New Hampshire’s Executive Council voted unanimously Monday to approve roughly $130 million in contracts for the state’s new rural health initiative, clearing a path for funding that had been briefly stalled over transparency concerns.
The state stands to receive approximately $200 million annually through the end of the decade from the federal Rural Health Transformation Program. The money targets health care affordability and access in rural communities. Gov. Kelly Ayotte launched the GO-NORTH initiative in late 2025 to manage those federal dollars, appointing Donnalee Lozeau, formerly CEO of the Community Action Partnership for Hillsborough and Rockingham Counties, to direct the program.
Earlier this month, GO-NORTH submitted contracts to the Executive Council to get the work moving. The council pumped the brakes, tabling the contracts to allow more time for review. Ayotte responded by calling a special session, which took place Monday. After receiving assurances that oversight and safeguards were built into the program, councilors approved the contracts without dissent.
The approved funding flows through four organizational “hubs” that will redistribute money to rural health projects across the state. The University System of New Hampshire and the Community College System of New Hampshire will focus on workforce development. The New Hampshire Community Development Finance Authority will handle capital improvements for health and child care facilities. The Foundation for Healthy Communities will address primary care access, new technologies, and related challenges. A fifth hub, Community Behavioral Healthcare, is in line for funding but will require separate council approval at a later meeting.
Planned projects under GO-NORTH include expanding telehealth options, improving transportation to and from rural hospitals, and helping rural health facilities navigate insurer reimbursement processes. Councilors also pushed for attention to rural emergency medical services and uncompensated care, two pressure points that strain rural health systems. Lozeau indicated both areas were already on the program’s radar.
The contracts drew scrutiny in part because they were awarded without a competitive bidding process, a practice known as sole-source contracting. Lozeau explained the four hub organizations were pre-approved by the federal government as part of New Hampshire’s original application for the funds. She also pointed to federally imposed deadlines as a reason the state needed to move quickly rather than open the contracts to competition. When the hubs distribute money to community organizations, Lozeau indicated that process would involve competitive awards.
Sole-source contracting tends to raise legitimate questions about whether taxpayers are getting the best value for public money and whether the selection process is shielded from outside scrutiny. The council’s initial decision to table the contracts reflected exactly that concern. The federal pre-approval framework does limit the state’s options here, but the speed at which Ayotte called a special session to push the contracts through warrants continued attention as the program moves forward.
GO-NORTH’s structure, with multiple layers between the state and the communities ultimately receiving services, also means accountability will depend heavily on how the hubs are monitored and whether their disbursements are publicly documented. Lozeau’s assurances about oversight satisfied councilors Monday, but the real test comes as that $200 million per year begins moving through the system.
Rural health in New Hampshire carries genuine urgency. Rural hospitals often operate on thin margins, EMS coverage in remote areas is fragile, and residents with limited transportation face serious barriers to basic care. The scale of federal investment flowing into the state represents a real opportunity to address those problems. Getting the governance structure right is not a bureaucratic nicety. It determines whether the money reaches the communities that need it or disappears into administrative overhead.
The council’s willingness to pause, ask hard questions, and demand accountability before approving the contracts is the model that should continue at every stage of this program. As GO-NORTH scales up and seeks approval for additional hubs and future contracts, scrutiny should not diminish just because Monday’s vote went smoothly.
