RHIF Frequently Asked Questions
About the Fund
The Rural Health Innovation Fund (RHIF) is an annual investment that helps rural health care providers use technology to improve how they deliver and coordinate care. It can help providers update systems, adopt digital tools and make care easier to manage for patients and providers. RHIF is part of the NC Rural Health Transformation Program (NCRHTP) and is delivered in partnership by NCDHHS and NCDIT.
About $20 million is planned for the Rural Health Innovation Fund each year for up to five years, contingent on continued funding from CMS.
Rural health care providers may not have access to the technology and tools that can make care easier to deliver, coordinate and manage. RHIF provides funding to help providers update their technology, better connect systems and information and use digital tools to improve care.
In June 2026, NCDHHS established an Interagency Agreement with NCDIT (Division of Broadband and Digital Opportunity) to administer the RHIF.
Eligibility
To apply for Year 1, Round 1, your organization must meet all four requirements:
- Health care organization: Meet the definition in North Carolina administrative code definition (10A NCAC 41A .0206(a)(1)).
- Serve rural North Carolinians: Be located in one of the 85 eligible rural counties or show that at least 40% of your patients live in rural areas.
- Meet risk requirements: Receive a low- or medium-risk assessment. High-risk applicants are not eligible.
- Be in good standing: Not be sanctioned or debarred by federal CMS or NC Medicaid.
For this funding round, your organization meets the rural requirement if:
- your facility is in one of North Carolina's 85 eligible rural counties; or
- at least 40% of the patients you serve live in rural areas.
The county list is based on the federal Federal Office of Rural Health Policy (FORHP) designation. You can check whether a county is FORHP-designated using the HRSA Rural Health Grants Eligibility Analyzer and filtering by State/County at https://data.hrsa.gov/topics/ruralhealth/rural-health-eligibility#ByStateCounty
Yes. Your organization may qualify if at least 40% of the patients you serve live in rural areas, even if your organization is located in an urban or suburban area.
Yes, the RHIF is designed with rural and small-practice needs in mind. Independent practices, local health departments, clinics, and safety-net providers are among those who can apply.
No. Organizations that don't meet the healthcare-organization definition cannot apply directly. Applicants may, however, use any qualified vendors and should detail vendor roles in their proposals.
No, matching funds are not required for this round.
It depends on the eligibility requirement. The Technical Assistance Center will notify you after the Intake Assessment if you do not meet the health care organization, rural or goodstanding requirements. NCDIT will notify applicants who do not meet the risk requirements after the full application.
Yes. Priority determines review order only; non-prioritized applicants are still reviewed and can be awarded.
What the Funds Can Be Used For
Funds support digital health modernization: telehealth/e-consults, remote patient monitoring, EHR upgrades/optimization, HIE connections, cybersecurity, data integration, analytics, patient portals, AI decision support, and related implementation services.
Yes — EHR upgrades and optimization are within scope, and RHIF is vendor-agnostic. Applicants must note in their application if they are seeking funding to support the replacement of an Electronic Medical Record (EMR) system if a previous HITECH certified EMR system is already in place as of September 1, 2025, due to CMS funds tracking.
Yes, within a defined limit. Awardees may have access to an additional 20% of their total funding ceiling to be used for implementation support. Access to that full 120% of the funding ceiling is based upon the merits of the application.
Yes, for cybersecurity needs — but not cybersecurity insurance. Applicants should explain how the upgrade meets their organizational and compliance needs.
Yes.
Broadband infrastructure buildout, building construction or renovation, food purchases, and cybersecurity insurance are all unallowable.
Funding Tiers
Your Intake Assessment score places you in one of five tiers:
| Tier | Name | Range | Focus (Examples) |
|---|---|---|---|
| 1 | Foundational Technologies | $0-$50,000 | Core hardware, internet hardware, scheduling software |
| 2 | Baseline EHR | $0-$200,000 | Acquire/upgrade a certified EHR that connects to NC HealthConnex |
| 3 | Interoperability | $0-$140,000 | FHIR APIs, HIE connections, data upgrades |
| 4 | AI Clinical Decision Support | $0-$200,000 | AI scribe, CDS, AI revenue cycle |
| 5 | Emerging Technologies | $0-$250,000 | RPM, telehealth platforms, predictive analytics |
No — the technology types are examples, not an exhaustive list. RHIF is vendor-agnostic.
How to Apply
- Complete the Intake Assessment. This determines whether you can move forward and your funding tier.
- Get help if you need it. The Technical Assistance Center can help you understand requirements and prepare your application.
- Submit your application. Complete the full application and risk assessment through the NCDIT Grant Portal.
The TAC provides office hours, guidance, and support on requirements, workflows, and sustainability planning.
It's a competitive, merit-based process. Applications showing clear impact, a strong sustainability plan, and demonstrates it is serving rural residents are favored over those that don't.
Applicants are required to only have a Unique Entity ID because you are applying for a subaward and not applying directly for federal funds. You can get a UEI for your entity without having to complete an entity registration. Visit SAM.gov for more information.
Timeline & Key Dates
| Milestone | Date |
|---|---|
| Intake Assessment Opens | September 30, 2026 |
| Application Opens | October 15, 2026 |
| Intake Assessment Closes | October 31, 2026 |
| Application Closes | December 7, 2026, at 11:59 p.m. |
| Review Window | November - December 2026 |
| Awards Announced | Anticipated January 2027 |
| Year 1 Activity Completed | July 30, 2027 |
| Year 2, Round 1 Opens | March 2027 |
After You Apply: Payment & Reporting
RHIF uses a reimbursement model. This means your organization generally pays an approved expense first and then submits documentation to be reimbursed.
Standard subrecipient requirements: periodic progress/outcome reports on program templates, expenditure documentation, interoperability compliance. Templates and cadence come with award agreements.
Round 1 awards are anticipated in January 2027; all applicants are notified, and those not awarded receive appeal-process information.
Once the award agreement (reimbursement) is signed, purchases can be made. The subrecipient will then submit the paid invoice(s) requesting reimbursement along with an expense report. The timeline from the approved expense report and invoice to the payment of reimbursable funds is 60 days.
Getting Help
Email RHIF@nc.gov and visit the NCRHTP website.
Yes — additional sessions will be announced through official channels.
Stevens Amendment Disclosure: This webpage is supported by the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $213,008,356.47 with 100% funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS, or the U.S. Government.