Medicare Rural Health Flexibility Program (Flex)

Critical Access Hospital Grants & Improvement Initiatives

“The Flex Program” refers to the Medicare Rural Hospital Flexibility Program, which was created by Congress in 1997. It allows small hospitals to be certified as Critical Access Hospitals (CAHs). Flex offers grants to states to help implement initiatives to strengthen the rural health care infrastructure. The grant program is administered by the Health Resources Service Administration’s Federal Office of Rural Health Policy. HRSA is a division of the U.S. Department of Health and Human Services.

Program Areas of the Flex Program

The Flex program focuses on six core areas:

  1. CAH Quality Improvement
  2. CAH Operational and Financial Improvement
  3. CAH Population Health Improvement
  4. Rural EMS Improvement
  5. Innovative Model Development
  6. CAH Designation

Participating states (currently 45 of 50) are required to develop a rural health care plan that:

  • Provides for the creation of one or more rural health networks
  • Promotes regionalization of rural health services in the state
  • Improves the quality and accessibility of hospital and other health services for rural residents of the state