North Dakota lawmakers will allocate hundreds of millions in federal funds to rural health programs during a three-day special session beginning January 21. Legislators will discuss five bills including one enabling the North Dakota Department of Health and Human Services to spend $397.9 million in federal money over the next two years.
The funds are part of more than $500 million North Dakota expects to receive through the rural health transformation program from the Centers for Medicare and Medicaid Services over five years. President Donald Trump created the grant through the One Big Beautiful Bill, with states splitting $50 billion for fiscal years 2026 through 2030. U.S. Senator John Hoever said he is working to double North Dakota’s grant to $1 billion.
North Dakota officially received $198.9 million for fiscal year 2026. Future funding could change depending on how effectively Health and Human Services spends money on programs and how closely the state follows federal requirements, according to HHS Chief Financial Officer Donna Aukland. If the state strays too far from requirements or misses the October 30 deadline to contract funds, CMS will take the money back and reduce future funding.
The state must allocate funds to four categories with “target” allocations: 58.4% for care closer to home, 16.8% to connect tech and data, 16.2% for workforce recruitment and retention, and 8.6% to “make North Dakota healthy again.” The latter could include programs promoting exercise, healthier eating, behavioral health and wellness support, and value-based programs. Federal money cannot go toward purchasing land, buildings, or construction, though “minor” renovations are allowed. Four policy bills accompanying the appropriations would require school-aged children to take a presidential fitness test every four years, mandate physicians complete nutrition and metabolic health education for license renewal, allow physicians from 20 other states to practice without relicensing, and let pharmacists prescribe certain medications.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.inforum.com/news/north-dakota/north-dakota-legislature-prepares-to-spend-400m-during-rural-health-special-session