Rural Health Transformation Program
North Carolina’s Rural Health Transformation Program (NCRHTP) is a statewide initiative, supported by over $213 million in federal funding in year 1 from the U.S. Centers for Medicare and Medicaid Services (CMS), designed to address longstanding challenges in rural health care access and delivery.
Why This Matters
North Carolina has the second-largest rural population in the U.S., with more than 3 million residents living in rural areas. This program reflects NCDHHS’ 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 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 program 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.
NCRHTP focuses on six interconnected initiatives:
- 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, improving health information sharing, and ensuring digital literacy for all residents
Partnerships Across Sectors
The North Carolina Rural Health Transformation Program is guided by a statewide steering committee including NCDHHS’ Office of Rural Health and divisions of Medicaid, Public Health, and Mental Health and Substance Use Services, working in partnership with the North Carolina Governor’s Office and numerous community partners. The NC Rural Health Transformation Program Advisory Committee, comprised of more than 40 representatives from across sectors, also guides how the program is designed and implemented for our rural communities.
Next Steps and Timeline
The department is committed to transparency throughout NC’s Rural Health Transformation Program and will provide regular public updates, community forums and opportunities for ongoing input and engagement.
Community members and partners are encouraged to connect with their regional NC ROOTS Hub Lead for additional ways to get involved. Future funding opportunities will be available on the NC Rural Health Transformation Program Grant Opportunities webpage. To view past NCRHTP webinars and virtual events, visit the NCDHHS YouTube channel.
Latest News
- Press Release: NCDHHS Announces NCRHTP Advisory Committee Membership
- Press Release: NCDHHS, NCDIT Announce Three Programs to Improve Health Care as Part of North Carolina’s Rural Health Transformation Program
- Press Release: NCDHHS Announces $10 Million for EMS Workforce Through NC Rural Health Transformation Program
- Press Release: NCDHHS Selects NC ROOTS Hub Leads to Strengthen Rural Health Care Across North Carolina
- Press Release: NCDHHS Announces NC Rural Health Transformation Program Director
- Press Release: Governor Stein, NCDHHS to Host Virtual Town Hall On North Carolina’s Rural Health Transformation Program
- Press Release: North Carolina Awarded $213 Million for Rural Health Transformation Program; Strategic roadmap and federal investment to improve health in rural communities
- Press Release: North Carolina Applies for $200 Million from Rural Health Transformation Program
By the Numbers
- More than 3 million rural North Carolinians served across 85 counties
- At least $200 million annually 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
The federal Rural Health Transformation Program 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 provides 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 $200 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:
Key Resources
Stevens Amendment Disclosure: This webpage is supported by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $213,008,356.47 with 100% funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS, or the U.S. Government.