Cook on Concord: A $200 million shot

Rural health investment is a once-in-a-generation chance — if we get it right

Brad Cook

Ever since Gov. Ayotte announced the GO-NORTH medical funding program, which deploys federal funds allocated to New Hampshire by the federal government, there has been much speculation on how it could be used.

This writer inquired about how it was intended to work and what the potential is, talking to the head of the Community Development Finance Authority, Katey Easterly Martey, and others: New Hampshire has been handed a rare opportunity: more than $200 million in federal funding to reshape the future of rural health. Through the state’s Rural Health Transformation plan and the newly launched GO-NORTH initiative, policymakers are aiming not only to repair infrastructure, but to fundamentally rethink how care is delivered, coordinated and sustained across rural communities.

At its core, the initiative is designed to strengthen the full ecosystem that determines whether people can get and stay healthy. That includes expanding access to primary and behavioral health services, improving care coordination, reducing avoidable hospital use, supporting the health care workforce, and addressing persistent barriers like transportation and child care. While capital investments are a visible component, they are a means to a larger goal: building a coordinated, accessible and sustainable system of care that works for rural communities.

The success of this effort will hinge not on funding alone but on how effectively it is implemented. That means prioritizing execution from the outset — clear guidance, timely decision-making and strong coordination across the multiple entities responsible for deploying resources (educational institutions, foundations, governmental and quasigovernmental agencies). Without that focus, even well-designed programs risk falling short of their potential.

Too often, rural health policy focuses narrowly on only one metric, disease or a specific workforce strategy. While staffing is critical, it is only part of the equation. If a clinic lacks sufficient exam rooms, if a nursing home cannot safely discharge patients due to outdated facilities, or if a community cannot attract workers because child care is unavailable, then hiring efforts will fall short.

The program’s recognition of these interconnected challenges — and its inclusion of child care as a workforce strategy — is an important step forward. But translating that insight into results will require aligned action across sectors.

The Community Development Finance Authority (CDFA), one of several designated hubs helping to administer and deploy portions of this funding, brings a strong track record of investing in community health infrastructure.

Other partners across the state will also play critical roles in providing technical assistance, coordinating regional efforts, and ensuring communities can access and effectively use these resources. Success will depend on how well these hubs work together — and how effectively they engage local stakeholders in shaping and implementing projects.

The Rural Community Health Infrastructure Program (RCHIP), administered by CDFA, is a key piece of this broader strategy. As a competitive grant program, it will fund renovation projects that strengthen the spaces where care is delivered. But its impact will depend on more than project selection.

Applicants and administrators alike must ensure that projects are integrated into broader regional strategies, aligned with state goals, and supported by realistic implementation and sustainability plans. Strong collaboration between applicants, state agencies and hubs will be essential to ensure projects move from concept to completion efficiently and effectively.

Sustainability must also remain a central focus. Capital investments are one-time expenditures; long-term success depends on whether communities can staff, operate and maintain what is built. That requires thoughtful planning and coordination with broader funding streams, not just at the project level but across the system, and a sustained commitment for funding on various levels.

Equally important is accountability. Success will be measured not by dollars spent or projects completed, but by outcomes: improved access to care, reduced hospitalizations, stronger behavioral health systems and a more stable workforce. These outcomes will only be achieved if data is shared, progress is evaluated and adjustments are made in real time — another area where collaboration across agencies and providers will be critical.

Finally, these investments offer an opportunity that extends beyond health care.

When executed well, they can strengthen local economies, support working families and make rural communities more vibrant and resilient. A health center can anchor a downtown; expanded child care can enable workforce participation; improved EMS capacity can enhance public safety.

That broader impact underscores what is at stake.

Brad Cook is a Manchester attorney. The views expressed in this column are his own. He can be reached at bradfordcook01@gmail.com.