North Carolina Rural Organizations Orchestrating Transformation for Sustainability (“NC ROOTS”) Hubs Grant

The North Carolina Department of Health and Human Services (NCDHHS), through its Office of Rural Health, issued a Request for Applications (RFA) for organizations to serve as NC ROOTS Hub Lead entities under the North Carolina Rural Health Transformation Program (NCRHTP). This initiative is part of a federally funded Rural Health Transformation Program administered in partnership with the Centers for Medicare & Medicaid Services. The program is designed to improve healthcare access, quality, and outcomes for nearly 3 million rural residents across North Carolina by transforming care delivery systems and strengthening regional health infrastructure. The NC ROOTS Hubs (Rural Organizations Orchestrating Transformation for Sustainability) are regionally based, locally governed networks responsible for coordinating and implementing NCRHTP initiatives. Each selected Hub Lead serves as the central coordinating and fiduciary entity for one of six Medicaid-aligned regions in the state. These entities are tasked with building and managing a network of partners including hospitals, public health departments, community-based organizations, and other stakeholders. The program emphasizes locally tailored strategies to address regional health disparities, including chronic disease, maternal health, workforce shortages, and access to care. Funding for this opportunity is substantial, with approximately $235,513,062 expected to be distributed across up to six awards in the first grant period alone. Each region may receive funding based on population size and regional needs, with projected funding of over $39 million per region for the first award period. The program operates on a reimbursement basis, requiring awarded entities to initially cover program costs and then request reimbursement. Funding is entirely federally sourced, and continuation of funding in subsequent years is contingent upon performance and availability of federal funds. The project period is expected to span multiple years, with initial contracts beginning around June 1, 2026 and continuing through October 2030. Eligible applicants include public and private entities, including Tribal organizations, that have at least three years of operational presence in North Carolina and demonstrate sufficient financial and administrative capacity to manage large-scale programs. Applicants must possess a Unique Entity Identifier (UEI) and be capable of serving as both programmatic and fiduciary leads. The program requires strong experience in managing partnerships, implementing large initiatives, and overseeing compliance with federal requirements. Subawards will be issued as financial assistance contracts, and recipients must adhere to extensive federal and state compliance standards. The scope of work for Hub Leads is comprehensive. Responsibilities include establishing governance structures, conducting regional needs assessments, developing a Hub Action Plan, coordinating service delivery across multiple initiatives, distributing funds to partners, and providing technical assistance. Core initiatives span primary care expansion, behavioral health coordination, workforce development, value-based payment models, and food and nutrition infrastructure. Hub Leads must also ensure culturally responsive programming and meaningful engagement with underserved populations, including Tribal communities. The application process required submission via email by April 2, 2026 at 5:00 PM Eastern Time. Applicants were instructed to include required documentation such as a cover letter, organizational information, budget, and multiple compliance certifications. Evaluation criteria include organizational capacity, regional strategy, alignment with program goals, and ability to manage funds and partnerships effectively. Inquiries were directed to a designated program email, and applicants were encouraged to participate in informational webinars prior to submission. This funding opportunity reflects a long-term, transformative investment in rural health systems across North Carolina. By establishing regionally coordinated hubs with strong local governance and accountability, the program aims to create sustainable improvements in healthcare delivery, workforce capacity, and population health outcomes. While the application period for this cycle has closed, the structured multi-year funding model and federal backing suggest potential for future recurring opportunities tied to program performance and continued federal support.

Demonstrate strong regional partnerships; align strategy with NCRHTP initiatives; show financial capacity for reimbursement model; emphasize community engagement and data-driven planning