North Dakota’s $199 million rural-health program reaches its implementation phase

North Dakota is moving from planning to implementation of a five-year Rural Health Transformation Program backed by a first-year federal award of $198,936,969.55, or about $199 million.

North Dakota Health and Human Services is accepting applications for projects involving ground ambulance modernization, workforce-supporting childcare, telehealth, remote patient monitoring, technology and non-emergency medical transportation. The first deadline is Sunday, Aug. 9.

The opportunities could affect emergency-response equipment, access to medical appointments, technology-enabled care and the ability of rural employers to recruit and retain workers. But awards are not automatic, and the state has not promised a new ambulance, clinic, transportation route, childcare slot or service in any particular community.

Deadlines begin Aug. 9

HHS lists these active opportunities and deadlines:

Rural Ambulance Modernization: Aug. 9, 2026, at 11:59 p.m. CT.
Childcare for the Rural Health Workforce: Aug. 11, 2026, at 5 p.m. CT.
Clinics without Walls: Telehealth Infrastructure: Aug. 14, 2026, at 5 p.m. CT.
Clinics without Walls: Remote Patient Monitoring: Aug. 14, 2026, at 5 p.m. CT.
Technology as an Extender: Aug. 18, 2026, at 5 p.m. CT.
Non-Emergency Medical Transportation Acquisition: Aug. 19, 2026, at 5 p.m. CT.

These are separate solicitations. Eligibility, allowable costs, award amounts, service requirements and reporting rules vary, so organizations should use the application guidance and FAQ for the specific opportunity they are considering.

What the grants are designed to support

HHS organized the Rural Health Transformation Program around four broad pillars: strengthening and stabilizing the rural health workforce; preventing chronic disease and improving population health; bringing high-quality care closer to home; and connecting technology, data and providers.

The ambulance opportunity is limited to licensed North Dakota ground ambulance providers and ambulance districts. HHS says the final guidance estimates about $22 million in total funding, with roughly 110 awards averaging about $200,000. Those figures are estimates, and final awards will depend on eligible applications, equipment needs and priorities, vehicle eligibility and available funding.

The ambulance solicitation is intended to modernize existing ambulances through eligible equipment, technology, connectivity and installation. HHS says purchasing a new ambulance or other vehicle is not allowable under this opportunity. Air ambulance services are also excluded.

The childcare opportunity is a planning grant intended to help address childcare needs connected to the rural health workforce. HHS says renovations are not allowed under that solicitation and that a planned childcare center would have to be located on a hospital campus, though not necessarily inside the hospital.

The telehealth and remote-monitoring opportunities are intended to bring care closer to rural residents. Technology as an Extender is a separate opportunity focused on using technology to extend the reach of providers. The transportation solicitation addresses acquisition for non-emergency medical transportation. Applicants must follow the project purposes and requirements in each solicitation rather than treating the program as unrestricted operating support.

Organizations may need registrations before payment

New vendors, contractors and federally funded subrecipients may need to complete administrative steps before contracting or receiving payment. HHS directs organizations new to doing business with the state to review Secretary of State registration, state vendor registration or W-9 requirements. Organizations receiving federal funding must register in SAM.gov and obtain a Unique Entity Identifier before contract execution or payment; the registration must remain active for the duration of the award.

Applicants should also account for the state’s contracting rule: purchases generally cannot begin until the contract has been officially executed. Applying for a grant does not authorize an organization to incur reimbursable costs.

First-year money has firm implementation deadlines

HHS says North Dakota’s approximately $199 million first-year allocation must be obligated to approved projects by Oct. 30, 2026. All first-year funds must be spent by Sept. 30, 2027.

The funding is federal financial assistance from the Centers for Medicare & Medicaid Services and the U.S. Department of Health and Human Services, not state money. HHS identifies the total award as $198,936,969.55 and 100% federally funded by CMS/U.S. HHS.

The program also extends beyond the first round of applications. North Dakota expects additional funding each year through 2030, but future installments depend on required milestones and performance measures. HHS says failure to meet the criteria could affect future portions of the approved funding.

That means an application must do more than identify a need. Organizations should show that the proposed project fits the specific solicitation, can be carried out within the required period, has measurable outcomes and, where required, can be sustained after the grant period. The approximately $199 million first-year award does not guarantee permanent local services or continued funding for every project.

Earlier Rural Health Transformation grants supported school and community projects such as physical education, gardens and walking programs. Those rounds are closed. The current applications represent a later phase involving rural health delivery, workforce infrastructure, technology, emergency response and transportation.

What applicants should do next

Organizations considering an application should first identify the legal entity eligible under the specific solicitation and confirm that the proposed purchases or activities are allowed. They should then review the application questions, prepare a budget and outcome measures, and begin any required state or federal registrations.

With deadlines beginning Aug. 9 and continuing through Aug. 19, applicants should not assume that a submission for one opportunity can be transferred to another. HHS says the individual solicitation and FAQs control the details for eligibility, award size, allowable costs, reporting and service requirements.

Sources

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