HB 1090, the RURAL Care Act, restructures North Carolina’s existing rural health care stabilization framework into a new Rural Healthcare Infrastructure Fund and a Rural Healthcare Infrastructure Council. The bill creates a nonreverting special fund in the Office of State Budget and Management, administered by the new council, to provide grants and below-market loans for the construction, renovation, modernization, and other infrastructure needs of health care facilities in rural areas. It also recodifies and revises existing statutory provisions, updates terminology throughout the law, and requires annual reporting on fund receipts, expenditures, projects supported, administrative costs, and future spending plans.
The bill does not immediately authorize the council to award assistance. Instead, it directs the council to develop, by July 1, 2027, a detailed implementation plan for a Rural Healthcare Infrastructure Program, including application criteria, eligibility rules, monitoring and compliance procedures, sustainability planning, and an assessment of rural infrastructure needs. The General Assembly must approve that plan before the program can be implemented or financial assistance awarded. The bill also creates a 17-member council with appointments split between the Governor and legislative leaders, includes professional and public representation, bars lobbyists and recent lobbyists from serving, and provides per diem and administrative support through the Department of Health and Human Services.
In terms of state law, HB 1090 repeals most of Article 2 of Chapter 131A, preserves and recodifies the core fund provisions into Chapter 131E, and transfers the remaining unrestricted cash balance of the old Rural Health Care Stabilization Fund into the new Rural Healthcare Infrastructure Fund on July 1, 2026. It also appropriates $1 million in nonrecurring funds to the Department of Health and Human Services to support a contract with Rural Healthcare Initiative, Inc. for continued rural health care planning work and to assist the new council and the Office of Rural Health. The bill further directs that future repayments and fund revenues flow into the new infrastructure fund.
The overall sentiment reflected by the bill’s structure is supportive of rural health investment and modernization, with a strong emphasis on long-term planning, accountability, and legislative oversight. The absence of recorded votes or committee transcript discussion limits direct evidence of debate, but the committee substitute favorable status suggests the bill advanced with at least some committee support. The bill’s design indicates a policy preference for targeted rural infrastructure investment rather than open-ended spending.
Potential points of contention are likely to center on the repeal of the existing stabilization program, the transfer and reallocation of fund balances, the creation of a new council with mixed executive and legislative appointments, and the requirement that the General Assembly approve the implementation plan before any assistance is awarded. Questions may also arise about the use of public funds for a nonprofit contract, the scope of eligible projects, and whether the new fund and council structure will improve access to care in rural communities efficiently and sustainably.
HB 1090 would amend Chapter 131E to create a new Rural Healthcare Infrastructure Fund and a new Rural Healthcare Infrastructure Council, while repealing most of the existing Rural Health Care Stabilization Program in Chapter 131A. It would transfer the remaining unrestricted cash balance from the old stabilization fund into the new fund, redirect future repayments to the new fund, and authorize the fund to support rural health facility construction, renovation, modernization, and related infrastructure projects through grants and low-interest loans. The bill also requires annual reporting and a legislatively approved implementation plan before the program can begin awarding assistance, and it appropriates $1 million for planning and technical support work.
The bill appears generally favorable toward expanding and modernizing rural health care infrastructure, with a policy focus on stabilizing and improving access in underserved areas. The committee substitute favorable status suggests support in committee, but the lack of recorded votes or transcript discussion means there is no direct evidence of broader debate. The structure of the bill indicates a consensus-oriented approach that pairs new funding with oversight and staged implementation.
Likely areas of contention include whether it is appropriate to repeal the existing stabilization program and replace it with a new framework, how much control the General Assembly should retain over implementation, and whether the new council’s membership and appointment structure is balanced. The transfer of existing fund balances, the $1 million nonprofit contract, and the bill’s limits on administrative spending may also draw scrutiny. Stakeholders most likely to have differing views include rural health providers, local governments, legislators concerned about oversight, and parties interested in how funds are allocated among hospitals, clinics, nursing homes, home health, and other infrastructure projects.