North Carolina

Build Rural Community Care Network Hubs

Each hub builds a regional provider network, coordinates referrals across medical, behavioral, and social services, and establishes care navigation and warm handoffs. The goal is a "no wrong door" experience for rural patients — replacing fragmented care with coordinated routing.

Create Models & Capacity for Expanded Primary Care, Prevention, and Chronic Disease Management

Mobile health units, school-based health centers, community health worker-led prevention programs, and chronic disease management for diabetes, hypertension, and cancer screening in underserved rural counties.

Expand and Integrate Behavioral Health and SUD Services

Expansion of mental health and SUD treatment, including crisis response capacity, school-based behavioral health, and telehealth for areas with no in-person providers. NC only expanded Medicaid in December 2023; over 80 rural counties are mental health professional shortage areas.

Build a Robust and Resilient Workforce and Innovative Care Team Models

Loan repayment with 5-year rural service commitments, community health worker certification and deployment, residency programs, and training pipelines through NC's 9 Area Health Education Centers. NC projects a shortage of 12,500+ RNs by 2033; 33% of LPN positions are currently unfilled.

Ensure Fiscal Sustainability of Rural Health Providers through Innovative Financial Models

Support for rural providers transitioning from fee-for-service toward capitation or population-based payments. NC is pursuing CHART CMS alternative payment model alignment — RHTP investment builds the data systems and care coordination infrastructure that makes value-based payment viable for providers who currently lack it.

Modernize Rural Care Delivery through Digital Solutions

Health information exchange connectivity for rural providers, EHR modernization, digital literacy training, and telehealth infrastructure. NC Health Connex (the state HIE) has expanded but rural provider connectivity remains uneven.

Six decisions that determine who controls RHTP money in each region. The organizations chosen will define how accessible funds are to small rural providers and community organizations. The fiduciary cash flow requirement structurally favors large health systems over community-rooted organizations.

Eastern NC has the worst health outcomes, the most hospital closures, and the weakest organizational infrastructure. A Hub Lead that is both capable of managing $39M and trusted by rural eastern communities may not exist — the selection here reveals whether NC ROOTS will deliver equity or concentrate resources upstate.

EBCI — NC's only federally recognized tribe — could apply as Hub Lead for Region 1 (western NC) or join as a network partner. Their decision signals whether the hub model is accessible to tribal health programs at the $39M fiduciary scale.

Hub Leads must float millions in costs before state reimbursement arrives. Organizations without strong balance sheets or credit lines will struggle. If a selected Hub Lead cannot sustain the cash flow gap, the entire regional network is at risk.

The hub model is only as strong as its network. Thin networks — where Hub Leads award funds primarily to affiliated organizations rather than recruiting independent rural providers — create an extractive rather than distributive structure.