North Dakota rural health grant opportunities imminent as feds OK spending plan

BISMARCK, N.D. (North Dakota Monitor) — The federal government has approved most of North Dakota’s nearly $200 million plan implementing the first year of a massive rural health grant — meaning organizations will soon be able to apply for a slice of the money.

The funding comes from the $50 billion Rural Health Transformation Program passed by Congress last summer. The five-year program, part of Congress’s budget reconciliation bill, was advertised as a way to partially make up for funding rural states will lose from Medicaid cuts included elsewhere in the legislation. All states are guaranteed at least $500 million from the program and are eligible for up to $1 billion.

North Dakota in late December learned it was authorized for $199 million for the first year of the program. The state plans to dole out most of its money in the form of grants.

But first, North Dakota had to have its program budget approved by the federal government.  North Dakota lawmakers in January convened for a three-day special session to create the budget, which then was submitted to the Centers for Medicare and Medicaid Services for final review.

North Dakota announced Monday that the federal government on Feb. 25 had cleared $194.8 million of the state’s 2026 Rural Health Transformation Program budget. About $4.13 million is still under review, according to the Department of Health and Human Services.

The state agency indicated previously that grant applications would open shortly after its budget was approved, though none were live as of Monday afternoon.

All funding opportunities will be posted on the Department of Health and Human Services’ Rural Health Transformation Program webpage as they become available.

The window for the state to process and approve applications will be relatively short. North Dakota is required by federal law to commit the money by the end of October and spend it within the following year.

Of the $199 million earmarked for North Dakota for 2026, the state plans to dedicate $33.4 million on technology, $116 million to expand health care access in rural areas, $32.2 million to address  workforce issues and $17.1 million to promote healthy lifestyles.

The Legislature in House Bill 1623 appropriated $397.9 million for the Rural Health Transformation program for the 2025-2027 budget cycle, the amount the state expects to receive for the first two years of the program.

North Dakota Monitor reporter Mary Steurer can be reached at msteurer@northdakotamonitor.com