Community paramedicine is capturing attention from state Flex and EMS programs; several states (e.g., Nebraska, Colorado, Maine, and Minnesota) are using Flex funding to support planning and development activities. This project examined the evidence-base for the use of community paramedics, their role in rural healthcare delivery systems, challenges states have faced in implementing programs (e.g., scope of practice laws, reimbursement, financing, and resistance from other health care professionals) and how these challenges may be overcome. In addition, the Flex Monitoring Team (FMT) examined and described the roles that State Flex Programs have taken in supporting community paramedicine programs.