BISMARCK – Gov. Kelly Armstrong issued an executive order Monday, Dec. 29, officially convening the Legislature Jan. 21 in a special session to consider spending federal rural health funds.

Armstrong announced North Dakota has been awarded $199 million from the Centers for Medicare and Medicaid Services (CMS) to support the first year of a statewide Rural Health Transformation Program. The funding will strengthen rural health care by improving access, quality and health outcomes for North Dakotans in rural communities over the next five years.

To accept and appropriate the funds, the Legislature, which meets every two years, requires a special session ahead of the next regular session in 2027.

“With this major investment through the Rural Health Transformation Program, we have a once-in-a-generation opportunity to rethink and reshape how health care is delivered to our rural communities,” Armstrong said in a news release. “We thank President Trump, HHS Secretary Kennedy, CMS Administrator Oz and our congressional delegation for their support in securing this funding, which will benefit citizens across our state and help make North Dakota the best place to live, work and raise a family.”

The state submitted its application to CMS on Nov. 3. The Rural Health Transformation Program centers on four strategic initiatives:

– Strengthening and stabilizing the rural health workforce.

– Making North Dakota healthy again with preventive care and healthy eating.

– Bringing high-quality health care closer to home.

– Connecting technology, data and providers for a stronger North Dakota.

“This funding allows North Dakota to build on existing partnerships and invest in long-term solutions to move toward making our state the healthiest in the nation,” said Pat Traynor, commissioner for North Dakota Health and Human Services (HHS), in the release. “Rural communities face unique challenges, and this program helps ensure people can get the care they need, close to home.”

As part of the application, the state also submitted a request to the U.S. Department of Agriculture for a Supplemental Nutrition Assistance Program (SNAP) food waiver to limit purchases of unhealthy food and help improve health outcomes for North Dakotans who participate in SNAP. The USDA approved the waiver on Dec. 10, making North Dakota eligible for additional funding beyond the $500 million minimum allocated to each state over the five-year period.

Leading up to the special legislative session, HHS is establishing a framework for grant funding prioritization, distribution and sustainability, compliance monitoring in alignment with federal guidance and stakeholder engagement. HHS expects the first release of subaward grant opportunities in the first quarter of 2026.

“Being awarded this grant funding is an important milestone,” said Sarah Aker, HHS medical services executive director, in the release. “Now, our focus shifts to implementation so the resources can start making an impact in rural communities.”

“This nearly $200 million award is a tremendous step toward implementing North Dakota’s plan for creating a more accessible and robust health care system for our rural communities,” said U.S. Sen. John Hoeven, R-ND, in a statement. “With nearly $500 million expected to be awarded to the state over the next five years, these funds will help address staffing needs over the long-term, open up new care opportunities for local residents and improve efficiency to reduce providers’ costs. Through efforts like these, we can improve the health and well-being of North Dakotans across our state and support the continued resiliency of our rural communities.”

“Rural hospitals are essential to the health and economic stability of their communities,” said U.S. Sen. Kevin Cramer, R-ND. “The creation of this fund reflects a clear commitment by the Trump administration to prioritize rural healthcare and protect access to care where it is needed most. I look forward to this money getting to North Dakota and providing the support it was designed to deliver.”

The Rural Health Transformation Program was part of the federal Working Families Tax Cut Act, which appropriated $50 billion over five years, with half allocated equally to all states. The other half was awarded to states based on their applications and metrics that show where the funding can make the most significant health impact in rural communities.