GO-NORTH: NH Launches a Billion-Dollar Investment in Rural Health

New Federal Funding Demands Both Agility and Accountability

Special Executive Council Meeting to be Held: Monday, March 16, 2026, at 1 pm

Recently, New Hampshire lawmakers approved a major federal investment that could shape health care access — and affordability — across the state for years to come.

Legislative budget writers accepted $204 million in federal Rural Health Transformation Funds (RHTF), allowing the state to begin hiring staff and preparing to award contracts to organizations workin

g to improve care in the North Country and other rural areas. The new federal funding is part of a broader federal rural health initiative approved by Congress last year, and New Hampshire received the largest first-year award of any New England state. The $204 million award is eligible to be renewed for five years - if key outcomes are achieved - for a total allocation of just over a billion dollars. 

This investment matters — not only for rural communities, but for the entire New Hampshire health care system.

The RHTF funding in New Hampshire is administered through the new Governor’s Office of New Opportunities and Rural Transformational Health (GO-NORTH), led by former Nashua mayor and statewide non-profit leader Donnalee Lozeau. Over the next 18 months, the office plans to hire roughly 20 staff members and begin issuing requests for additional proposals so nonprofits, health providers, educational institutions, and community organizations can compete for funding aimed at strengthening rural health systems.

While the GO-NORTH activity is officially underway, the first round of contracts to implement key RHTF programs did not move smoothly through the Executive Council, which voted on March 4 to table $773 million in related contracts amid concerns about the proposed structure and the need for greater transparency and accountability.

As proposed, the state’s RHTF plan would use five “hub” organizations to distribute funds, raising questions about whether sub-grants could be issued by these entities without competitive bidding or direct Council approval. Gov. Kelly Ayotte has defended this approach as necessary to move funds quickly into communities, promising oversight and full transparency as the program moves forward. Without agility in distributing funds to rural health providers and statewide partners, DHHS and executive leaders are concerned that deadlines and outcomes will not be met. The funding debate comes as rural populations also face mounting impacts from cuts to Medicaid and the elimination of health insurance subsidies.

A special meeting of the Executive Council has been set for March 16 at 1 pm to revisit these pending contracts.

According to recent Executive Council filings, the state is launching the first round of funding and administration through the GO-NORTH office, with proposed contracts under consideration totaling $773 million over the next five years. The Executive Council has begun the process of reviewing these agreements, but action has been tabled while outstanding concerns are addressed. 

The proposals before the Executive Council show the state is planning to distribute much of the funding through several key institutions: The Foundation for Healthy Communities, a Concord-based nonprofit that partners with hospitals and health system stakeholders, would coordinate clinical investments intended to expand access to primary care, specialty services, emergency care, home-based care, and school-based health programs. The Community Development Finance Authority would help finance infrastructure improvements that strengthen rural health care networks and facilities. The NH Community Behavioral Health Association will receive funding to strengthen the mental health system by coordinating sustainable models of care that are responsive to local needs.

Meanwhile, workforce development is expected to play a major role. The University of New Hampshire would lead efforts to expand rural health career pathways, including administering a new Governor’s Health Scholars Award Program that would support students pursuing careers in high-need fields such as nursing, behavioral health, dental care, and primary care. In exchange, students receiving support would commit to working in rural communities after graduation. The Community College System of New Hampshire would also receive funding to expand training programs and partnerships with high schools and rural health providers to strengthen the health workforce pipeline.

The focus of the GO-NORTH investments is to address several long-standing challenges in rural health care: to improve access to primary care, address workforce shortages, expand behavioral health services, and strengthen coordination across health systems. One proposed initiative would establish certified community behavioral health clinics, allowing community mental health centers to receive higher reimbursement and expand services for patients who are uninsured or underinsured. These services often operate under significant financial strain, and strengthening them could help relieve pressure on hospital emergency departments and reduce costly gaps in care.

As New Hampshire moves forward, rural health policy must be closely tied to the broader conversation about health care affordability. When access to primary care or behavioral health services breaks down or is out of reach, patients delay treatment. Conditions worsen, emergency departments become the default source of care, and hospitals absorb more uncompensated costs. Those costs ultimately ripple across the system, contributing to higher insurance premiums and higher deductibles statewide. A shortage of providers in Coös County may seem like only a local issue, but its financial impact can be felt by families and employers in Concord, Manchester, and Nashua.

The GO-NORTH initiatives also come with a tight timeline. The first round of funding must be deployed relatively quickly, and future federal support will depend in part on whether the program demonstrates measurable improvements in access and outcomes on a short horizon. In that sense, the program represents both an opportunity for innovation and a test of nimble implementation. If New Hampshire can show that targeted investments improve access to care and strengthen rural health systems, additional funding could follow. If not, the program could be scaled back.

Many important details still remain unresolved. The upcoming contract awards and next round of grantmaking will determine which organizations are funded, what projects are prioritized, and how success will be measured. More requests for proposals are expected in the coming months, and should provide a clearer picture of priorities and expectations.

For those focused on health care costs in New Hampshire, the state’s GO-NORTH initiative sits at an important crossroads. The state has spent years debating hospital pricing, insurance premiums, and market concentration. Those issues remain critical. But this investment recognizes another reality: health care costs are also driven by what happens outside hospital walls. When prevention, primary care, and behavioral health systems fail upstream, the entire system pays the price later.

This federal investment of RHTF funds in GO-NORTH represents one of the largest targeted health initiatives New Hampshire has ever undertaken. The state must execute with both agility and accountability. Whether it ultimately improves access and affordability will depend less on the size of the grant and more on how strategically it is managed. The essential question is whether it will be deployed in a manner which will change outcomes — improving access, strengthening rural communities, and reducing the cost burden faced by families and employers across the state.