Here are some frequently asked questions about North Dakota's Rural Health Transformation Program. This page will be updated often.
Funding
How much funding will North Dakota receive?
North Dakota has received approximately $199 million to date for 2026, with an expectation of receiving additional funds each year through 2030. The remaining funds are contingent on meeting required milestones and performance measures established as part of the approval.
The federal law that created the Rural Health Transformation Program required states to submit an application that outlined how they plan to strengthen rural health care and improve the health and well-being of individuals. States were guaranteed to receive at least $100 million per year for 5 years. Additional funding was awarded based on the strength of a state’s application, rural population factors, and policy actions the state commits to take.
Why are we getting these funds?
North Dakota was approved for federal Rural Health Transformation funding because the state faces significant rural health challenges and presented a comprehensive, statewide plan to address them. Workforce shortages, financially fragile rural facilities, health outcome gaps—especially in tribal and frontier communities—and outdated or fragmented technology threaten access to care close to home.
The funding supports North Dakota’s five-year Rural Health Transformation Program, led by North Dakota Health and Human Services, to stabilize the current system and build a stronger, more sustainable rural health future.
What will North Dakota use the funds for?
he funds support a five-year, statewide strategy to strengthen rural health care and help make North Dakota the healthiest state in the nation. Investments focus on long-term system improvements rather than short-term fixes, organized around four key pillars:
1. Strengthen and stabilize rural health workforce
- Expanding rural training and residency programs
- Growing in-state workforce pipelines
- Supporting recruitment and retention
- Helping providers work at the top of their license
2. Preventing chronic disease and improving population health
- Launching Eat Well ND and ND Moves Together
- Expanding evidence-based nutrition, physical activity and behavioral health strategies
- Aligning care models and payment approaches to support lasting health improvements
3. Bringing high-quality health care closer to home
- Expanding telehealth, mobile clinics and remote patient monitoring
- Improving access to preventive services and screenings
- Reducing delays in care and reliance on scarce physical workforce
4. Connect technology, data and providers for a stronger ND
- Connecting and upgrading health data systems
- Improving transparency and care coordination
- Creating efficiencies and savings through shared infrastructure
Is this new funding or a continuation of previous federal funding?
This is new, transformational funding, not simply a continuation of existing federal programs. While it builds on prior experience and infrastructure, the Rural Health Transformation Program has new goals, accountability measures and performance requirements tied to long-term system change.
Funding Eligibility and Criteria
What happens if we don’t meet the criteria?
The funding is milestone- and performance-based. If required benchmarks are not met, North Dakota may not receive future portions of the approved funding. This structure ensures accountability and that federal dollars are tied to measurable progress in strengthening rural health care.
How soon do we need to meet the criteria?
In the first year of the program, the $199 million in grant funding must be obligated to approved projects by Oct. 30, 2026, with all funds spent by Sept. 30, 2027.
Rationale
Why does this matter now?
North Dakota’s rural health system is under growing strain. More than one in three adults in the state are obese, more than one in four report no physical activity in the past month, and more than one in three have high blood pressure—risk factors that contribute to chronic disease and rising health care costs. This program focuses on prevention, access and sustainability so people can get high-quality care close to home and communities can remain strong for generations to come.
Where can the public learn more?
Information about the Rural Health Transformation Program and available grants can be found on the Rural Health Transformation Program webpage.