North Dakota
North Dakota Health and Human Services (ND HHS)
Year 1 Award
$198.9M
Solicitations
01
This state has published its solicitation framework — eligible entity criteria and allocation methodology are available — but has not yet opened the formal application window.
Analysis
North Dakota stands out in the RHTP cohort as one of the fastest-moving Phase 2 states: ND HHS has already posted its first sub-grantee funding opportunity — a workforce retention grant for Critical Access Hospitals — with an April 30, 2026 application deadline, making North Dakota one of the first states to actually open a solicitation window to providers. The state's RHTP program is organized under four investment pillars (Workforce, Chronic Disease, Care Access, and Technology) with additional funding categories noted as "Coming Soon." The phased release model — one solicitation type at a time, announced over time — reflects a pragmatic approach to a state with 37 CAHs and a frontier geography that makes centralized capacity-building difficult. The tribal dimension in North Dakota is one of the most significant compliance and policy tensions in this state's RHTP implementation. North Dakota is home to five federally recognized tribes — including the Three Affiliated Tribes (MHA Nation), Standing Rock Sioux Tribe, Turtle Mountain Band of Chippewa Indians, Spirit Lake Nation, and Sisseton Wahpeton Oyate — representing a large share of the state's population in frontier counties. The KFF Health News tribal RHTP analysis confirmed that North Dakota legislators "declined to support a proposal that would have pledged 5% of federal allotment to tribes," meaning no dedicated tribal set-aside exists in the current program structure. Tribes are eligible as applicants under general program language, but the absence of a set-aside in a state with high frontier-tribal overlap is a significant equity signal. The first CAH-focused solicitation explicitly excludes non-CAH entities, meaning tribal health programs operating outside a CAH structure are not eligible for Year 1 funds.
Applications & Compliance
Implementation Model
North Dakota is using a direct-to-provider competitive grant model, administered by ND HHS, with funding released in phases by investment pillar. Applicants apply directly to ND HHS (not through a regional intermediary or hub). The first solicitation — Workforce Retention for Critical Access Hospitals and Their Owned and Operated Clinics — targets all 37 of North Dakota's CAHs with an estimated $270,000 per hospital (total pool approximately $10 million). Applications are submitted via Qualtrics (not a state procurement portal), and the state has indicated that additional eligibility sites will be added in mid-2026 funding rounds. Three additional investment pillar solicitations are listed as "Coming Soon" on the funding page: Make North Dakota Healthy Again (chronic disease), Bringing High Quality Care Closer to Home (care access/telehealth), and Connecting Technology, Data and Providers for a Stronger ND (technology infrastructure). For smaller organizations — FQHCs, tribal health programs, RHCs — the Year 1 model effectively excludes them from the first funding round (CAHs and their owned/operated clinics only). Mid-2026 funding rounds are expected to broaden eligibility. Organizations that cannot apply as CAHs should monitor the ND HHS RHTP funding page (hhs.nd.gov/rural-health-transformation/funding) and consider reaching out to rhtp@nd.gov for advance notice of upcoming opportunities.
Investment Priorities
Strengthen and Stabilize Rural Health Workforce
The first-year priority. Funding covers retention bonuses, tuition reimbursement, childcare subsidies, wellness programs, and professional development for staff at CAHs and their owned/operated clinics. Financial incentives require 5-year service commitments. Staff must be on payroll at the time of application posting. No administrative costs, capital expenditures, or vehicle purchases are allowable. Technical assistance call scheduled for March 30, 2026.
Make North Dakota Healthy Again
Listed as "Coming Soon." Addresses chronic disease prevention — obesity reduction, physical activity, depression/anxiety/suicide prevention, farm-to-table food distribution. Aligns with "Eat Well ND" and "ND Moves Together" state initiatives.
Bringing High Quality Care Closer to Home
Listed as "Coming Soon." Focuses on expanding telehealth access, increasing preventive services, improving care timeliness for frontier communities. Telehealth hubs and mobile clinics are listed as intended investments.
Connecting Technology, Data and Providers for a Stronger ND
Listed as "Coming Soon." Modernization of health data systems, improved transparency, shared infrastructure across providers and counties. AI-assisted care and remote monitoring are mentioned as specific areas of investment.
What to Watch
CAH workforce grant application window (ACTIVE — closes April 30, 2026)
ACTIVEThe Workforce Retention for Critical Access Hospitals solicitation is currently open. Only CAHs and their owned/operated clinics are eligible for Year 1 funds. Applications are due April 30, 2026, 5:00 PM CT via Qualtrics. Award amounts are approximately $270,000 per hospital (37 awards expected; applicants may request more than the estimated amount). Monitor hhs.nd.gov/rural-health-transformation/funding/workforce for any updates or deadline changes.
Mid-2026 solicitations for broader eligible entities
Mid-2026ND HHS has explicitly stated that "additional funding opportunities will be announced in mid-2026" and will include "additional eligibility sites" beyond CAHs. This is the signal for FQHCs, RHCs, tribal health programs, and community organizations to begin preparation. The phased model means the full range of investment categories and eligible entity types won't be available until later in the program year.
Tribal eligibility in future funding rounds
Mid-2026North Dakota's legislative process produced a notable outcome: a proposal to pledge 5% of federal allotment to tribal nations was declined. No tribal set-aside exists. However, the state's RHTP plan does propose physician residency expansions with tribal rotations. Whether tribes and tribal health programs can access future funding rounds as direct applicants is a critical signal to monitor. The five federally recognized tribes — MHA Nation, Standing Rock, Turtle Mountain, Spirit Lake, Sisseton Wahpeton — collectively serve frontier communities with among the worst health outcomes in the state.
Phased release pace and Year 1 expenditure pressure
Summer 2026The phased solicitation model (one pillar released at a time) creates expenditure pressure: North Dakota must spend Year 1 funds by September 30, 2027. With only one solicitation open as of late March 2026, and three more pillars listed as "Coming Soon," the pace of solicitation release and award processing will determine whether the state meets the federal deadline.
Frontier geography and organizational capacity
Year 1North Dakota has 37 CAHs serving an extremely sparse frontier population (39% nonmetro, average county density among the lowest nationally). Many CAH applicants in Year 1 may be single-facility organizations with limited grant administration experience. Watch for whether ND HHS provides technical assistance beyond the March 30 call.