ND awarded $199M for Rural Health Transformation Program to strengthen care in rural communities

BISMARCK, N.D. - Gov. Kelly Armstrong today announced that North Dakota has been awarded $199 million from the Centers for Medicare and Medicaid Services (CMS) to support the first year of a statewide Rural Health Transformation Program. The funding will strengthen rural health care by improving access, quality and health outcomes for North Dakotans in rural communities over the next five years.

To accept federal funding, North Dakota lawmakers must appropriate it before it can be spent. Armstrong issued an executive order today officially convening the Legislature for a special session starting Jan. 21.

"With this major investment through the Rural Health Transformation Program, we have a once-in-a-generation opportunity to rethink and reshape how health care is delivered to our rural communities," Armstrong said. "We thank President Trump, HHS Secretary Kennedy, CMS Administrator Oz and our congressional delegation for their support in securing this funding, which will benefit citizens across our state and help make North Dakota the best place to live, work and raise a family."

The state submitted its application to CMS on Nov. 3. The Rural Health Transformation Program centers on four strategic initiatives:

• Strengthening and stabilizing the rural health workforce
• Making North Dakota healthy again with preventive care and healthy eating
• Bringing high-quality health care closer to home
• Connecting technology, data and providers for a stronger North Dakota.

"This funding allows North Dakota to build on existing partnerships and invest in long-term solutions to move toward making our state the healthiest in the nation," said Pat Traynor, commissioner for North Dakota Health and Human Services (HHS). "Rural communities face unique challenges, and this program helps ensure people can get the care they need, close to home."

As part of the application, the state also submitted a request to the U.S. Department of Agriculture (USDA) for a Supplemental Nutrition Assistance Program (SNAP) food waiver to limit purchases of unhealthy food and help improve health outcomes for North Dakotans who participate in SNAP. The USDA approved the waiver on Dec. 10, making North Dakota eligible for additional funding beyond the $500 million minimum allocated to each state over the five-year period.

Leading up to the special legislative session, HHS is establishing a framework for grant funding prioritization, distribution and sustainability, compliance monitoring in alignment with federal guidance and stakeholder engagement. HHS expects the first release of subaward grant opportunities in the first quarter of 2026.

"Being awarded this grant funding is an important milestone," said Sarah Aker, HHS medical services executive director. "Now, our focus shifts to implementation so the resources can start making an impact in rural communities."

The Rural Health Transformation Program was part of the federal Working Families Tax Cut Act, which appropriated $50 billion over five years, with half allocated equally to all states. The other half was awarded to states based on their applications and metrics that show where the funding can make the most significant health impact in rural communities.

To learn more about the Rural Health Transformation Program, including signing up to receive program notifications, visit hhs.nd.gov/rural-health-transformation.