# Cramer Urges North Dakota Rural Health Coordination

Senator Kevin Cramer asked HHS and CMS to work with North Dakota on a phased transition to changes in Medicaid expansion state-directed payment reimbursements and on implementing the Rural Health Transformation Program (RHTP). The **$50 billion RHTP** and the statutory schedule to begin reducing certain approved state-directed payment rates on **January 1, 2028** could affect rural healthcare funding and delivery. The signal describes a request for agency-state collaboration, not a solicitation or contract award.

- North Dakota healthcare providers and organizations supporting rural healthcare can use the request as planning context for potential changes in reimbursement and RHTP implementation.
- For contractors, this is program and funding context rather than an active procurement opportunity; the signal provides no solicitation, award, vendor, or eligibility details.
- Businesses serving rural healthcare should distinguish RHTP-related funding activity from federal contract opportunities and avoid assuming that the funding will be awarded through a procurement.

**Jurisdictions:** federal
**Industries:** Healthcare
**Topics:** Grants & Funding
**Published:** November 09, 2026

### Government Entities
- U.S. Department of Health and Human Services (HHS)
- Centers for Medicare and Medicaid Services (CMS)
- North Dakota state government
- U.S. Senate

### Key Quotes
> To help address these concerns, I requested Secretary Kennedy and Administrator Oz work with North Dakota on a phased approach to implementing any changes and partner on harnessing the RHTP to transform healthcare in our state.
> — Kevin Cramer, U.S. Senator

### Sources
- [Cramer Requests HHS, CMS Implement Phased Approach, Collaboration With Medicaid Expansion, Rural Health Funding](https://www.cramer.senate.gov/news/press-releases/cramer-requests-hhs-cms-implement-phased-approach-collaboration-with-medicaid-expansion-rural-health-funding) - Cramer Senate