New Hampshire is about to become one of the most closely watched test cases in rural health reform nationwide.
Beginning this year, more than $1 billion in federal funding will flow into the state over the next five years—an unprecedented investment aimed at expanding access to care, strengthening the rural workforce, and modernizing aging health infrastructure. For rural providers, municipalities, and community partners, the opportunity is significant—but so is the competition to access these dollars. The funding is being delivered through the federal Rural Health Transformation Program and New Hampshire’s newly created Office of New Opportunities & Rural Transformational Health (GO‑NORTH) initiative, a hub‑based model that will shape how and where resources are deployed across the state.
Here’s how the program is unfolding—and why the details matter for organizations on the ground.
Why this funding is different
New Hampshire’s GO-NORTH initiative is funded through the “One Big Beautiful Bill,” which distributes $10 billion annually across all 50 states from 2026 through 2030. The Centers for Medicare & Medicaid Services (CMS) awarded New Hampshire over $204 million for 2026—the largest first-year award in New England—with similar annual allocations expected through 2030, totaling more than $1 billion for the state over the life of the program. The funds are designed to make health care more affordable and accessible in rural communities, with an emphasis on primary care access, workforce development, capital improvements, and behavioral health.
How NH is deploying the money: GO-NORTH and the hub structure
To deploy the funds, Governor Ayotte established the Governor’s Office of New Opportunities & Rural Transformational Health (GO-NORTH) and appointed Donnalee Lozeau—formerly CEO of the Community Action Partnership for Hillsborough and Rockingham Counties—to lead the effort. GO-NORTH oversees six hubs that together will manage more than $1 billion in federal grants over the next five years.
Five of the hubs are organizations pre-approved by CMS as part of NH’s original grant application:
- Foundation for Healthy Communities
- NH Community Development Finance Authority
- University System of NH
- Community College System of NH
- NH Community Behavioral Health Association
GO-NORTH itself serves as the sixth hub, and will issue its own competitive RFPs to direct funding to communities across the state.
Latest Action: Executive Council approves four hub contracts (March 16)
The path to approval had a brief but notable detour. In early March, the Executive Council unanimously voted to table the initial contracts, with councilors saying the program felt rushed and needed more scrutiny. Among their chief concerns was that the hub contracts were sole-source—awarded without competitive bidding—and that the council lacked sufficient oversight over how funds would be spent downstream. GO-NORTH addressed those concerns by agreeing to a 10% cap on administrative costs, adding contract renewal dates requiring Executive Council reapproval, and committing that hubs would return to the council for approval before issuing any sole-sourced sub-grants. With those agreements in place, the council signed off unanimously on March 16.
The four approved contracts authorize $133 million in first-year spending across the following hubs:
- Foundation for Healthy Communities — $66.6 million
- Supports rural providers such as federally qualified health centers, critical access hospitals, county nursing homes, home health agencies, and EMS units, with the goal of expanding access to primary care and prevention.
- NH Community Development Finance Authority — $43.8 million
- Funds rural capital improvement programs, including large county nursing home renovation projects in Coos and Merrimack counties, and efforts to embed child care programs within rural health care providers.
- University System of NH — $15.7 million
- Expands site-based and online educational programs for rural employers and launches the Governor’s Health Scholars Awards Program to grow the rural health professional workforce.
- Community College System of NH — $6.7 million
- Builds career pipelines from high school through post-secondary programs through expanded paraprofessional training, career navigation, employer-linked apprenticeships, and mobile clinical simulation training.
What organizations should be watching now
The four approved hubs will begin designing their programming and deploying funds to communities across the state. The Executive Council will also vote later this spring on nine competitive RFPs that the hubs plan to issue before making final sub-grant decisions. A fifth hub contract—with the NH Community Behavioral Health Association—is expected to come before the council around March 25. GO-NORTH, as the sixth hub, will separately issue its own competitive RFPs to direct additional funds statewide. Year-two funding decisions will return to the Executive Council for approval in October 2026.
Bernstein Shur’s Strategic Economic Solutions (SES) group is advising organizations on how to position themselves to participate meaningfully in addressing these significant challenges to rural health care.
To discuss further, reach out to Taylor Caswell, Managing Director of SES, at [email protected].