Build Rural Community Care Network Hubs (NC ROOTS)
Locally governed regional hubs, one lead per Medicaid region, that connect medical, behavioral health and social services and fund local projects.
RHTP state profile · North Carolina
North Carolina Rural Health Transformation Program
North Carolina received $213.0 million in Year 1 of the $50 billion federal Rural Health Transformation Program, 10th of 50 states. The North Carolina Department of Health and Human Services (NCDHHS) runs the program, which funds six initiatives across 85 of the state's 100 counties that have rural areas, from regional NC ROOTS Hubs and behavioral health to workforce and digital health.
Year 1 awards, all 50 statesNC: $213.0M
Texas $281.3MNew Jersey $147.3M
$213.0MYear 1 award, 10th of 50
6Funded initiatives
85 / 100North Carolina counties are rural
NCDHHSNorth Carolina Department of Health and Human Services
Spending data in the RHTP Year One Report covers December 29, 2025 to July 31, 2026, the latest CMS reporting window.
At a glance
North Carolina's program at a glance
The award is fixed for the year. Spending moves every quarter, so North Carolina's section of the RHTP Year One Report tracks how much was put to work, and with whom, through July 31, 2026. It updates after each CMS data release.
Year 1 award$213,008,356, 10th of 50 states
Run byNorth Carolina Department of Health and Human Services
Budget Period 1December 29, 2025 to October 30, 2026
Initiatives6
Rural counties85 of 100
Spending data through July 31, 2026North Carolina's section of the Year One Report →Initiatives
What does North Carolina's RHTP fund?
North Carolina's RHTP funds six initiatives across regional care hubs, prevention and chronic disease, behavioral health, workforce, value-based payment and digital health. The largest share of the five-year plan goes to the NC ROOTS Hubs, and every NCDHHS funding opportunity maps to one of the six.
Create Models and Capacity for Expanded Primary Care, Prevention, and Chronic Disease Management
Scales proven programs for primary care access, food as medicine, diabetes and hypertension control, cancer screening and maternal health.
Expand and Integrate Behavioral Health and Substance Use Disorder Services
Grows Certified Community Behavioral Health Clinics, mobile crisis and opioid treatment, school-based services and integration with primary care.
Build a Robust and Resilient Workforce and Innovative Care Team Models for Rural Communities
Rural training, residencies, fellowships, certifications and incentives to recruit and retain clinicians, EMS staff and community health workers.
Ensure Fiscal Sustainability of Rural Health Providers Through Innovative Financial Models
Helps rural practices and hospitals build the capacity to join value-based payment models.
Modernize Rural Care Delivery Through Digital Forward Solutions
Health information exchange connections through NC HealthConnex, digital health help through NC 211, AI tools for providers and the Rural Health Innovation Fund.
Recipients by initiative are in North Carolina's section of the RHTP Year One Report.
Source documents
North Carolina's full plan is public
The approved plan has more detail than any summary: goals, partners, metrics and timelines for each initiative. Read it before responding to a North Carolina funding opportunity.
PDFNCDHHSNorth Carolina RHT Program Project NarrativeThe full plan NCDHHS submitted to CMS in November 2025, including all six initiatives, the list of 85 rural counties and North Carolina's policy commitments.PDFNCDHHSNorth Carolina RHT Program Project SummaryNCDHHS's short abstract of the five-year plan.PDFNCDHHSNorth Carolina RHT Year One Report Executive SummaryNCDHHS's summary of Year 1 progress, released September 2026.PDFCMSCMS State Project AbstractsEach state's own summary, side by side.
Rural county (85)Other counties (15)
Eligibility
Which North Carolina counties are eligible for RHTP funding?
North Carolina's plan treats 85 of the state's 100 counties as rural: any county with at least one census tract the federal Office of Rural Health Policy designates as rural, home to nearly 3 million rural residents. Organizations don't have to be based in a rural county to take part, but their work must serve rural residents, and each funding opportunity states its own eligibility rules. The six NC ROOTS Hub regions together cover all 100 counties.
How to apply
How can North Carolina providers apply for RHTP funding?
North Carolina providers apply through NCDHHS requests for applications (RFAs), posted on its RHTP Grant Opportunities page, and through local funding rounds run by the regional NC ROOTS Hub Leads. Most Year 1 rounds have closed. Rural Health Innovation Fund applications are due December 7, 2026, for providers that completed the readiness intake by October 31. Providers and vendors don't apply to CMS directly.
- Match the work to an initiative.Funding only goes to work that fits one of the six, and it must benefit rural North Carolinians.
- Contact your NC ROOTS Hub Lead.Hub Leads in each of the six regions are building local networks and will fund local projects, so get on their lists early.
- Watch for new rounds.Sign up for NCDHHS RHTP email updates and check the Grant Opportunities page, where Year 2 RFAs will post.
- Register in SAM.gov.Hub Lead RFAs require a Unique Entity Identifier (UEI) from SAM.gov, and many grants pay on a reimbursement basis.
