NC Rural Health Providers Get $100M Federal Boost
Rural healthcare operators in North Carolina will see year-two program funds shift from planning into project implementation.
Updated on Nov. 2, 2026 in Healthcare
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North Carolina received an initial $100 million from the U.S. Centers for Medicare & Medicaid Services under the Rural Health Transformation Program, and the state is now moving year-two funding from planning into implementation. The program affects rural health providers and the operators who serve more than 3.5 million rural North Carolina residents.
Why it matters
North Carolina has the second-largest rural population in the United States, and the program was created by an economic bill signed by President Donald Trump on July 4, 2025. The funding is intended to shore up rural care capacity, but state projections warn of significant losses in health care funding over the next decade under the same legislation.
North Carolina's initial CMS award was $100 million, and the state's year-one dashboard reports more than $213 million in program spending. More than 3.5 million people in the state live in rural communities, and the program provides funding across five fiscal years.
The players
Centers for Medicare & Medicaid Services
The federal agency that administers Medicare and Medicaid and awards Rural Health Transformation Program funds to states.
NC Department of Health and Human Services
North Carolina's state agency overseeing Medicaid, public health, and the state's administration of the rural health program.
President Donald Trump
The current President of the United States, who signed the economic bill creating the Rural Health Transformation Program.
The details
Year-one funds were used to establish NC ROOTS Hubs to lead program initiatives, fund emergency medical services agencies in Washington and Lenoir County, and expand opioid treatment provider services in Bertie County. The state tracks these allocations through a public dashboard maintained by the NC Department of Health and Human Services. Year two shifts the emphasis from planning to implementation of rural healthcare projects.
Timeline
July 4, 2025: President Trump signed the economic bill that created the Rural Health Transformation Program.
November 2, 2026: CMS awarded North Carolina its initial $100 million.
Year one: The state spent more than $213 million and established the ROOTS Hubs.
Year two: North Carolina moves from planning to implementing funded projects.
Next ten years: The state projects losses of tens of billions of dollars in health care funding.
Market Landscape
The Rural Health Transformation Program is a five-year federal funding stream created by the July 4, 2025 economic bill, and North Carolina is among the first states implementing it. Rural hospitals and providers nationally face the same program structure, with awards tied to each state's rural population and project plans.
Rural health providers and operators in North Carolina should track which year-two projects receive state allocations, since those decisions will set the funding available for their services. Businesses that depend on rural patient volume should review their payer mix and Medicaid exposure with a qualified accountant as state projections of long-term funding change.
The takeaway
Rural health operators should treat the program's five-year schedule as a planning window and watch how North Carolina allocates year-two funds across ROOTS Hubs, EMS, and treatment services. Monitor the state's public spending dashboard, and consult a qualified accountant before adjusting budgets against projected federal health funding changes.
What happens next
North Carolina will move year-two rural healthcare projects from planning to implementation under the program's five-year funding schedule.
Further reading
For broader context on how public funding shapes care delivery, see Healthcare coverage on We are Main Street.
Source note: This article includes information reported by Witn.
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