Gov. Kelly Armstrong signs legislation that positions North Dakota to launch its Rural Health Transformation Program. Jan. 23, 2026
BISMARCK, N.D. (KFGO) – Gov. Kelly Armstrong signed legislation that positions North Dakota to launch its Rural Health Transformation Program, with nearly $200 million in federal funding appropriated for the first year of the five-year initiative.
Armstrong thanked lawmakers for their work during a three-day special session, which concluded Friday morning.
“Our citizens who depend on rural health care stand to benefit greatly from this program, and the Legislature deserves a ton of credit for staying focused and quickly moving these bills across the finish line,” Armstrong said. “Now comes the challenge of deploying these dollars in ways that improve the health and well-being our citizens.”
Armstrong convened the special session to address $199 million awarded in late December by the U.S. Centers for Medicare and Medicaid Services (CMS) for the first year of the Rural Health Transformation Program. The program aims to strengthen rural health care by improving access and health outcomes for North Dakotans in rural communities over the next five years.
Lawmakers approved an appropriations bill authorizing total program expenditures of $398 million over the first two years. That assumes funding will remain constant in the second year, though that won’t be known until the award is announced in October.
The process began last summer with a statewide survey, followed by listening sessions in the fall and the drafting of bills by an interim committee in October. The state filed its application to CMS in early November and was notified of the $199 million award in late December.
Armstrong thanked the Legislature’s Rural Health Transformation Committee for its work on the four policy bills to make state law consistent with federal law, improving the state’s application score with CMS and resulting in an award that nearly doubled the base funding level of $100 million for each state.
The four bills:
- Require the Presidential Physical Fitness test in physical education courses, with criteria and exceptions established by the North Dakota Department of Public Instruction.
- Add nutrition education to the continuing education requirements for physicians.
- Allow North Dakota to join the physician assistant licensure compact.
- Expand the scope of practice for pharmacists to allow them to order certain laboratory tests and independently prescribe certain medications to patients.
The North Dakota Department of Health and Human Services will now promote the program’s upcoming grant opportunities and encourage participation across the state. Listening sessions, technical assistance calls, meetings and outreach activities are currently being planned.
The Rural Health Transformation Program, part of the federal Working Families Tax Cut Act passed by Congress and signed into law by President Trump, focuses 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.
The HHS website will post ongoing updates, timelines and announcements related to the rural health transformation efforts.
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