The legislature adjourned the three-day special session today after the passage of five bills setting the $199 million federal award to North Dakota for the Rural Health Transformation Program in motion.

“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, and we’re excited to work with our partners across the state to make North Dakota the healthiest state in the nation.”
The program aims to strengthen rural health care by improving access, quality and health outcomes for North Dakotan’s in rural communities over the next five years. North Dakota has the opportunity to receive $1 billion over that time for this purpose but those future dollars hinge on how they are utilized in year one.
Lawmakers approved an appropriations bill authorizing total program expenditures of $398 million over the first two years which assumes the funding would remain constant in year 2, although that won’t be known until the award is announced in October 2026.
The ND Department of Health and Human Services will be promoting and overseeing the grant and application process. The grants will focus on four initiatives:
- Strengthening and stabilizing rural health workforce.
- Making ND healthy again with preventative care, activity, and nutrition.
- Bringing high-quality health care closer to home.
- Connecting technology, data and providers for a stronger ND.
There is an urgent timeline for these funds to be applied for, obligated and spent. The funds need to be obligated by October 1st, 2026 and spent by September 2027.
“We encourage our counties to start thinking and brainstorming about programs and projects they may want to apply for grant dollars. This is an incredible opportunity in our state to expand and improve the health of our citizens. Top of mind could be programs, equipment or improvements for public health, jails, NDSU Extension, county parks, county food banks, or projects to increase activity of residents,” said NDACo Executive Director Aaron Birst.
NDDHHS is expected to open the application process in February. NDACo will keep you informed on the applications and timeline when more information is released. You can sign up for updates on the program at the NDDHHS website that also includes more information on the program.
Four policy bills were also passed during the special session to enhance the Rural Health program that does the following:
- 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.
Lawmakers Act on other bills unrelated to Rural Health Transformation Program
Legislative Management on Tuesday allowed for six bills and one resolution to be considered as well during the special session. Lawmakers defeated two bills that addressed school lunches. HB 1627 expanded the current eligibility for free school meals, HB 1624 would have provided free school meals to all students. These bills were submitted in hopes of heading off a proposed ballot measure that would put it in the state’s constitution for the state to cover the cost of school breakfasts and lunches.
The other bill of note relates to how the discount for paying property taxes early is applied to the primary residence credit (PRC) on tax bills. HB 1626 ensures those receiving the PRC get the full amount of the PRC. Starting in tax year 2026, the discount will be applied before the PRC. Click here to view the video from HB 1626’s hearing.
Listing of un-related bills acted on during special session:
- HB 1624 – School Meals – DEFEATED
- HB 1627 – School Meals – DEFEATED
- HB 1626 – Discount for early payment of property taxes – PASSED
- HB 1625 – Use of proceeds from sale of UND Golf Course land – PASSED
- SB 2403 – $5 million low interest loan for Jacobson Memorial Hospital in Elgin – PASSED
- SB 2404 – Emergency funding for PSC & ITD
- HCR 3038 – Recognizing 175th Anniversary of YMCA