- Plan for federal rules.Grant recipients follow federal grant, reporting and audit rules. A Single Audit applies at $1 million or more in federal spending a year.
- Ask NCDHHS directly.Email ruralhealthtransformation@dhhs.nc.gov.
Federal terms
Four rules that shape every award
Federal terms follow the money down to every North Carolina recipient.
Grants and contracts carry different obligations
A subaward makes your organization a subrecipient that carries out part of the program, with federal reporting and audit requirements. A contract pays for goods or services, with lighter requirements.
New rounds follow CMS budget approval
States can't post funding opportunities until CMS approves their budget, so windows can open months into a budget period.
Workforce incentives need a rural commitment
Recruitment and retention payments require clinicians to commit to serving rural communities for at least five years.
Recipients must disclose the federal funding
Under the Stevens Amendment, websites, social posts and other public materials about a funded project must name the federal funding.
Allowable costs
What can North Carolina's RHTP funding pay for?
North Carolina's RHTP funding can pay for work on existing facilities, uncovered care, technology and administration, within federal caps on each use. Applied to North Carolina's Year 1 award, the maximums are:
Capital and infrastructure20% of award
About $42.6M
Provider payments15% of award
About $32.0M
Administrative costs10% of award
About $21.3M
Rural Tech Catalyst Fund10% or $20M, whichever is less
$20.0M
Replacing an existing EMR system5% of award
About $10.7M
Provider payments and capital
Provider payments cover services insurance doesn't pay for, quality bonuses and outcome-based payments tied to North Carolina's plan. They can't raise rates for services providers already bill.
Capital funds go to existing facilities: renovations, accessibility upgrades, HVAC and like-for-like equipment replacement.
Off limits
- New construction, demolition and major expansions
- Cosmetic work such as painting, carpet or decor
- Clinician salaries at facilities that use non-compete clauses
- Home broadband installation and service
- Costs already covered by other federal or state funding
Policy commitments
North Carolina's policy commitments carry deadlines
North Carolina committed to three policy actions in its application. None is done yet. CMS can reduce or recover funding if they slip.
EMS licensure compact
Pass legislation to join the EMS Personnel Licensure Interstate Compact
North Carolina was not among the compact's 28 member states as of June 2026Presidential Fitness Test
Bring back the Presidential Fitness Test statewide and expand school-based prevention
Nutrition education for physicians
Pass a law requiring nutrition continuing medical education
North Carolina already belongs to the nurse, physician, psychology and physician assistant licensure compacts, and joined the social work compact in June 2025.
Years 2 to 5
$40B
Future awards depend on progress
Year 1 is not a guaranteed annual amount. CMS plans up to $40 billion more nationwide through 2030 and rescores every state each year on progress, data and policy actions.
Unobligated money leaves the state
Funds not obligated by the end of a budget period can't be obligated later and are redistributed to other states.
Funds can be clawed back
CMS can withhold, reduce or recover money for unallowable costs, unapproved plan changes or missed policy commitments. States get 90 days to fix a violation, and most decisions can't be appealed.
Oversight is growing
CMS's Office of Rural Health Transformation plans site visits in all 50 states in 2026. Audits start in 2027.
Method
Reading North Carolina's spending data
Use the numbers in North Carolina's section of the RHTP Year One Report to understand direction and pace, not as an audit.
Put to work is not paid out
Obligated money is signed to a contract or grant. Cash reaches recipients later.
Through July 31, 2026 only
The data covers December 29, 2025 to July 31, 2026, as North Carolina reported it to CMS. Commitments made after July 31, 2026 are not counted yet.
Recipients sit inside line items
The CMS report has no recipient column. Search North Carolina's line item descriptions by name.
Quarterly refresh
CMS updates the data after each quarterly state report, starting with the November 30, 2026 filing.
Announcements
Major North Carolina announcements
NCDHHS launches a dashboard of every Year 1 project, the counties served and the amounts committed, and says CMS has awarded an initial $100 million for Year 2.
Governor Stein and NCDHHS announce more than $17 million for rural mental health, including behavioral health clinics, opioid treatment units and youth mobile crisis teams.
Governor Stein launches the Rural Health Innovation Fund, about $20 million a year for up to five years for rural provider technology.
NCDHHS names the members of the NCRHTP Advisory Committee.
NCDHHS and NCDIT announce three digital health programs: the innovation fund, NC HealthConnex connections for rural providers and digital health help through NC 211.
NCDHHS announces $10 million for 39 local EMS agencies to expand mobile integrated health and opioid treatment.
NCDHHS selects five NC ROOTS Hub Leads for the state's six Medicaid regions.
NCDHHS names Maggie Woods director of the North Carolina Rural Health Transformation Program.
CMS awards North Carolina $213.0 million for Year 1.
Awards announced after July 31, 2026 are not in the CMS spending data yet. They will appear after the next CMS refresh.
Timeline
Key dates
- Dec 29, 2025Year 1 award; Budget Period 1 begins
- Apr 2, 2026NC ROOTS Hub Lead applications close
- May 1, 2026NC ROOTS Hub Leads selected
- Jul 31, 2026End of the first CMS reporting window; Year One Report spending data runs through this date
- Oct 30, 2026Deadline to commit remaining Year 1 funds; Budget Period 1 ends
- Oct 31, 2026Rural Health Innovation Fund readiness intake closes
- Nov 30, 2026Quarterly reports due; CMS refreshes funding data
- Dec 7, 2026Rural Health Innovation Fund applications due
- Dec 2026EMS compact policy deadline
- Jan 2027Rural Health Innovation Fund awards expected
- Jul 30, 2027Rural Health Innovation Fund projects must be complete
- Dec 2028Fitness test and nutrition education deadlines
- 2030Final year of the five-year program
Implications
What this means
For rural hospitals
Most new money will flow through the six NC ROOTS Hubs, which drew $123.5 million in Year 1 commitments and will soon fund local projects. Talk to your region's Hub Lead now. The value-based payment initiative is also building tools to help rural hospitals move toward outcome-based contracts.
For partners and vendors
North Carolina routes much of its work through intermediaries: the Hub Leads, LME/MCOs, NCDIT, NC HealthConnex and NC 211. Partnering with them is one route in, alongside NCDHHS RFAs. Behavioral health, EMS mobile integrated health, digital health and AI tools, and health information exchange are the most active lanes.
For applicants and grantees
Build tracking for the measures North Carolina reports to CMS before an award lands. Subrecipients can't opt out of reporting, and their results feed North Carolina's annual rescoring. Many awards pay on a reimbursement basis, so plan for upfront costs. CMS has awarded an initial $100 million for Year 2, with more to follow.
FAQ
North Carolina RHTP FAQs
Who runs North Carolina's Rural Health Transformation Program?
The North Carolina Department of Health and Human Services (NCDHHS) runs North Carolina's Rural Health Transformation Program, using federal funding from the Centers for Medicare & Medicaid Services (CMS). NCDHHS manages the state's plan, posts funding opportunities and answers questions at ruralhealthtransformation@dhhs.nc.gov. Five NC ROOTS Hub Leads coordinate the work in the state's six regions. The program is North Carolina's share of the $50 billion federal Rural Health Transformation Program.
How much RHTP funding did North Carolina receive?
North Carolina received $213,008,356 for Year 1 of the Rural Health Transformation Program, 10th of 50 states. Every state got $100 million in baseline funding, and the rest of North Carolina's award was based on its rural needs, its policy commitments and the strength of its plan. Later years depend on North Carolina's progress.
Can North Carolina RHTP funding pay for construction?
No. RHTP funds can't pay for new construction, demolition or major expansions. Up to 20% of North Carolina's award each year, about $42.6 million in Year 1, can go to work on existing facilities, such as renovations, accessibility upgrades, HVAC replacement and like-for-like equipment replacement.
Can North Carolina providers use RHTP funding to pay for patient care?
Only for care that insurance doesn't already pay for. Provider payments can cover nonreimbursed services, quality bonuses and outcome-based payments tied to North Carolina's plan, up to 15% of the award each year, about $32.0 million in Year 1. They can't raise rates for services providers already bill.
Where can I see how North Carolina is spending its RHTP funding?
The RHTP Year One Report tracks how much of North Carolina's award was put to work through July 31, 2026, by initiative and recipient, using state-reported data from CMS, and is updated after each CMS data release. NCDHHS also posts its own dashboard of Year 1 projects, which includes awards made after July 31, such as more than $17 million for rural mental health in October 2026.
The Alliance
RHT Alliance members serving North Carolina
These RHT Alliance members serve North Carolina providers, with support that spans virtual nursing, virtual care, telehealth workflow, remote monitoring, health data, diagnostics, patient education and grant writing.
Azalea HealthCloud EHR and billing with AI-assisted charting for rural hospitals and clinics.
CorstrataTelehealth access to board-certified wound, ostomy and continence nurses.
Equum MedicalTelehealth-enabled physician coverage across specialties.
Health Recovery SolutionsRemote patient monitoring and care management at home.
InterSystemsHealth data platforms and interoperability.
Medical Equipment SourceDigital pathology, mobile labs and lab equipment services.
Rural Health Transformation Funding NetworkGrant writing support for RHTP funding opportunities.
Self Care DecisionsEvidence-based triage that directs patients to the right level of care.
Solid StartsInfant feeding guidance and education for families, built by pediatric feeding specialists.
Teledentistry.com24/7 virtual dental evaluations and emergency triage.
VitalChatVirtual nursing and continuous audio and video care across hospitals.
ViTel NetWorkflow platform for hub-and-spoke telehealth programs.
WebMD IgniteMedically reviewed patient education and outreach, including its HEART rural program.Follow North Carolina's money as it moves
The RHTP Year One Report tracks obligations, initiatives and recipients for all 50 states after each CMS data release.