North Dakota Rural Health Transformation Program
A five-year, statewide strategy to:
- Strengthen rural health care
- Make ND the healthiest state in the nation
Our commitment
We are taking bold, practical steps to improve the health and well-being of North Dakotans. Our goal is simple – healthier people, stronger communities and a rural health system built to last.
More than 1 in 4 North Dakota adults report no physical activity in the past month.
More than 1 in 3 adults in North Dakota are obese, a major risk factor for heart disease, diabetes and chronic conditions.
More than 1 in 3 adults in North Dakota have high blood pressure.
Nearly 18% of North Dakota high school students considered attempting suicide.
Explore grant funding opportunities to help make North Dakota the healthiest state in the nation
More than 1 million people in the U.S. die each year from cardiovascular disease and diabetes — conditions largely linked to preventable risk factors.
Never smoking, physical activity, healthy weight and healthy diet appear to lower the risk of developing major chronic diseases by about 80%.
Strong social connections are associated with up to a 30% lower risk of major cardiovascular diseases.
Lead Agency: North Dakota Health and Human Services | Total Investment & Timeline: $199 million for 2026
Why this matters
North Dakota’s rural health system is under growing strain. Workforce shortages, financially fragile facilities, widening outcome gaps for tribal and frontier communities and fragmented technology threaten access to care close to home. Plus, people in rural areas often experience higher rates of chronic diseases.
The Rural Health Transformation Program (RHTP) is North Dakota’s comprehensive, statewide roadmap to stabilize today’s system, build a more sustainable, modern rural health future and prevent diabetes, heart disease and stroke and other chronic diseases. Through four key initiatives, the program focuses on long-term solutions to help make North Dakota the healthiest state in the nation.
Timeline
- Submission deadline November 5. ND HHS submitted November 3.
- ND HHS Provider Readiness Survey November 2025
- Awardee decisions by December 31
- Anticipated release of subawards opportunities January 2026
- All awards will require an agreement between HHS and the entity awarded funds.
- Award process will include a mechanism to ensure funding is prioritized relative to impact to communities in need and/or tribal and rural/frontier communities. HHS intends to limit administrative burden on applying for awards. All awards will require reporting and monitoring in compliance with federal guidance. Subawards will be released on a rolling basis.
What we’re working to achieve
Rebuild and retain a rural health workforce
- Increase rural provider retention
- Reduce health professional shortages
- Expand remote monitoring and AI-assisted care
Prevent chronic disease, restore health and reduce costs
- Increase physical activity and reduce obesity
- Reduce chronic disease
- Prevent depression, anxiety and suicide
Bring high-quality care closer to home
- Expand telehealth and remote monitoring use
- Increase access to preventive services and screenings
- Improve timeliness of care
Gain efficiency with modern technology and data
- Modernize and connect health data systems
- Increase transparency
- Create savings through shared infrastructure and cooperative purchasing
How North Dakota will use the funds
Strengthen and stabilize rural health workforce
- New rural residencies and training programs
- Grow-your-own workforce pipelines
- Recruitment and retention grants
- Training to help providers work at the top of their license
Make North Dakota healthy again
- Launch Eat Well ND and ND Moves Together
- Expand evidence-based nutrition, physical activity and behavioral health strategies
- Align care models and payment approaches to sustain long-term health improvements
Bring high-quality health care closer to home
- Expand telehealth hubs, mobile clinics and remote patient monitoring
- Reduce reliance on scarce physical workforce
- Improve care coordination and timeliness
- Support sustainability by diversifying revenue sources and right-sizing care delivery models
Connect technology, data and providers for a stronger ND
- Modernize health technology infrastructure
- Improve secure data sharing
- Support shared systems that reduce costs and improve care
Background Information
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 to Interim Rural Health Transformation Committee - Oct. 21, 2025
Presentation to Interim Rural Health Transformation Committee - Oct. 14-15, 2025
Presentation on Rural Health Transformation Program to Budget Section - Sept. 24, 2025