In State of the State Address, Armstrong says rural health care challenges in ND demand bold action

BISMARCK, N.D. - North Dakota's rural health care challenges demand bold action and new approaches, Gov. Kelly Armstrong said in a State of the State Address today as the 69^th Legislative Assembly convened in special session to appropriate nearly $200 million in federal funding for a statewide Rural Health Transformation Program.

"This is a generational opportunity to not only improve how health care is delivered to our citizens, but also help revitalize communities as people continue to seek out safe places to live with strong health care, great schools and abundant economic opportunity," Armstrong said to a joint session of the House and Senate.

Armstrong convened the special session to address $199 million awarded in late December by the U.S. Centers for Medicare and Medicaid Services (CMS). The funding will support the Rural Health Transformation Program, which aims to strengthen rural health care by improving access, quality and health outcomes for North Dakotans in rural communities over the next five years.

Lawmakers will consider an appropriations bill providing authority to spend $398 million for the first two years of the program. The $398 million is an estimate that represents double the $199 million awarded for the first year of the program. The second year's award is expected in October 2026.

"This program only works if North Dakota taxpayers have confidence in how we're spending the money," Armstrong said. "It needs to be authorized and appropriated quickly. We need to be responsible stewards and track it closely. And it needs to have a tremendous impact on the well-being of our citizens."

Armstrong thanked the Legislature's Rural Health Transformation Committee for their input and work to advance four policy bills that helped improve the state's application to CMS, resulting in an award that nearly doubled the base funding level of $100 million for each state. The bills will:

• Require the Presidential Physical Fitness test in physical education courses.
• Include nutrition education in continuing education requirements for physicians.
• Join the physician assistant licensure compact.
• Expand the scope of practice for pharmacists.

Armstrong noted nearly 75% of North Dakota's rural counties face primary care shortages. Almost half lack adequate dental care, and 17 counties have no practicing dentist. Mental health access is even more limited - 44 of 53 counties are designated shortage areas.

"These challenges demand bold action," he said. "By expanding access, promoting long-term wellness and driving innovation, we have the chance to be the healthiest state in the nation."

The state submitted its program application Nov. 3, centering 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.

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. The North Dakota Department of Health and Human Services expects the first release of subaward grant opportunities in the first quarter of 2026.

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