Federal grant programs / Department of Health and Human Services

State Rural Hospital Flexibility Program (93.241)

Also known as The Rural Hospital Flexibility Program (Flex),The Rural Veterans Health Access Program

• Awarded, FY 2021 to 2025$92.7 million
• Grant awards58
• Typical award$1.4 million
• Awarded in FY 2025$41.3 million
• Size rank838 of 1824
• Type of assistanceProject grants

Key findings

• It is the 838th largest of 1,824 federal grant programs by five-year awards.
• The 20 largest recipients received 64% of the money.
• Awards went to recipients in 45 states and territories.

What the program funds

The Medicare Rural Hospital Flexibility Program (Flex) enables state designated entities to support critical access hospitals in quality improvement, quality reporting, performance improvement, and benchmarking; to assist facilities seeking designation as critical access hospitals; and to create a program to establish or expand the provision of rural emergency medical services. The Flex Program objectives include quality, operational, financial, and population health improvement with the goal of supporting access to necessary health care services in rural communities. State Flex programs will act as resources and focal points for these activities within their respective states. The Rural Veterans Health Access initiative provides funding to states to coordinate activities to provide rural veterans access to services for needed mental health care via the use of networks, electronic communication and telehealth networks. The program targets states with high percentages of veterans to the total population. The Medicare Rural Hospital Flexibility Program Evaluation Cooperative Agreement improves healthcare in rural areas by analyzing Critical Access Hospital (CAH) data, capturing best practices, and targeting limited CAH resources. The Information Services to Rural Hospital Flexibility Recipients Cooperative Agreement provides TA, capacity building and support to the Medicare Rural Hospital Flexibility Program and the Small Rural Hospital Improvement Program. The Rural Quality Improvement Technical Assistance Cooperative Agreement provides TA to FORHP recipients, Critical Access Hospitals (CAHs), and other rural providers, using data to demonstrate improvement in quality of care for rural patients

From the federal Assistance Listing. Read the full listing on SAM.gov.

Open opportunities

No opportunity under this program is open or forecast on Grants.gov right now. Programs often post once a year, so the funding history below shows what to expect.

Rules from the program listing

Who can apply

State (includes District of Columbia, public institutions of higher education and hospitals), Federally Recognized lndian Tribal Governments, State, Native American Organizations (includes lndian groups, cooperatives, corporations, partnerships, associations) Flex and Rural Veterans Recipients: Only states with certified Critical Access Hospitals are eligible for this Program. The Governor designates the eligible applicant from each state. All other states need to submit an application to the Regional Administrator of their CMS Regional Office that expresses the state's interest in developing a Medicare Rural Hospital Flexibility Program before they can apply for funds. Medicare Rural Hospital Flexibility Program Evaluation, Information Services to Rural Hospital Flexibility Recipients Cooperative Agreement, and Rural Quality Improvement Technical Assistance: domestic public, private, and nonprofit organizations, including federally recognized tribal government and tribal organizations.

What the money can and cannot pay for

All funds awarded are to be expended solely for the purposes outlined in the approved projects. Administrative (indirect) expenses are limited to the lesser of 15 percent of the award or the state’s federally negotiated indirect rate for administering the award.

Matching requirements

This program has no statutory formula. Matching requirements are not applicable to this assistance listing. MOE requirements are not applicable to this assistance listing.

Award range and average, in the agency's words

Medicare Rural Hospital Flexibility Program $299,780 to $1,048,885; Average, $682,089 Rural Veterans Health Access Program: $294,903 to $299,999; Average $297,901.

Quoted from the program's federal Assistance Listing. The notice of funding opportunity is the official source for each competition's rules.

Who usually wins

By state

33 states have a page for this program: those that received at least $1 million or 10 awards.

Award amounts are federal obligations reported to USAspending.gov for fiscal 2021 to 2025; see how our data works.