Workforce Retention for Critical Access Hospitals and Their Owned and Operated Clinics

North Dakota's Workforce Retention for Critical Access Hospitals solicitation is the first RHTP sub-grant opportunity in the state — and one of the earliest CAH-specific workforce grants in the national RHTP program. ND HHS announced this opportunity on March 18, 2026. The program distributes approximately $10 million across all 37 of North Dakota's CAHs, with an estimated award of approximately $270,000 per hospital. The grant period aligns with the federal Year 1 budget period.

The solicitation is narrow by design: only CAHs and their owned and operated clinics may apply. This targeted approach reflects ND HHS's assessment that workforce retention is the most urgent near-term need for North Dakota's frontier CAH network. Three additional investment pillar solicitations — covering chronic disease, care access, and technology — are listed as "Coming Soon" on the ND HHS funding page and are expected in mid-2026, with broader eligibility including non-CAH entities.

Who may apply: Critical Access Hospitals (CAHs) in North Dakota — all 37 are eligible — and clinics owned and operated by a North Dakota CAH. Who may not apply: FQHCs not affiliated with a CAH, Rural Health Clinics (RHCs) not owned/operated by a CAH, tribal health programs and Indian Health Service facilities, community mental health centers or CCBHCs not owned by a CAH, local health departments, and independent physician practices. The "owned and operated" standard is strict: clinics that have a partnership, affiliation, or management agreement with a CAH but are not formally owned and operated by the CAH entity are likely ineligible. Staff at eligible clinics must be on the applicant CAH's payroll at the time of application posting.

Allowable uses: retention bonuses for current staff, tuition reimbursement for continuing education, childcare subsidies for employees, wellness programs for staff, professional development for staff. Unallowable uses: administrative costs, capital expenditures, vehicle purchases. Financial incentives require a 5-year service commitment from the recipient employee.

Estimated total available: ~$10,000,000 (Year 1). Estimated award per hospital: ~$270,000. Applicants may request more or less than the estimated amount — the $270K figure is an estimate, not a cap. Applications are scored on three published criteria: (1) long-term sustainability of the project; (2) expected impact on rural communities; (3) ability to concretely measure success. With an estimated 37 awards for 37 eligible CAHs, the competitive dynamics may be limited — most eligible CAHs are expected to be funded if applications are compliant.

Tribal health programs are not eligible for this solicitation. None of North Dakota's five federally recognized tribes — the Three Affiliated Tribes (MHA Nation), Standing Rock Sioux Tribe, Turtle Mountain Band of Chippewa Indians, Spirit Lake Nation, and Sisseton Wahpeton Oyate — operates a CMS-designated Critical Access Hospital. The exclusion of tribal health programs from the Year 1 CAH workforce solicitation is the operational consequence of North Dakota's legislative decision not to establish a tribal set-aside. Tribes are eligible under general program language for future rounds.