Rural Workforce Retention for Critical Access Hospitals and Their Owned and Operated Clinics

Funding Opportunity

Funding Opportunity 

his Rural Workforce Retention funding opportunity provides retention grants to support a variety of disciplines and strategies within critical access hospitals and their owned or operated clinics. The goal is to strengthen and stabilize rural practice environments, ultimately improving access to care in rural communities.

This opportunity supports North Dakota’s rural workforce by offering retention grants designed to make rural practice more sustainable for existing practitioners. It aligns with the Strengthen and Stabilize Rural Health Care Workforce Initiative under North Dakota’s RHTP. Administrative costs, capital expenditures, and vehicle purchases are not allowed under this funding opportunity. Eligible workforce retention projects include, but are not limited to:

Employee Incentive and Support Strategies

  • Retention bonuses*
  • Tuition reimbursement*, education awards* (loan repayment not allowed),  and support for upskilling or career pathway development (e.g., CNA→LPN→RN, MA→LPN, administrative to clinical pathways including Community Health Workers)* 
  • Preceptor or mentorship stipends (includes the five-year service commitment if this leads to a certification or licensure*)
  • Transportation and housing supports for staff who travel long distances or face weather-related commute challenges*
  • Employee engagement and organization culture measurement tool

Child Care Support 

  • Child care partnerships, including reserved child care slots, subsidized child care* or on-site child care expansion (does not include establishing new on-site child care; this will be addressed in a separate funding opportunity)

Wellness, Resilience and Burnout Prevention

  • Workplace wellness programs and staff recognition programs
  • Activities that support resilience, reduce burnout and strengthen a positive workplace culture, including confidential counseling access, critical‑incident debriefing, peer support teams, etc.
  • Partnerships with gyms, parks departments, community centers or schools to provide affordable family access to healthy activities
  • Structured stay interview programs or tools aimed at identifying burnout or turnover risks early 

Flexible Scheduling and Innovative Staffing Models

  • Technology or workflow solutions that assist in administrative efficiency, such as improved scheduling tools or documentation support technologies

Education, Training and Professional Development 

  • Leadership development and cross-training programs
  • Continuing education (including CMEs and CEUs for nursing and other disciplines)
  • Licensure fees and renewal costs
  • Tuition Reimbursement as described in Employee Incentive and Support Strategies*

Shared Learning, Mentorship and Professional Support Networks

  • Shared decision-making councils or staff engagement committees
  • Mentorship programs, clinical supervision partnerships or structured on-going evaluations designed to improve job satisfaction and support a positive work environment
  • Telementoring and virtual professional development opportunities, including teleconsults, virtual grand rounds and rural collaborative learning networks

*Note: Per federal grant guidance, financial incentives are tied to a minimum five‑year service commitment. As part of the application review, the Department will determine whether any additional applicant‑proposed strategies are subject to the federal five‑year service commitment requirement and will notify the applicant accordingly. 
Staff receiving a financial incentive must be employed and on the payroll at the time this funding application was posted. 

On-site child care incurs a five-year service commitment if offered at free or reduced cost to the individual. If funds are being used to expand on-site child care and the fees are charged to the individual, then no commitment applies. 

Refer to the Project Narrative and Action Plan under Application Requirements for additional details on the five‑year service commitment and to the Budget section for information on allowable and unallowable costs.

Additionally, this funding opportunity aims to support improvement in metrics identified for the Strengthen and Stabilize Rural Health Care Workforce Initiative found on pages 52-53 of the project narrative and pages 10-11 of the appendices:

  • Increase the rural provider retention rate at 3 and 5 years 
  • Expand remote monitoring and AI-assisted care to reduce staffing needs 
  • Reduce Health Professional Shortage Area (HPSA) counties
  • Increase the rural primary care provider retention rate

Eligibility

Critical Access Hospitals that include their owned and operated clinics.

Note: Additional funding opportunities will be announced in mid-2026 and will include additional eligibility sites and recruitment efforts.  

Funding 

This is an application process for Year One of RHTP funding. An application process for rural and tribal health care workforce recruitment and retention efforts, including additional eligible site types, will be released in mid-2026. Additional funding opportunities will be offered in future years of the program.

The funding period will begin once the agreement has been fully executed, following all required approvals and signatures. It will end on September 30, 2027, and all funds must be fully expended by that date.

Approximately $10,000,000 in federal funding is available in Year One for Critical Access Hospitals and their owned and operated clinics to support rural health care workforce retention efforts. An estimated 37 awards of approximately $270,000 each are expected to be made in Year One. Applicants may submit a prioritized funding proposal and requested amounts may exceed $270,000. Activities not funded in the initial awards may be considered later in the year pending a review of available funds in August 2026. Refer to Project Narrative, Action Plan and Budget Sections under Application Requirements for additional detail.

