Using data from the Centers for Medicare & Medicaid Services (CMS) researchers report on the challenges faced by CMS-designated Critical Access Hospitals during the federal Public Health Emergency, and the impact of special funding on their financial performance. The report is the work of the Flex Monitoring Team, a consortium of researchers from the Universities of Minnesota, North Carolina-Chapel Hill, and Southern Maine, funded by the Federal Office of Rural Health Policy to evaluate the impact of the Medicare Rural Hospital Flexibility Grant Program (the Flex Program).