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A blog for aging services leaders, homeless services providers, and the practitioners bridging both worlds.
North Carolina’s Rural Health Transformation Program (RHTP) is bringing more than 200 million dollars in new federal investment to rural communities in 2026, with a five-year plan to redesign how care is delivered, paid for, and connected to social supports across the state.
Background
RHTP is a federal program created under H.R. 1 that allows states to apply for multi-year allotments to transform rural health care access, quality, and sustainability. North Carolina submitted its application in November 2025 and received approval from the Centers for Medicare & Medicaid Services (CMS) at the end of 2025.
Nationwide, RHTP sets aside 50 billion dollars over five fiscal years (2026–2030), with half distributed evenly across approved states and half allocated based on factors such as rural population size and the number and condition of rural health facilities. For North Carolina, this structure recognizes that the state has the second-largest rural population in the country and a robust safety-net infrastructure that can be leveraged for transformation.
Why RHTP Matters in North Carolina
More than 3 million North Carolinians live in rural areas. They face persistent challenges in accessing primary care, behavioral health, maternal health, and specialty services. Rural hospitals and clinics often operate on razor-thin margins, struggle to recruit and retain staff, and depend heavily on fee-for-service payment models that reward volume rather than outcomes.
In December 2025, CMS awarded North Carolina approximately 213 million dollars in first-year RHTP funding to begin addressing these challenges. Over the full five-year period, the state expects hundreds of millions in additional federal investment tied to RHTP participation. State leaders have framed this as a once-in-a-generation opportunity to stabilize rural providers while building more integrated, community-rooted models of care.
Core Strategies of North Carolina’s RHTP Plan
North Carolina’s RHTP plan organizes its work around several core strategies designed to meet rural needs while aligning with value-based care and population health goals. Key strategies include:
Expanding behavioral health services, including treatment for substance use disorders and improved access to mental health care in rural communities.
Improving prevention and chronic disease management, with a focus on high-burden conditions and underserved ZIP codes.
Strengthening maternal health and nutrition programs to improve outcomes for rural families and children.
Investing in the rural health workforce through scholarships, internships, training on team-based models, and high-school-to-job pipelines.
Supporting providers as they transition to value-based care, such as primary care capitation pilots and new rural Medicaid VBP arrangements.
Enhancing health care technology and infrastructure to support data sharing, telehealth, and care coordination.
Spotlight on NC ROOTS Hubs
At the center of North Carolina’s approach are NC ROOTS (Rural Organizations Orchestrating Transformation for Sustainability) Hubs, regional, locally governed networks that will coordinate services and lead implementation of RHTP initiatives. Each NC ROOTS Hub will:
- Serve as a regional backbone organization, responsible for convening partners and managing funds for its area;
- Build a network that can include hospitals, FQHCs and RHCs, local health departments, behavioral health providers, community-based organizations, schools, and other local partners;
- Align and implement statewide initiatives like chronic disease prevention, behavioral health expansion, workforce, and value-based care so they make sense in each rural region, and
- Lead regional planning and needs assessments, and track performance measures so the work can adapt over time.
In practice, many of the concrete opportunities people are watching for, e.g. regional grants, care coordination investments, chronic disease and behavioral health projects, and technical assistance around value-based payment, are likely to flow in and through these NC ROOTS structures.
Why This Matters for Aging Services
It’s no secret that rural North Carolina is getting older. The same access gaps RHTP is tackling, including primary care, behavioral health, transportation, nutrition, and chronic disease management, are exactly the issues aging and adult services have been working on for years.
NC ROOTS Hubs give Area Agencies on Aging, senior centers, home-delivered meals providers, transportation programs, and caregiver support initiatives a new regional table to plug into. As hubs map needs and build out referral and care coordination pathways, aging partners can help define what aging in place should look like in each rural region and bring longstanding services and relationships into the center of the conversation. For older adults and their caregivers, that could eventually translate into more coordinated access to primary care, behavioral health, and community supports without having to navigate multiple disconnected systems on their own.
How Technology Like CaseWorthy Fits In
As NC ROOTS Hubs start to knit together rural health, behavioral health, and social supports, the technology behind that coordination will matter just as much as the funding. CaseWorthy is already supporting aging and human services organizations across North Carolina, helping more than 40 county agencies and nonprofits connect programs, partners, and data in a single, secure system instead of relying on fragmented spreadsheets and point solutions.
That kind of shared platform is exactly what regional hub models need to track referrals, document services, and see the full picture of a person’s journey across multiple programs. With integrations to statewide tools and a focus on person centered, closed loop workflows, platforms like CaseWorthy can give NC ROOTS Hubs and their partners the data backbone they need to make RHTP investments visible, accountable, and sustainable over time.
