The federal Centers for Medicare & Medicaid Services (CMS) has awarded North Carolina $213 million through the Rural Health Transformation Program (RHTP) to improve health care access in rural communities. North Carolina submitted its application for the 2026 funding with bipartisan support from the state’s congressional delegation and will be eligible for additional funds annually over the next five years. The grant aims to address unique health care challenges faced by the state’s rural population, connecting more residents to high-quality, patient-centered care.
Governor Josh Stein emphasized North Carolina’s leadership in advancing rural health care solutions and highlighted the potential for the program to support innovative approaches that improve health outcomes for rural families. The North Carolina Department of Health and Human Services (NCDHHS) developed the state’s plan through engagement with over 420 stakeholders, including hospitals, community health centers, local health departments, Tribal communities, and faith-based organizations, ensuring that the program addresses the diverse needs of rural residents.
North Carolina has the second-largest rural population in the U.S., representing over five percent of the national rural population. The state’s RHTP outlines six strategies to transform rural health care systems over the next five years. These strategies include creating locally governed NC ROOTS hubs to integrate medical, mental health, and social services, expanding prevention and chronic disease management programs, increasing access to mental health and substance use disorder services, investing in the rural health workforce, supporting the transition to value-based care models, and enhancing health care technology through artificial intelligence and expanded broadband access.
Implementation will involve a coalition of state agencies, community-based organizations, academic institutions, rural providers, and private-sector partners. One innovative initiative under the program is the Rural Health Innovation Fund (RHIF), designed to help rural providers access technology that supports patient care. Once federal funding is received, NCDHHS will establish a statewide governance structure, build regional NC ROOTS hubs, and involve stakeholders in funding decisions to ensure coordinated and sustainable impact.
The RHTP will be guided by a statewide steering committee including NCDHHS divisions of Medicaid, Public Health, and Mental Health, in collaboration with universities, community colleges, health centers, rural clinics, small hospitals, and school-based clinics. NCDHHS plans a virtual event on January 16, 2026, to highlight program goals, statewide impact, and the importance of federal partnerships in addressing root causes of disease. The first-year focus will be expanding the reach of existing efforts while establishing foundations for long-term sustainability.
Over the next five years, the program is expected to improve health care delivery for more than three million rural North Carolinians, support over 400 rural health facilities, and bring hundreds of millions in federal investment to the state. Despite challenges posed by projected federal Medicaid funding losses under H.R. 1, which could reduce nearly $50 billion over 10 years, North Carolina aims to maximize the RHTP funding while continuing to advocate for additional resources to strengthen its rural health care system.
