Rightsizing Health Care Delivery Systems for the Future: Rural Federally Qualified Health Centers and Critical Access Hospitals Grants

The Rightsizing Health Care Delivery Systems for the Future: Rural Federally Qualified Health Centers and Critical Access Hospitals funding opportunity is offered through the North Dakota Health and Human Services (ND HHS) Rural Health Transformation Program (RHTP). The RHTP was established following Public Law 119-21, which created a $50 billion Rural Health Transformation Program administered by the Centers for Medicare and Medicaid Services (CMS) to support rural communities in redesigning and strengthening health care delivery systems. North Dakota’s five-year RHTP strategy focuses on four initiatives: making North Dakota healthier, strengthening the rural health workforce, bringing high-quality care closer to home, and improving connectivity among technology, providers, and data systems. This specific opportunity falls under Initiative 3, which seeks to improve sustainable access to quality rural health care services through rightsizing efforts and operational modernization. The funding opportunity is intended to provide technical assistance and operational analysis to rural Critical Access Hospitals (CAHs) and Federally Qualified Health Centers (FQHCs) in North Dakota. The goal is to help facilities evaluate physical infrastructure, licensure, scope of services, governance, financial performance, workforce needs, telehealth capabilities, and long-term sustainability. The program is designed to assist organizations in aligning their services and infrastructure with the actual needs of their communities while preparing for future sustainable care delivery models such as Rural Emergency Hospitals or regional service hubs. The funding is limited to planning and analysis activities during the first year of the program, while future RHTP funding opportunities are expected to support implementation activities arising from the assessments and recommendations developed through this initiative. ND HHS selected Eide Bailly as the preferred vendor to provide the technical assistance required under this funding opportunity. Award recipients will be required to execute an agreement directly with Eide Bailly, although ND HHS is not a party to that agreement. Technical assistance activities include educational sessions for facility leadership and governing boards, ongoing project communications, financial and operational assessments, strategic planning reviews, revenue cycle assessments, market analyses, governance evaluations, staffing productivity reviews, telehealth assessments, and Medicare reimbursement analyses. Critical Access Hospitals may additionally elect to implement Eide Bailly’s CAH Analytics Tool, which includes dashboards and financial monitoring capabilities valued at approximately $42,000 during the first year. Continued use beyond the first year requires a sustainability plan addressing the estimated $2,000 monthly maintenance cost. Eligible applicants include rurally located Critical Access Hospitals and Federally Qualified Health Centers in North Dakota, including their owned and operated clinics. Urban entities located in Fargo, West Fargo, Grand Forks, and Bismarck may qualify only if at least 50 percent of the population served consists of rural North Dakota residents or if the funding primarily supports rural North Dakotans. Only one application per health system may be submitted. The program is a competitive application process with approximately $2,310,000 in available federal funding during the first year. ND HHS expects to issue 42 awards of $40,000 each, with potential supplemental funding for eligible CAHs participating in the analytics tool implementation. The operating period begins upon execution of the agreement and continues through September 30, 2027, at which point all awarded funds must be fully expended. Applications must include organizational background information, project leadership contact details, governing board approval documentation, a project narrative, action plan, timeline, metrics, key personnel descriptions, and a detailed budget using the ND HHS Itemized Subrecipient Budget Template. Applicants must explain the need for the proposed rightsizing activities, identify measurable goals and outcomes, describe sustainability strategies, and explain how the project aligns with CMS and RHTP evaluation metrics. Evaluation criteria focus on the quality and completeness of the submitted application materials and alignment with RHTP objectives. Reporting requirements for successful applicants include reimbursement requests, progress reports, impact stories, and other reporting obligations that may extend for up to five years or longer if required by CMS guidance. The application period opened following the funding announcement posted on April 30, 2026. Applications must be submitted electronically through Qualtrics no later than May 22, 2026, at 5:00 p.m. Central Time. A technical assistance webinar was scheduled for May 7, 2026, and recordings and FAQs will be published on the RHTP webpage for future reference. Applicants are strongly encouraged to submit questions to the RHTP FAQ Survey no later than seven days before the submission deadline to improve the likelihood of receiving responses. ND HHS reserves the right to negotiate budgets, request supplemental responses, or modify project proposals to ensure alignment with CMS requirements and North Dakota’s Rural Health Transformation Program commitments.

Applicants should clearly connect proposed rightsizing activities to measurable rural health outcomes telehealth access Medicaid care coordination and long-term financial sustainability. Strong applications will provide data-supported community need evidence realistic implementation timelines and clear explanations of how technical assistance will improve operational viability without duplicating existing funding sources.