Overview
The One Big Beautiful Bill Act (Section 71401) creates a new Rural Health Transformation grants program administered by the Centers for Medicare and Medicaid Services (CMS), allocating $50 billion nationwide from federal fiscal years 2026 through 2030 — $10 billion annually. Funds will flow through states, which must submit a Rural Health Transformation Plan to CMS by Dec. 31, 2025, to access and manage these resources.
North Dakota is expected to receive approximately $100 million per year, totaling $500 million over five years, to improve rural health care access, quality, and sustainability.
What is the Rural Health Transformation Plan?
States must submit a one-time application to CMS, including a plan that outlines how the state will:
Improve access to hospitals, providers, and health care services for rural residents
Enhance health outcomes for rural communities
Use emerging technologies focused on prevention and chronic disease management
Strengthen partnerships between rural hospitals and providers to improve quality and financial stability
Support recruitment and training of rural health care clinicians
Prioritize data-driven solutions and technology to deliver high-quality care close to home
Address financial solvency and operating models of rural hospitals
Identify causes driving hospital closures, conversions, or service reductions
Eligible Activities
States must fund at least three or more designated activities.
Evidence-based prevention and chronic disease management interventions
Payments to providers for specified services
Consumer-facing technology solutions for chronic disease management
Training on advanced tech such as remote monitoring, AI, and robotics
Recruiting and retaining rural clinical workforce with service commitments
IT upgrades improving efficiency, cybersecurity, and outcomes
Helping communities optimize health care delivery systems
Expanding opioid use disorder, substance use, and mental health services
Innovative care models including value-based care and alternative payments
Other CMS-approved activities to ensure sustainable rural health care
North Dakota’s Outreach and Engagement
HHS is engaging with stakeholders to help shape North Dakota’s Rural Health Transformation Program. A month-long public survey was launched on Aug. 13, followed by three listening sessions scheduled in October to share survey results and gather more input. The state’s application must be submitted by Nov. 5, 2025, to the Centers for Medicare and Medicaid Services (CMS) with awards announced by Dec. 31, 2025. States will partner with CMS to ensure strong oversight and lasting impact.
Resources
Rural Health Transformation Program - Centers for Medicare and Medicaid Services
Rural Health Transformation Program grant opportunity - Grants.gov
Presentation on Rural Health Transformation Program to Budget Section - Sept. 24, 2025
Resources from Listening Sessions
Listening session presentation
Strengthen and Stabilize Rural Health Workforce Survey Form
Make ND Healthy Again Survey Form
Bring High-Quality Health Care Closer to Home Survey Form
Connect Tech and Data for a Stronger ND Survey Form
Contact Us
Email: rhtp@nd.gov
Page last updated: Oct. 10, 2025