State Initiatives Funded by the Medicare Rural Hospital Flexibility Grant Program (Policy Brief #3)


To document effective state initiatives using Flex Grant Program funds, Flex Coordinators in all 45 participating states were asked to identify and discuss their states’ three most successful initiatives in the past two years. This document is designed to provide an overview of key findings and trends from these interviews.

Key Findings

  • States have implemented a range of successful program activities addressing hospital quality and performance improvement, rural hospital viability, community-focused initiatives, EMS, HIT implementation, and workforce development, among others;
  • States have used Flex funds to seed the development of many of these initiatives, with other sources of funds being tapped to augment those from the grant;
  • Flex funds have been critical to the development of projects to support CAHs and rural health systems for which there were no other sources of funding;
  • Flex has engaged stakeholders from health care organizations and state agencies and created relationships that have value added beyond the Flex Program.


EMS (Emergency Medical Services) Hospital Services Quality Improvement State Flex Programs