demonstrates alignment to the NC ORH mission and vision. The plan must ensure the availability and accessibility of primary health care services to all individuals in the service area and target population with collaborative and coordinated delivery systems. Applicants must be providing care within a site physically located in North Carolina.   

As a condition of receiving state funds, the SDRHC agrees to comply with the standards of the NC Division of Controllers Office, NC Office of Budget and Management standards, and NC ORH Operations Program. Link for the detail requirements includes (1) Compliance Standards (Completion of all NC DHHS Contract Approval Forms), (2) Contractual Agreement, and (3) Program Operations.

 Applicants are required to include the following attachments:

  • Submit three (3) letters of support from community partners or stakeholders (encouraged to link to one or more proposed activities)   
  • Submit Copy of Bylaws or documentation of 501c3 status   
  • Submit a weblink to the most recent county or regional community health needs assessment (CHNA)    
  • Provide Organizational Chart and description of Quality Improvement Team 
  • Completed Project Narrative - Narrative Link
  • Complete Budget Template and Narrative - Budget Link
  • Acknowledge and sign the attestation agreement. - Attestation Link


Applicants may apply for multiple funding options within the same application.  For example, an applicant can apply for behavioral health funds and operating/infrastructure funds. The maximum total grant award is dependent upon response to the application, documented need, operating structure, and past performance (for continuing applicants) at each of the sites and is contingent upon funding availability. Grant funds must be used at physical location(s) where primary medical care is provided and may not be used for vehicles or to pay down loans.  Applicant awardees will be awarded for a 1-year period, with the option to renew for a year 2 and must comply with participating in a site visit or desk review within 3 months of the awarded start date. Award notifications are anticipated to be sent by April 15, 2022.

FUNDING CYCLE: The funding cycle is July 1, 2022, through June 30, 2023. All grantees must fully expend grant funds prior to June 30, 2023.   All invoices for completed and projected work must be submitted to NC ORH for reimbursement no later than June 7, 2023.  

SCORING CRITERIA: Grant awards will be based on the following criteria. Failure to fully complete all sections will impact the funding amount, up to disqualification. Applications will be reviewed and scored according to all the following criteria regardless of the funding categories requested.

Overview of the Organization - 5 Points 
Community Need - 20 Points 
Improved Access to Care - 20 Points  
Community Collaboration (e.g., health departments, departments of social services, housing authority, etc.) - 15 Points 
Performance Measures - 15 Points 
Sustainability Model - 10 Points 
Budget - 15 Points 
Total Points Awarded - 100 Points