Ensuring Safety Net Service Delivery Grants

The Ensuring Safety Net Service Delivery funding opportunity is part of the North Dakota Rural Health Transformation Program (RHTP), a federally funded initiative established under Public Law 119-21 and administered through the Centers for Medicare and Medicaid Services. The broader Rural Health Transformation Program was created to help rural communities redesign and strengthen health care delivery systems while improving health outcomes for underserved populations. North Dakota Health and Human Services developed a five-year strategy focused on expanding access points, modernizing care delivery, strengthening the rural workforce and improving coordination between technology, providers and data systems. This specific opportunity falls under Initiative 3, Bring High-Quality Health Care Closer to Home, and is intended to strengthen the rural and tribal health care safety net across the state. The purpose of the funding opportunity is to fill gaps in health care and behavioral health service delivery systems for rural and tribal residents in North Dakota. Eligible projects include technical assistance, planning, workforce training, infrastructure development, equipment purchases and remodeling activities tied to improving access to care. The solicitation identifies several priority service areas including medically managed withdrawal management services, behavioral health crisis response, youth and adult partial hospitalization and day treatment programs, pediatric and ventilator beds, obstetric care and home-based services. The program also supports telehealth expansion and outreach services for underserved communities, including telehealth equipment, mobile clinics, virtual care rooms and outreach model development. The initiative is designed to improve measurable outcomes such as reducing avoidable emergency department visits, improving coordination of care, increasing telehealth encounters, improving specialist access and decreasing suicide attempts among Medicaid members and rural populations. Eligibility is broad and includes hospitals, clinics, behavioral health providers, long-term care facilities, tribes and tribal health organizations, emergency medical service providers, nonprofit organizations, transportation providers, local public health agencies, education systems, community organizations and other health care providers that serve rural or tribal North Dakota residents. Although organizations located in Grand Forks, Fargo, West Fargo and Bismarck are generally considered urban and not eligible, they may apply if at least 50 percent of the population served through the project consists of rural North Dakota residents or if the project directly benefits rural residents. Applicants may submit multiple applications across different Rural Health Transformation Program opportunities, and there is no limit to the number of submissions an organization may make. Approximately $15 million in federal funding is available during the first year of this competitive opportunity, with North Dakota Health and Human Services expecting to issue approximately 50 awards averaging around $300,000 each. Applicants may request any funding level necessary to complete the proposed project so long as all funds are expended by September 30, 2027. The operating period begins once the agreement is fully executed and approved. The solicitation notes that the department reserves the right to negotiate budgets based on project scope, application volume and available funding. Allowable costs include minor renovations, equipment upgrades, workforce training, outreach development and telehealth expansion. However, major construction, building expansion, purchasing buildings, cosmetic renovations, supplanting existing funding, replacing reimbursable clinical services and several other categories of expenses are prohibited. Administrative and indirect costs are capped at 10 percent, and provider payments generally may not exceed 15 percent of total funding in a budget period. The application process requires submission through Qualtrics no later than May 29, 2026 at 5 p.m. Central Time. The application package includes organizational background information, a project narrative, an action plan and an itemized budget using the state-provided budget template. Applicants must clearly describe the identified community need, target populations, measurable outcomes, sustainability plans, implementation timelines, staffing plans and evaluation metrics. Projects must align with the Rural Health Transformation Program evaluation framework and demonstrate how the proposal supports improved access, technology adoption, partnerships, workforce development, financial sustainability and data-driven solutions. Applicants must also explain how the project expands existing services rather than duplicating or replacing current funding sources. Applications will be reviewed competitively based solely on the submitted materials and scored using a formal review tool. North Dakota Health and Human Services may request supplemental information or modifications to proposed projects before awards are finalized. Successful applicants will be required to submit reimbursement documentation, progress reports and impact stories, and some reporting obligations may extend up to five years depending on federal requirements. A technical assistance conference call is scheduled for May 8, 2026 from noon to 12:45 p.m. Central Time, and additional frequently asked questions and resources will be posted on the Rural Health Transformation Program webpage. The department strongly encourages applicants to submit questions before the final week of the application period due to anticipated demand and limited response capacity near the deadline.

Prioritize projects that directly address identified rural behavioral health and continuum of care gaps. Demonstrate measurable outcomes tied to Initiative 3 metrics. Clearly explain sustainability after funding ends and show how the project expands rather than duplicates existing services. Provide strong rural and Medicaid member impact data and clearly connect technology investments to long-term service delivery improvements.