Gov. Kelly Armstrong asks Legislature to authorize multi‑year appropriation to deploy $199 million in federal rural health funds

BISMARCK, N.D. — Gov. Kelly Armstrong told a joint special session on Wednesday that North Dakota has been awarded $199,000,000 in federal funding for the first year of a Rural Health Transformation Program and urged the Legislature to approve two years of appropriation authority so officials can quickly disperse a potential second tranche.

Armstrong said the award — the result of an application to the Centers for Medicare and Medicaid Services (CMS) — is aimed at strengthening health care across the state, especially in rural counties that face shortages of primary care providers. "This program is a pivotal step forward in strengthening North Dakota health care across the state," Armstrong said in the joint session.

The governor outlined four pillars for the plan: promoting community wellness (including nutrition and exercise initiatives and substance‑abuse prevention), stabilizing the rural health workforce with training and retention grants, expanding access through telehealth, transportation and mobile clinics, and using better technology and data to make the system more responsive.

Armstrong said an interim Rural Health Transformation Committee and broad stakeholder input helped shape the application and that four bills endorsed by that committee "significantly helped" North Dakota's CMS application score. He said he expects to sign those bills along with an accompanying appropriation measure. According to Armstrong, the state is projected to receive at least $500,000,000 over five years depending on deployment of the funds.

The governor described what the plan will not do: it will not rely on constructing new state buildings or creating unsustainable programs that would become long‑term taxpayer obligations once federal funding ends. "We must create lasting impact that we can sustain after this federal funding expires," Armstrong said.

Armstrong also reviewed the process that led to the application: a statewide survey, three listening sessions last fall, and the interim committee's October endorsements. He said officials filed the state's application to CMS in early November and that the year two award period begins Oct. 1, creating the need for multi‑year appropriation authority to ensure timely distribution.

Procedural notes: Representative Bosch moved to appoint committees to escort Lieutenant Governor Michelle Strinden and Governor Armstrong to the rostrum and to print the governor's remarks in the journal; the motions carried on voice votes. After the governor's address, the joint session was dissolved by voice vote and the House adjourned until 8:30 a.m. Thursday, Jan. 22, 2026.

Armstrong closed his remarks by thanking legislators, tribal leaders and federal partners for their work on the application and urging careful stewardship and tracking of the new funds.