NC Rural Health Transformation Program Frequently Asked Questions

NC RHTP is a proposed statewide program led by NCDHHS to transform rural health care delivery, improve health outcomes, and ensure sustainable access to care for nearly 3 million rural North Carolinians across 85 counties. 

RHTP is part of H.R. 1 federal legislation. Under the program, states apply for financial allotments to improve the access/quality of care of services in rural areas, such as through enhanced technology, strategic partnerships, and workforce training.  The application was due November 5, 2025 to the Centers for Medicare & Medicaid Services (CMS). The CMS must approve or deny applications by December 31, 2025; states that receive approval do not need to reapply each year. Governors designate a “lead entity” to submit application. NCDHHS the designee for NC. 

North Carolina has the second-largest rural population in the U.S. Rural communities face persistent challenges—provider shortages, hospital closures, chronic disease, and health disparities—that require bold, coordinated action. 

1.    Catalyze innovative care models 
2.    Transform the rural care experience 
3.    Create a sustainable rural delivery system 
 

1. North Carolina Rural Organizations Orchestrating Transformation for Sustainability (“NC ROOTS”) Hubs: Locally governed, community-tailored networks connecting medical, behavioral, and social supports.
2. Expanded Primary Care & Prevention: Improve access to primary care, chronic disease management, maternal health, and nutrition.
3. Behavioral Health & Substance Use Disorder Services: Expand and integrate mental health and substance use services, including crisis response and school-based care.
4. Workforce Development: Invest in rural training centers, fellowships, and certification programs to recruit, train, and retain clinicians and allied health professionals.
5. Value-Based Payment Models: Build capacity for rural hospitals and providers to participate in advanced payment models for financial sustainability.
6. Digital Health & Technology: Increase health information exchange, digital literacy, and adoption of AI-based and other technology for providers and patients 

Initiatives selection was informed by robust stakeholder engagement, which included the review of over 400 inputs from the public, a townhall event with more than 600 attendees, and multiple targeted community conversations, and legislative engagements. Initiative selection was further informed by federal funding priorities, potential for sustainability, and evidence of what works in rural North Carolina. The selection reflects public input on local needs, federal priorities, and proven NC models. 

Some organizations were highlighted as illustrative examples, for their leadership in rural health innovation, readiness to scale impact, and partnerships with NC DHHS.

NC Rural Organizations Orchestrating Transformation for Sustainability “ROOTS” Hubs are regional networks that coordinate care, deploy tailored initiatives, and serve as anchors for other program activities. Each Hub is responsible for implementing projects in primary care, behavioral health, workforce, value-based payment, and digital health. Critically, each ROOTS Hub is locally-governed and community-tailored, responsible for coordinating and implementing the program’s initiatives to meet local needs. 

By expanding primary care clinics, mobile health units, telehealth, and care coordination, especially in counties with provider shortages or recent hospital closures. 

The program will expand Certified Community Behavioral Health Clinics (CCBHCs), launch crisis centers, mobile outreach, and school-based health centers, and increase access to opioid treatment and mental health services. 

Through new rural residencies, fellowships, simulation labs, interprofessional training, high school-to-job pipelines, and incentives for rural service commitments. 

NC RHTP invests in telehealth, expanding health information exchange, AI-powered tools, and digital literacy programs to modernize rural care delivery and improve access. 

The program will pilot capitation and value-based payment models for rural primary care and hospitals, helping providers focus on outcomes, quality and financial sustainability. 

Metrics include increased access to care, reduced chronic disease burden, improved maternal and child health, expanded behavioral health services, workforce retention, and digital health adoption. Each initiative has specific targets and timelines. 

Stakeholders provided input through surveys, town halls, listening sessions, and direct engagement. Their feedback shaped every aspect of the application, from initiative selection to implementation strategies. 

If awarded, NC DHHS is committed to maintaining and expanding stakeholder involvement as part of NC RHTP. As the Department works to rapidly and effectively implement the initiatives outlined in the application, the intent is to do so in a manner which consistently centers the perspectives of those in rural North Carolina.  
 

Visit the NCDHHS Rural Health Transformation Program page for updates, documents, and contact information. Community members will be asked to participate in ongoing engagement opportunities and advisory forums to help shape program implementation. 

North Carolina’s application is seeking a minimum of $200 million annually, per CMS guidance, in federal funding over five years to transform healthcare delivery across 85 of North Carolina's 100 counties. Final funding awards will be determined by the state’s federal partners at CMS.  

North Carolina has not yet been awarded funding for NC RHTP. The state’s federal partners at Centers for Medicare and Medicaid Services, CMS, are reviewing applications from across the country.

We will post information about how to apply for NC RHTP funding on the NC DHHS RHTP webpage.  

NCDHHS used the broadest federal definition available to maximize eligibility for the Rural Health Transformation Program (RHTP). Specifically:

“North Carolina defines ‘rural’ using the Health Resources and Services Administration’s (HRSA) Rural Health Grants Eligibility Analyzer and the Federal Office of Rural Health Policy (FORHP) designations. For the purposes of this application, these include counties of at least one census tract designated as rural.”

— NCRHTP Project Narrative, Section A: Rural Health Needs and Target Population

This definition of rural pertains to where the program is intending to have impact--counties with at least one rural census tract. The goal was to maximize the number of counties and rural communities eligible to benefit from NCRHTP initiatives.  

As a result, 85 of North Carolina’s 100 counties were designated as rural for the purposes of the NCRHTP. Organizations serving these counties, but located outside of them, will also be crucial in the implementation of the RHTP.  

Critically, the scope, timing, and reach of NCRHTP are dependent on the level of funding awarded by CMS, which is still under review. Implementation will be contingent on the final award amount and terms. NCDHHS will provide updates once CMS has completed its evaluation and issued a funding decision. 

Yes, if they serve rural populations. RHTP’s intended impact is focused on the designated rural counties, but institutions and providers located outside those counties may still be eligible to participate if they deliver services to rural residents.

For example, an independent provider based in a non-rural county may qualify to participate in NCRHTP if they regularly serve patients from surrounding rural counties. Similarly, statewide organizations, such as academic institutions, health systems, or community-based organizations, may receive funding or play implementation roles if their work supports the goals of the RHTP and benefits rural communities.

The NCRHTP is designed to transform health outcomes in rural North Carolina. These activities may have spillover benefits for communities across North Carolina. However, funding, technical assistance, and implementation strategies are structured to prioritize benefits to rural populations. This ensures the program remains focused on addressing the root causes of disease and access challenges that disproportionately affect rural communities. Ultimately, the scope, timing, and reach of NCRHTP are dependent on the level of funding awarded by CMS, which is still under review. 

•    Application submitted: November 2025 
•    CMS award decisions expected: December 2025 
•    Implementation begins: Early 2026 
•    Program duration: 5 years (through 2031)