# North Carolina — Rural Health Transformation Program (RHTP)

North Carolina's Rural Health Transformation Program is in the implementation phase, with six regional ROOTS Hubs launched in 2026 to coordinate initiatives across 85 rural counties. Major focus areas include integrating primary, behavioral, and social health services, advancing chronic disease prevention, expanding maternal and school health centers, supporting workforce development, preparing providers for value-based care, and investing in digital health innovation and infrastructure modernization. Current structured plan tracks 6 key initiatives and 14 strategic goals.

## At a glance

- Federal awards to date: $429,832,929.77 (Year 1 $213.0M + Year 2 $216.8M)
- Implementation phase (RCJ): IMPLEMENTING
- Funding opportunities tracked: 13 (2 open or announced, 11 closed)
- Awards recorded: $203.8M to 73 recipients
- Critical Access Hospitals: 27
- Rural population share: 30%

## Current progress

North Carolina continues implementation of the Rural Health Transformation Program. As of October–November 2026, six NC ROOTS Hub Leads are operating, each with advisory boards and active RFAs for initiatives in workforce, maternal health, and nutrition. The $20 million Rural Health Innovation Fund is launched and accepting applications, and both statewide and regional grant opportunities are open for local providers. Year 1 funds have been awarded and projects are underway, with $123.5M to ROOTS hubs and $11.2M to EMS programs; application periods remain ongoing for additional grants. State opportunities: 1 active (1 closing soon, 9 past/closed), $21.8M listed funding. Key opportunities: North Carolina Rural Health Innovation Fund; Expanding School Health Centers to Rural Areas Funding Opportunity; NC Mobile Integrated Health (MIH) and Community Paramedicine Program Grant. Strategy alignment: supports telehealth, care access, workforce priorities.

## CMS published status (State Data Maps)

- State Policy Action commitments: 3 of 19
- Initiatives (6), current CMS stage of each:
  - Build a Robust & Resilient Workforce & Innovative Care Team Models for Rural Communities — Stage 2
  - Build Rural Community Care Network "Hubs" — Stage 2
  - Create Models & Capacity for Expanded Primary Care, Prevention, and Chronic Disease — Stage 2
  - Ensure Fiscal Sustainability of Rural Health Providers Through Innovative Financial Models — Stage 2
  - Expand and Integrate Behavioral Health and Substance Use Disorder Services — Stage 2
  - Modernize Rural Care Delivery Through Digital Forward Solutions — Stage 2
- CMS data captured 2026-11-11, last confirmed 2026-11-11

## Open and announced opportunities

- [North Carolina Rural Health Innovation Fund](https://www.ruralcarejourney.com/opportunities/north-carolina-rural-health-innovation-fund--6bb836649f) — GRANT; Closing soon; due 2026-11-17; $20.0M
- [North Carolina Medicaid Primary Care Capitation Pilot (official RFA pending)](https://www.ruralcarejourney.com/opportunities/north-carolina-medicaid-primary-care-capitation-pilot-official-rfa-pending--ec203e8b0e) — OTHER; Announced, not yet open

