Expand Rural Health Care Rotations Grant Program

The Expand Rural Health Care Rotations funding opportunity is administered by North Dakota Health and Human Services (ND HHS) under the broader Rural Health Transformation Program (RHTP), a federally funded initiative created through Public Law 119-21. Congress established the $50 billion RHTP to help rural communities redesign health care delivery systems, strengthen local provider capacity and improve long-term health outcomes in underserved rural and tribal communities. The Centers for Medicare and Medicaid Services (CMS) oversees the national initiative, while ND HHS is responsible for implementing North Dakota’s approved five-year transformation strategy. North Dakota’s RHTP framework includes four statewide initiatives focused on improving public health, strengthening the rural workforce, expanding access to care and modernizing health care infrastructure and data systems. This funding opportunity falls specifically under Initiative 2: Strengthen and Stabilize Rural Health Workforce. The purpose of this funding opportunity is to support the development, expansion and enhancement of rural and tribal clinical training rotations for health care professional students. ND HHS intends to increase exposure to rural practice environments in order to improve long-term recruitment and retention of providers in underserved communities. Eligible projects may include expanding rural rotations to new learner types, increasing the number of available student placement slots, embedding students in rural health facilities and providing short-term housing support for students participating in rural rotations. Housing-related support may include conventional lodging such as apartments, hotels or leased housing, as well as certain nonconventional lodging options when traditional accommodations are unavailable. Recreational vehicle-related temporary lodging expenses may also qualify under limited conditions. The funding opportunity specifically prohibits use of funds for purchasing recreational vehicles, construction projects, building expansions, cosmetic renovations and other capital expenditures that materially increase the value of facilities. Eligible applicants include hospitals, clinics, home care providers, long-term care facilities, behavioral health providers, emergency medical services providers, tribal health organizations excluding Indian Health Services, nonprofit organizations, local public health agencies, educational systems and other health care providers serving rural or tribal North Dakota communities. Organizations located in Grand Forks, Fargo, West Fargo and Bismarck are generally considered urban and therefore ineligible unless at least 50 percent of the population served consists of rural North Dakota residents or the funding activities directly benefit rural populations. Applicants may submit multiple applications across RHTP funding opportunities without limitation. RHTP funds cannot be used to duplicate or replace existing funding sources, meaning applicants must demonstrate how proposed activities expand or enhance existing efforts rather than supplant currently funded programs. Approximately $3,000,000 in federal funding is available during year one of this competitive program, with ND HHS anticipating approximately 15 awards averaging around $200,000 each. Applicants may request any funding amount necessary to complete their proposed activities provided the project can reasonably be completed within the operating period. The operating period begins upon execution of the funding agreement and concludes September 30, 2027, with all funds required to be fully expended by that date. ND HHS reserves the right to negotiate budgets based on project scope, funding availability and application volume. Reporting obligations for successful applicants include reimbursement documentation, progress reports and impact stories. Certain projects involving financial incentives may also require five-year service commitment agreements and extended reporting obligations for up to five years as required by CMS guidance. Applications are due by May 15, 2026 at 5:00 p.m. Central Time and must be submitted electronically through Qualtrics. Late submissions will be considered non-responsive and will not be reviewed. Required application components include organizational background information, a detailed project narrative, an action plan and an itemized budget using the ND HHS template. The project narrative must describe workforce challenges, target trainee populations, measurable outcomes, sustainability planning, data-driven decision-making and any partnerships supporting the project. Applicants must also explain how the project aligns with the RHTP evaluation framework, including goals related to provider recruitment, retention and reduction of Health Professional Shortage Area counties. The action plan must identify implementation timelines, milestones, metrics and key personnel responsible for project activities. Budget narratives must justify all requested costs and comply with federal cost principles under 2 CFR Part 200 and Part 300. Applications will be reviewed competitively based solely on submitted materials and scored using ND HHS evaluation criteria and scoring tools. ND HHS may request supplemental information or negotiate modifications to proposed projects in order to align awards with statewide RHTP goals and CMS cooperative agreement requirements. The department has indicated that no changes to the agreement terms and conditions will be permitted after award due to the compressed implementation timeline associated with the federal funding source. A technical assistance conference call was scheduled for May 7, 2026, with additional frequently asked questions and guidance materials to be published afterward on the RHTP webpage. Questions regarding the funding opportunity may be submitted through the RHTP FAQ Survey or directed to rhtp@nd.gov. The funding announcement notes that all program guidance remains subject to future federal updates and CMS involvement throughout the project period.

Emphasize measurable workforce outcomes alignment with Initiative 2 metrics and sustainability beyond the funding period. Clearly demonstrate how the proposal expands rather than duplicates existing programs and explain rural community impact using local workforce data. Projects with strong partnerships measurable trainee outcomes and feasible implementation timelines are likely to score more competitively.