Rural Health Transformation Program

NCDHHS will apply to receive funding from the federal Rural Health Transformation Program (RHTP) on or before November 5, 2025. The U.S. Centers for Medicaid and Medicare Services released the Notice of Funding Opportunity on Monday, September 15, 2025. CMS is expected to announce awards by December 31, 2025.

Please see the slides and recording of the Rural Health Transformation Program Town Hall held on October 3, 2025.

We want your feedback on North Carolina’s application.

Partners, providers and the public are encouraged to give feedback on what should be considered for North Carolina’s application. As NCDHHS application is due by November 5, 2025, feedback submitted before October 10, 2025, will be used for this application period. Feedback after that date will be used and considered for future updates and modifications as permitted by CMS as the program continues through the next five years.

Partner Feedback 

Once the application is approved, a public notice will be issued to provide details regarding the Program. NCDHHS will have more information related to the funding process in early 2026.

The Vision for Rural Health in North Carolina

NCDHHS envisions a rural North Carolina where every person, regardless of geography or income, has access to affordable, high-quality and culturally responsive care. Our rural communities thrive when care is accessible, infrastructure is modern and connected and services are rooted in the lived experiences of the people they serve.

  • 3.6 million people live in rural North Carolina; the second highest in the country behind Texas.
  • 71 of North Carolina’s 100 counties are considered rural.

We are at critically low levels for providers in rural settings.

  • 94 counties have a health professional shortage.
  • 97 counties have a mental health professional shortage.
  • 93 counties have a dental health provider shortage.

People in rural settings are feeling the impact with lower life-expectancy rates, higher instances of substance use and increases in chronic diseases like heart disease and diabetes.

  • 437,185 people in rural North Carolina have heart disease, 53% higher than people in urban areas with heart disease.
  • 508,855 people in rural North Carolina have diabetes; 29% higher than in urban areas.
  • 1,135,967 people in rural North Carolina suffer from chronic diseases, 16% higher than the number of people who live in urban areas.
  • Rural counties have a higher average incidence rate of overdose deaths than urban counties in North Carolina.

More on RHTP

RHTP is part of H.R. 1, a federal reconciliation bill signed into law in July that includes significant changes to Medicaid. The RHTP provides one-time funding to states to support rural communities in improving health care access, quality and outcomes. The RHTP is a cooperative agreement designed to help states transform rural health care delivery systems by investing in innovation, infrastructure, partnerships and workforce development. It is not a replacement for Medicaid funding, but rather a strategic opportunity to strengthen rural health systems in the face of longstanding challenges.

The first $25 billion from RHTP will be split evenly between all 50 states and will equal about $100 million each year for the next five years for North Carolina. The second $25 billion will be split at CMS' discretion among all 50 states over the next five years.

You can see more about the needs of Rural North Carolina at the following websites:

You can see more about the Rural Health Transformation Program at the following CMS websites:

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