## Closed opportunities (11, most recent first)

- [NC ROOTS — Trillium: I Gave Birth Implementation (Regions 2 & 5)](https://www.ruralcarejourney.com/opportunities/nc-roots-trillium-i-gave-birth-implementation-regions-2-5--020906f559) — RFA; Closed; due 2026-09-01; $50,000 – $100,000
- [NC ROOTS — Trillium: Food is Medicine Program Expansion (Regions 2 & 5)](https://www.ruralcarejourney.com/opportunities/nc-roots-trillium-food-is-medicine-program-expansion-regions-2-5--843d517243) — RFA; Closed; due 2026-08-31
- [NC ROOTS — Trillium: LOCATe Implementation (Regions 2 & 5)](https://www.ruralcarejourney.com/opportunities/nc-roots-trillium-locate-implementation-regions-2-5--2899fa6b37) — RFA; Closed; due 2026-08-31; $50,000 – $100,000
- [NC ROOTS — Trillium: Food is Medicine Community Training Partner (Regions 2 & 5)](https://www.ruralcarejourney.com/opportunities/nc-roots-trillium-food-is-medicine-community-training-partner-regions-2-5--fe70be0c0a) — RFA; Closed; due 2026-08-25
- [NC ROOTS — Trillium: NCCARE360 Adoption (Regions 2 & 5)](https://www.ruralcarejourney.com/opportunities/nc-roots-trillium-nccare360-adoption-regions-2-5--172943a08b) — RFA; Closed; due 2026-08-25
- [Expanding School Health Centers to Rural Areas Funding Opportunity](https://www.ruralcarejourney.com/opportunities/expanding-school-health-centers-to-rural-areas-funding-opportunity--6f79d7edc0) — RFA; Closed; due 2026-08-12; $1.3M
- [North Carolina Minority Diabetes Prevention Program - Region 8 Rural Health Transformation Grant – FY 2026](https://www.ruralcarejourney.com/opportunities/north-carolina-minority-diabetes-prevention-program-region-8-rural-health-transf--f959ff7e0e) — RFA; Closed; due 2026-07-17; $195,105
- [NC Mobile Integrated Health (MIH) and Community Paramedicine Program Grant](https://www.ruralcarejourney.com/opportunities/nc-mobile-integrated-health-mih-and-community-paramedicine-program-grant--b3bfc9d418) — RFA; Closed; due 2026-05-20; $75,000 – $200,000
- [NC ROOTS Hub Leads — Rural Health Transformation Program](https://www.ruralcarejourney.com/opportunities/nc-roots-hub-leads-rural-health-transformation-program--a7306fc47a) — RFA; Closed; due 2026-04-02
- [North Carolina Federal RHTP Award: Year 1 (FY 2026)](https://www.ruralcarejourney.com/opportunities/north-carolina-federal-rhtp-award-year-1-fy-2026--f048c6adfd) — AWARD; Closed; $213.0M
- [North Carolina Federal RHTP Award: Year 2 (FY 2027)](https://www.ruralcarejourney.com/opportunities/north-carolina-federal-rhtp-award-year-2-fy-2027--2bacae4b0d) — AWARD; Closed; $216.8M

## Largest recorded awards

- Trillium Health Resources — $44.5M (FY2026)
- North Carolina Department of Information Technology — $23.7M (FY2026)
- Vaya Health — $23.5M (FY2026)
- Impact Health — $20.9M (FY2026)
- UNC Health — $20.7M (FY2026)
- Access East — $20.6M (FY2026)
- East Carolina University — $5.7M (FY2026)
- NC HealthConnex / North Carolina Department of Information Technology — $5.5M (FY2026)
- Alliance Health — $5.4M (FY2025)
- NCDHHS Division of Health Benefits — $3.5M (FY2026)
- Duke-Margolis Institute for Health Policy — $3.5M (FY2026)
- Alliance Health — $2.3M (FY2026)
- Partners Health Management — $1.6M (FY2025)
- Trillium Health Resources — $1.6M (FY2025)
- Partners Health Management — $1.3M (FY2026)

## Official sources RCJ monitors

- [NC RHTP Primary](https://www.ncdhhs.gov/divisions/office-rural-health/rural-health-transformation-program)
- [NC OEMS MIH Grant Page](https://hpp.nc.gov/mobile-integrated-health-rfa/)
- [NC Release / Application](https://governor.nc.gov/news/press-releases/2025/11/21/north-carolina-applies-200-million-rural-health-transformation-program)
- [NC ROOTS Hub: Trillium Health Resources (Region 5)](https://trilliumhealthresources.org/NC-ROOTS-Region-5)
- [NC ROOTS Hub: Trillium Health Resources (Region 2)](https://trilliumhealthresources.org/NC-ROOTS-Region-2)
- [NC RHTP Grant Opportunities](https://www.ncdhhs.gov/divisions/office-rural-health/rural-health-transformation-program/rural-health-transformation-program-grant-opportunities)

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Source: Rural Care Journey (RCJ), https://www.ruralcarejourney.com/states/nc — data as of 2026-11-11.
Cite the RCJ page for the summary and the linked official source for authoritative terms, deadlines, and amounts.