What Is the Rural Health Transformation Program?
The Rural Health Transformation Program (RHTP) is a landmark $50 billion federal initiative created under Section 71401 of the One Big Beautiful Bill Act (Public Law 119-21). Administered by CMS, the program distributes $10 billion annually from FY2026 through FY2030 to all 50 states through cooperative agreements — no state matching funds required.
RHTP is designed to transform rural healthcare by investing in infrastructure, technology, workforce, and care delivery models that create lasting, sustainable improvements for rural communities. Learn more about RHTP on our hub page.
Five Strategic Goals
North Carolina’s RHTP Program
Key Initiatives & Focus Areas
- NC ROOTS Hubs — 6 Regional Organizing and Operational Transformation Support hubs
- 5 NC ROOTS Hub Leads selected May 1, 2026 — contracts finalizing June 1, 2026
- Healthcare workforce development and recruitment
- Telehealth and digital health expansion
- Behavioral health and substance use treatment
Unique Aspects of North Carolina’s Program
- NC ROOTS Hubs (Regional Organizing and Operational Transformation Support) — 6 regional hubs
- Second-largest rural population in the U.S. (nearly 3 million)
- Hub Lead applications closed April 2, 2026; 5 organizations selected May 1, 2026
- 420+ stakeholders engaged in transformation plan development
- Alignment with Medicaid Standard Plan regions for coordinated implementation
How Technology Supports RHTP in North Carolina
The Interoperability Challenge
Rural healthcare facilities face significant technology gaps compared to their urban counterparts. Nationally, only 48% of rural hospitals have achieved basic interoperability, compared to 62% of urban hospitals. This data-sharing gap directly impacts care quality, coordination, and outcomes for rural patients.
RHTP’s Strategic Goal 5 specifically targets technology innovation, including a Technology Innovation Catalyst Fund that supports interoperability, telehealth, remote patient monitoring, AI-enabled health tools, and cybersecurity.
How Julota Addresses RHTP Technology Requirements
Julota is a cloud-based SaaS interoperability platform purpose-built for the challenges rural healthcare organizations face. Here’s how Julota supports RHTP goals in North Carolina:
- FHIR-Native Interoperability: Julota’s platform supports HL7 FHIR APIs and G10 compliance, meeting the interoperability standards required by RHTP and the 21st Century Cures Act. Learn about Julota’s platform.
- Health Information Exchange Connectivity: Connect rural providers across North Carolina to state and regional HIEs, enabling real-time data sharing that improves care coordination and reduces duplication.
- Care Coordination & Closed-Loop Referrals: Julota’s closed-loop referral management ensures patients don’t fall through the cracks — critical for rural communities where follow-up can require long-distance travel.
- MIH-CP & Community Paramedicine Support: Julota’s MIH-CP solution supports the mobile integrated health and community paramedicine models that many states are funding under RHTP.
RHTP Eligibility in North Carolina
RHTP funds flow from CMS to North Carolina through a cooperative agreement. The state then distributes funds to eligible subrecipients through competitive processes.
Eligible Organization Types
- Critical Access Hospitals (CAHs) — Rural hospitals with 25 or fewer beds
- Federally Qualified Health Centers (FQHCs) — Community health centers serving underserved populations
- Rural Health Clinics (RHCs) — Clinics in designated shortage areas
- Community Behavioral Health Providers — Including Certified Community Behavioral Health Clinics (CCBHCs)
- Emergency Medical Services (EMS) — Ambulance services and first responders
- Tribal Health Organizations — Indian Health Service and tribal facilities
- Local Health Departments — County and regional public health agencies
- Universities and Training Programs — Workforce development partners
How to Apply
Organizations in North Carolina should contact NCDHHS (Office of Rural Health) for subrecipient application details. Most states distribute RHTP funds through competitive RFP processes that require demonstrating alignment with the state’s approved Rural Health Transformation Plan.
Key compliance requirements include SAM.gov registration, adherence to 2 CFR 200 uniform guidance, and commitment to quarterly and annual reporting on performance metrics and milestones.
Key Questions About RHTP in North Carolina
What are NC ROOTS Hubs?
NC ROOTS (Regional Organizing and Operational Transformation Support) Hubs are 6 regional centers established under North Carolina's $213 million RHTP to coordinate rural health transformation across the state's nearly 3 million rural residents.
How much did North Carolina receive for RHTP?
North Carolina received $213,000,000 in FY2026 RHTP funding, administered by NCDHHS Office of Rural Health. The program is organized around 6 NC ROOTS Hubs aligned with Medicaid Standard Plan regions.
How do I become an NC ROOTS Hub Lead?
Hub Lead applications closed April 2, 2026. NCDHHS announced the five selected Hub Leads on May 1, 2026: Impact Health (Region 1), Trillium Health Resources, Vaya Health, UNC Hospitals, and Access East. Contracts are being finalized with a target of June 1, 2026. Future subrecipient opportunities will flow through these Hub organizations — contact NCDHHS Office of Rural Health for details.
Who is eligible for North Carolina RHTP funding?
Eligible organizations include Critical Access Hospitals, FQHCs, Rural Health Clinics, behavioral health providers, EMS agencies, and other healthcare organizations serving North Carolina's nearly 3 million rural residents.
What technology does NC's RHTP support?
NC's RHTP supports telehealth infrastructure, digital health tools, health information exchange connectivity, EHR modernization, remote patient monitoring, and interoperability platforms across the 6 ROOTS Hub regions.
How many stakeholders shaped NC's RHTP plan?
Over 420 stakeholders participated in developing North Carolina's Rural Health Transformation Plan, making it one of the most collaboratively designed RHTP implementations nationally.
How does NC's RHTP align with Medicaid?
NC ROOTS Hubs are aligned with the state's Medicaid Standard Plan regions, ensuring coordinated implementation between RHTP-funded services and existing Medicaid managed care infrastructure.
How can NC providers participate in RHTP?
North Carolina providers should contact NCDHHS Office of Rural Health and monitor ncdhhs.gov for subrecipient opportunities through the NC ROOTS Hub framework.
Ready to Build RHTP-Ready Infrastructure in North Carolina?
Julota helps rural healthcare organizations meet RHTP interoperability requirements with a cloud-based platform that connects providers, enables data sharing, and supports care coordination across your community.