Medicare Rural Hospital Flexibility Program | HRSA 24 002

Opportunity Information: Apply for HRSA 24 002

The Medicare Rural Hospital Flexibility (Flex) Program is a federal funding opportunity from the Health Resources and Services Administration (HRSA) designed to strengthen rural health care by helping states support Critical Access Hospitals (CAHs) and rural emergency medical services (EMS). At its core, the program funds state-led efforts to improve how rural hospitals and EMS systems measure quality, report performance, learn from benchmarking, and carry out practical improvement work. It also supports rural hospitals that are seeking to become designated as CAHs, recognizing that CAH status can be a key tool for sustaining access to hospital care in rural communities.

The overall aim is to make sure rural communities have access to high-quality health care that matches local needs, spanning the full continuum of care. That includes preventive and outpatient services, pre-hospital and emergency response, and inpatient care when needed. HRSA frames the end goal as building a rural health system that delivers high value, improves patient outcomes, and contributes to healthier rural populations over time. Rather than focusing on one-off projects, the Flex Program emphasizes training, technical assistance, capacity-building, and sustainable improvements that states can carry forward.

The program lays out long-term objectives for both CAHs (including CAH-owned clinics) and rural EMS agencies. These objectives include demonstrating and improving quality of care, stabilizing finances while maintaining essential services, adapting to changing community health needs, and integrating patient care across the rural delivery system so patients experience more coordinated care. The notice also highlights that the health care environment is shifting quickly toward value-based care and alternative payment models, and it encourages states to pursue innovative care models when they fit local circumstances.

State Flex funding is organized around five program areas, with clear expectations about what is required versus optional. Program Area 1, CAH Quality Improvement, is required and focuses on helping CAHs improve clinical quality, measurement, reporting, and performance improvement practices. Program Area 2, CAH Financial and Operational Improvement, is also required and targets hospital sustainability through stronger financial practices, operational efficiency, and management strategies that help CAHs remain viable while continuing to serve rural residents. Program Area 3, CAH Population Health Improvement, is optional and supports strategies that improve community health outcomes and address population-level needs. Program Area 4, Rural EMS Improvement, is optional and supports efforts to establish, expand, or improve rural EMS systems, recognizing the outsized role EMS plays in rural access and outcomes. Program Area 5, CAH Designation, is required if a state is requesting funds to assist rural hospitals that are seeking CAH designation, supporting the steps needed for conversion and readiness.

Eligibility is limited to states, including those already receiving Flex awards and those applying through a newly submitted application. HRSA will accept only one application per state, and the applicant organization must be designated by the Governor to apply on the state’s behalf, which positions the program as a statewide coordinating resource and focal point rather than a collection of separate local applications. The opportunity is offered as a cooperative agreement, meaning HRSA expects substantial involvement and partnership during the project period. The funding opportunity number is HRSA-24-002 (CFDA 93.241), with an original closing date of April 16, 2024, and an expected total of 45 awards. The notice lists an award ceiling of 0, which typically signals that applicants should rely on the official funding announcement details and related guidance for any limits or funding parameters rather than assuming a fixed maximum from the summary field alone.

• The Health Resources and Services Administration in the health sector is offering a public funding opportunity titled "Medicare Rural Hospital Flexibility Program" and is now available to receive applicants.
• Interested and eligible applicants and submit their applications by referencing the CFDA number(s): 93.241.
• This funding opportunity was created on 2024-01-17.
• Applicants must submit their applications by 2024-04-16. (Agency may still review applications by suitable applicants for the remaining/unused allocated funding in 2026.)
• The number of recipients for this funding is limited to 45 candidate(s).
• Eligible applicants include: State governments, Others.

Apply for HRSA 24 002

[Watch] Creating a grant proposal using the step-by-step wizard inside the applicant portal: