North Carolina

North Carolina is receiving approximately $213 million in Year-1 funding under the federal $50 billion Rural Health Transformation Program. Year 1 is the first tranche of an approximately $1 billion five-year plan; the award is structured by CMS as an annual award across a five-year performance period.

The program is administered by the NCDHHS Office of Rural Health, with new RHTP director Maggie Woods leading the effort. HHS Secretary Dev Sangvai and Governor Josh Stein have publicly championed it, and IT Secretary Nate Denny co-leads the digital-infrastructure work through NCDIT. Program contact: corey.alford@dhhs.nc.gov.

North Carolina is building its program around five regional ROOTS Hubs (Rural Organizations Orchestrating Transformation for Sustainability) — locally-governed networks covering all 100 counties across six Medicaid regions. The state is betting on existing infrastructure over net-new entities, with a repeated theme of "strengthen, expand, sustain." The hubs, not Raleigh, will award most subgrants once their needs assessments and governance are in place. Alongside the hubs, NC is investing in digital infrastructure — a statewide Health Information Exchange, digital health navigators, and a Rural Health Innovation Fund.

Money is flowing through the ROOTS Hubs and several named initiatives:

• Five ROOTS Hub leads: Impact Health (western/Region 1), Trillium Health Resources (Regions 2 and 5), Vaya/VIA Health with Appalachian State and Partners Health Management (Region 3), UNC Health with Granville Vance Public Health and Piedmont Health Services (Region 4), and Access East, an ECU Health affiliate (Region 6).
• Rural Health Innovation Fund — $20 million a year for up to five years, launching this fall.
• Mobile Integrated Health / EMS — $10 million to 39 local EMS agencies.
• Digital infrastructure — connectivity to NC HealthConnex (the state HIE), onboarding 400+ rural providers, plus digital health navigators via NC 211.
• Minority Diabetes Prevention Program expansion and a School Health Centers expansion.

The full breakdown is in North Carolina's budget narrative and grant-opportunities postings.

North Carolina's flagship procurement was the NC ROOTS Hub Lead RFA, which named the five regional leads in May. Since then the state has posted a Minority Diabetes Prevention Program funding opportunity (extended via addendum), a Mobile Integrated Health Grant, and an invited-only Expanding School Health Centers to Rural Areas opportunity (questions due July 29, applications due 5 p.m. August 12, 2026). The Rural Health Innovation Fund is expected to open a provider-facing application this fall. Individual ROOTS Hubs are now issuing their own letters of interest and subgrant opportunities on their own timelines. Every dated dispatch covering North Carolina is listed below, newest first.

Concrete near-term dates include the School Health Centers opportunity (questions due July 29; applications due 5 p.m. August 12, 2026) and the Rural Health Innovation Fund fall launch. Because ROOTS Hubs are now setting their own subgrant windows and the state posts on a rolling basis, live dates surface first in the dated dispatches below and on the NC RHTP Grant Opportunities page.

The Rural Health Transformation Program was created by Section 71401 of the One Big Beautiful Bill Act (2025) and is administered federally by CMS. North Carolina administers its award through the NCDHHS Office of Rural Health under its CMS-approved project and budget narratives, routing digital-infrastructure funds through the NC Department of Information Technology. A public advisory committee is convening to guide the program.

Eligibility runs on two tracks. Direct-to-state contracts go out as competitive RFAs, where firms bid as prime contractors. Subgrants and subawards flow to rural providers — hospitals, Rural Health Clinics, FQHCs, EMS agencies, school-based health centers, and county and community organizations — increasingly through the five ROOTS Hubs, and it is here that technology vendors and consultants most often engage as subcontractors or implementation partners rather than direct grantees. Because the hubs (not Raleigh) will award most subgrants, engaging early with the regional lead in your service area is the practical entry point.

Track opportunities on the NC RHTP Grant Opportunities page and the RHTP hub, and subscribe to the state's RHTP newsletter.

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