The North Carolina Department of Health and Human Services (NCDHHS) earlier this month submitted its Rural Health Transformation Plan to the Centers for Medicare & Medicaid Services (CMS). The plan demonstrates how the state could use $200 million in federal funding annually over five years to improve health across 85 of North Carolina’s 100 counties. CMS is expected to announce funding decisions by December 31, 2025.
North Carolina’s Rural Health Transformation Program application is designed to ensure that every North Carolinian, regardless of where they live, has access to high-quality, affordable health care. NCDHHS developed the plan through extensive engagement with more than 420 stakeholders, including rural hospitals, community health centers, local health departments, Tribal communities, faith-based organizations, and residents.
"Our plan reflects North Carolina’s commitment to ensuring that every North Carolinian, no matter where they live, has access to high-quality health care," said Governor Josh Stein. "North Carolina is on the cutting edge of technology and innovation, and our application for the Rural Health Transformation Program shows that we’re ready to continue our leadership in rural health care. Let's keep people healthy and ensure our rural communities remain vibrant. I also want to thank the bipartisan partners who helped develop this plan and will help carry it out."
"Rural health care providers are the backbone of their communities, working tirelessly to ensure people have access to care when and where they need it," said NC Health and Human Services Secretary Dev Sangvai. "North Carolina is a leader in prioritizing rural health and remains committed to investing in rural health care and the rural health workforce. The North Carolina Rural Health Transformation Plan is one part of our efforts to support the more than 3 million people in North Carolina who live in a rural community."
North Carolina has the second-largest rural population in the country behind Texas and faces unique obstacles, such as workforce demands.
North Carolina’s Rural Health Transformation Plan outlines six key strategies to transform rural health care systems. These include:
- Launching a locally governed “NC ROOTS” Hub to connect medical, mental health, and social supports
- Expanding prevention, chronic disease management, and nutrition programs
- Increasing access to mental health services, including substance use disorder treatment
- Investing in the rural health care workforce
- Supporting rural providers in transitioning to value-based care models
- Enhancing technology in health care
These initiatives will be implemented through a broad coalition of state agencies, community-based organizations, academic institutions, rural providers, and private-sector partners. As an example of innovation and collaboration, the application outlines creation of the Rural Health Infrastructure Fund (RHIF) that will help rural health care providers get access to technology that will support their practices.
On November 21, NCDHHS staff will brief members of North Carolina’s congressional delegation, as well as members of the NC General Assembly, on the Rural Health Transformation Plan, highlighting the program’s goals, the program’s statewide impact, and the importance of federal partnership in addressing root causes of disease.
NCDHHS continues to work with CMS regarding the NC plan and expects a notice of approval by December 31. The program will begin in early 2026. A public notice will be issued following CMS approval, and additional details about the funding process will be shared in early 2026. The program will be guided by a statewide steering committee, including NCDHHS’s Office of Rural Health and divisions of Medicaid, Public Health, and Mental Health, in collaboration with universities, community colleges, Community Health Centers, Rural Health Clinics, small rural hospitals, school-based clinics, and local partners.
The program will improve health and care delivery for nearly 3 million rural North Carolinians, support more than 400 rural health facilities, and bring an anticipated $200 million a year in federal investment to the state over five years. North Carolinians are encouraged to learn more about the Rural Health Transformation Program by visiting www.ncdhhs.gov/rhtp.