HHS reserves the right to negotiate the applicant’s budget based on the number of applications received, the content of the proposed project work plan, and total budget requested by the Critical Access Hospitals and their owned and operated clinics for this rural health care workforce retention funding opportunity, prior to issuing the notice of award.

Refer to the Budget section under Application Requirements for details on allowable and unallowable costs.

Additional funding opportunities will be available for other RHTP activities and initiatives will be posted on the RHTP webpage (see Funding Opportunities). Eligible applicants may apply for more than one funding opportunity – there is no limit to the number of applications that can be submitted.

Reporting Requirements 

The successful applicant(s) will be required to submit reimbursement requests or supporting information, progress reports and impact stories to HHS. Templates will be provided for reporting requirements. Due dates and additional information will be provided in the agreement.

Successful applicants may be required to report for up to five years or as otherwise required by CMS.

Additional reporting requirements may be required based upon updated federal guidance. 

Application Submission 

Applications for this funding announcement are due by April 30, 2026, 5:00 p.m. CT. Applications must be submitted to HHS through Qualtrics at: HYPERLINK.

Applications not received by the submission date and time will be considered non-responsive and not reviewed.

Technical Assistance 

A technical assistance conference call has been scheduled for the following date/time:

  • March 30, 2026, at 3:00 p.m. CT

The link to join the technical assistance call will be posted on the RHTP webpage under Funding Opportunities – Strengthen and Stabilize Rural Health workforce.

The technical assistance call will be recorded and posted on the RHTP webpage for future viewing. 

Resources pertaining to this funding announcement (e.g., Frequently Asked Questions, example five-year service agreements) will be published on the RHTP webpage after the technical assistance call.

Contact rhtp@nd.gov with questions. Please identify the funding opportunity name and number in the subject line.

Application Requirements 

Interested entities are required to submit an application to be considered for the Rural Workforce Retention funding opportunity for Critical Care Access Hospitals and their owned and operated clinics. Do not include any proprietary or confidential information in application materials as the application will become an open record.

Below is the outline and related details for the application. All application components will be submitted through Qualtrics. Add Qualtrics link

  1. Background Information

  2. Project Narrative

a. Identified Need and Proposed Goals
Strategies, Activities, and Measurable Outcomes
Action Plan
Timeline and Milestones
Metrics
Key Personnel and external sources, such as consultants
Budget
 

Background Information 

Provide the following background information: 

  1. Organization Name and Background – Provide the name of your Critical Access Hospital, noting its location and the owned or operated clinics it includes and the estimated population served.
  2. Project Lead and Contact Information – Identify the project lead who will serve as the primary point of contact to receive communications about your application. Provide first and last name, title, phone number and email. 
  3. Project title and brief description of why you’re applying. 

Project Narrative 

The project narrative must clearly address the identified need and the planned strategies, services, tasks, or activities. Be as specific and concise as possible, keeping the narrative focused on how the project will strengthen rural health workforce retention.

Identified Need and Proposed Goals

Identify the need for the proposed project 
 

  • Discuss the workforce challenges and retention issues your organization aims to address through the proposed project (e.g., staff turnover, vacancy rates, burnout, childcare barriers, staffing shortages, gaps in training and professional development). When available, include relevant local data to demonstrate the scope and urgency of the need
    Describe the specific retention issues impacting your Critical Access Hospital and its owned or operated clinics.
    Outline the overarching goals of your proposed project and the workforce groups who will benefit (e.g., medical and nursing staff, allied health professionals such as behavioral health specialist, radiology technician, respiratory therapist, laboratory technician, physical therapist, occupational therapist, dietitians, etc.).
    Goals should describe the broad, high‑level change your organization seeks to achieve (e.g., Strengthen workforce stability by improving retention among nursing staff and allied health professionals through initiatives that support long‑term engagement and reduce turnover; Enhance workplace well‑being by strengthening support systems for medical staff, nursing teams, and allied health professionals, fostering a more resilient and engaged rural health workforce.). 
    Identify any similar projects being implemented and their funding sources. Explain how your proposed project will enhance, rather than duplicate, existing efforts, including how you plan to coordinate with partners to prevent duplication. If requesting funds for an expansion, describe why the expansion is needed and how the new funds will support additional efforts.    
    RHTP funds cannot be used to duplicate or replace existing funding, known as supplanting. RHTP funds may be used to expand or enhance an existing project. See the Budget section for additional details.
     

Action Plan 

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Budget 

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Application Review and Selection

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Questions