Rural Health Transformation Program

NCDHHS has submitted its Rural Health Transformation Plan to the Centers for Medicare and Medicaid Services (CMS), seeking $200 million in funding over five years to transform healthcare delivery across 85 of North Carolina's 100 counties. CMS is expected to announce awards by Dec. 31, 2025.

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.

Key Resources 

North Carolinians interested in learning more about the Rural Health Transformation Program are encouraged to check back on this page for the latest updates. For questions or comments, please share your insights and perspectives using the feedback form.

Why This Matters

North Carolina has the second-largest rural population in the U.S., with nearly 3 million residents living in rural areas. This plan reflects NCDHHS’s commitment to ensuring that every North Carolinian, no matter where they live, has access to high-quality healthcare. The North Carolina Rural Health Transformation Program (NCRHTP) emerged from extensive engagement with more than 420 stakeholders across the state, including rural hospitals, community health centers, local health departments, faith-based organizations, Tribal communities and community members.

A Plan Built With, and For, Rural North Carolina

The plan is designed so that every North Carolinian can see the benefit of this work —from farmers in Robeson County to teachers in Madison County, small business owners in Bertie County, and parents in Dare County. It aims to strengthen the healthcare infrastructure that supports individuals, families, and communities across the entire state.

The comprehensive initiative focuses on six interconnected strategies:

  • Community-Rooted Care Networks: Establishing locally governed "NC ROOTS" Hubs that connect medical, behavioral health, and social services, making it easier for rural residents to access comprehensive care close to home
  • Prevention and Chronic Disease Management: Expanding programs for diabetes and hypertension control, cancer screening, maternal health services, and nutrition support, including "food as medicine" initiatives
  • Behavioral Health Expansion: Growing mental health and substance use disorder services through new clinics, mobile crisis teams, school-based programs, and integration with primary care
  • Workforce Development: Training and retaining healthcare professionals through rural residency programs, incentives and innovative career pathways—creating jobs while addressing provider shortages
  • Financial Sustainability: Helping rural practices and hospitals transition to value-based payment models that reward keeping people healthy, not just treating illness
  • Technology and Innovation: Deploying cutting-edge artificial intelligence to support rural providers, expanding broadband access, improving health information sharing, and ensuring digital literacy for all residents

Partnerships Across Sectors

Implementation will be guided by a statewide steering committee including NCDHHS’ Office of Rural Health and divisions of Medicaid, Public Health, and Behavioral Health, working in partnership with university and community college partners, and numerous community partners.

Next Steps and Timeline

NCDHHS anticipates receiving CMS's funding decision by December 31, 2025. If awarded, implementation would begin in early 2026 with continued community engagement to refine and expand programs based on local needs.

The department is committed to transparency throughout implementation, with regular public updates, community forums, and opportunities for ongoing stakeholder input.

By the Numbers

  • Nearly 3 million rural North Carolinians served across 85 counties
  • At least $100 million in federal investment over five years
  • 400+ rural health facilities supported
  • Six integrated initiatives addressing workforce, access, technology, behavioral health, chronic disease, and payment models
  • 420+ stakeholders engaged in application development

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. RHTP provides one-time funding to states to support rural communities in improving health care access, quality and outcomes. The program 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:

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