Opportunity Information: Apply for HRSA 19 024
The Medicare Rural Hospital Flexibility Program (often called the Flex Program) is a federal cooperative agreement offered through the Health Resources and Services Administration (HRSA), within the U.S. Department of Health and Human Services. It is designed to strengthen rural health care by funding state-level Flex programs that, in turn, provide hands-on support to Critical Access Hospitals (CAHs) and certain related rural partners. The basic idea is that states use Flex funding as a hub for training, technical assistance, and coordination so rural facilities can improve how they deliver care, measure and report performance, and remain financially viable while continuing to meet the needs of their communities.
A central focus of the opportunity is improving the quality and value of care in rural communities. The program emphasizes practical quality improvement work such as quality reporting, performance improvement projects, and benchmarking so CAHs can compare their results to peers and track whether changes are actually working. At the same time, the program recognizes that rural hospitals operate with tight margins and limited workforce, so it also prioritizes operational and financial improvement efforts that help stabilize finances and maintain access to services. In addition, the Flex Program is intended to help rural health systems adapt as community needs change, whether that means shifts in demographics, chronic disease burden, service demand, or local access challenges.
The broader, long-term goal is to ensure high-quality health care is available in rural areas and is aligned with what the community truly needs. The opportunity frames rural health care in a full continuum, not just hospital inpatient services. It explicitly includes prevention, ambulatory care, pre-hospital care, emergency care, and inpatient care, with an expectation that these services should be coordinated and integrated across the rural delivery system. In other words, the program is not simply trying to keep rural hospitals open; it is trying to support rural systems that deliver better outcomes, provide higher value to patients and communities, and contribute to healthier rural populations.
The grant lays out several long-term objectives for what state Flex programs should enable CAHs (including CAH-owned clinics) and rural EMS agencies to accomplish. These objectives include demonstrating and improving quality of care, stabilizing finances while maintaining essential services, adjusting operations and service lines to meet changing community needs, and ensuring patient care is integrated across providers and settings throughout the rural health care system. The emphasis on integration reflects the reality that rural patients often move between clinics, hospitals, EMS, and referral centers, and that better coordination can improve outcomes and reduce avoidable costs.
For the covered period of performance, state Flex funding is expected to serve as a resource and focal point for measurable work across six program areas. Three areas are required in key circumstances, and three are optional depending on state priorities and needs. Program Area 1, CAH Quality Improvement, is required and centers on building CAH capacity to improve clinical quality, strengthen quality reporting, and use data-driven methods to improve care. Program Area 2, CAH Operational and Financial Improvement, is also required and focuses on helping CAHs improve business and operational practices, strengthen financial performance, and sustain services in challenging rural markets. Program Area 6, CAH Designation, is required if rural hospitals in the state request assistance with becoming designated as CAHs, meaning the state program may provide guidance and support for facilities pursuing that designation.
The remaining program areas are optional but represent significant opportunities for states to tailor the program to local circumstances. Program Area 3, CAH Population Health Improvement, supports work that connects hospitals to broader community health needs, often involving prevention strategies, chronic disease management approaches, and partnerships that address health outcomes at the community level. Program Area 4, Rural EMS Improvement, supports the establishment or expansion of rural emergency medical services and improvements in EMS performance and capacity, reflecting the importance of pre-hospital care and emergency response in rural areas where travel times are long and resources are scarce. Program Area 5, Innovative Model Development, encourages states and rural partners to test and spread new approaches that can improve rural health system performance and sustainability, supporting innovation rather than a one-size-fits-all model.
Administratively, this opportunity is a discretionary grant (funding instrument type: grant) in the health activity category, listed under CFDA 93.241, with the funding opportunity number HRSA-19-024. It was created on January 24, 2019, with an original closing date of March 29, 2019, and HRSA anticipated making around 45 awards. Eligibility is indicated as “Others,” with further clarification typically provided in the full announcement’s eligibility section, but the structure described makes clear that funding is intended to operate through state Flex programs that then support rural hospitals and EMS partners. Overall, the program is structured to push practical improvements where they matter most in rural settings: measurable quality, stronger operations and finances, integrated care across the continuum, and sustained access to essential services for rural communities.Apply for HRSA 19 024
- The Department of Health and Human Services, 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 Jan 24, 2019.
- Applicants must submit their applications by Mar 29, 2019. (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: Others (see text field entitled Additional Information on Eligibility for clarification).
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| Poison Center Network Apply for HRSA 19 048 Funding Number: HRSA 19 048 Agency: Department of Health and Human Services, Health Resources and Services Administration Category: Health Funding Amount: Case Dependent |
| Medicare Rural Hospital Flexibility Program – Emergency Medical Services Supplement Apply for HRSA 19 095 Funding Number: HRSA 19 095 Agency: Department of Health and Human Services, Health Resources and Services Administration Category: Health Funding Amount: Case Dependent |
| Targeted Capacity Expansion: Special Projects Apply for TI 19 007 Funding Number: TI 19 007 Agency: Department of Health and Human Services, Substance Abuse and Mental Health Services Adminis Category: Health Funding Amount: $375,000 |
| Network of Forecasting Centers to Improve Forecast Accuracy and Communication for Seasonal and Pandemic Influenza Apply for RFA IP 19 004 Funding Number: RFA IP 19 004 Agency: Department of Health and Human Services, Centers for Disease Control and Prevention - ERA Category: Health Funding Amount: $700,000 |
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| Grants to Support New Investigators in Addressing Cross-Cutting Violence Prevention and Opioid Overdose Prevention Apply for RFA CE 19 006 Funding Number: RFA CE 19 006 Agency: Department of Health and Human Services, Centers for Disease Control and Prevention - ERA Category: Health Funding Amount: $100,000 |
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| Networks for Oral Health Integration within the Maternal and Child Health Safety Net Apply for HRSA 19 053 Funding Number: HRSA 19 053 Agency: Department of Health and Human Services, Health Resources and Services Administration Category: Health Funding Amount: $1,283,333 |
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| Evaluation of Return to School Programs for Traumatic Brain Injury Apply for RFA CE 19 003 Funding Number: RFA CE 19 003 Agency: Department of Health and Human Services, Centers for Disease Control and Prevention - ERA Category: Health Funding Amount: $550,000 |
| Local Service Delivery Activity Apply for RFI 617 19 OHH Funding Number: RFI 617 19 OHH Agency: Agency for International Development, Uganda USAID-Kampala Category: Health Funding Amount: $50,000,000 |
| PEPFAR Small Grants Program Annual Program Statement Apply for AFREO 19 GR 001 AF 121919 Funding Number: AFREO 19 GR 001 AF 121919 Agency: Department of State, U.S. Mission to Botswana Category: Health Funding Amount: $25,000 |
| Collecting Violent Death Information Using the National Violent Death Reporting System (NVDRS) Apply for CDC RFA CE19 1905 Funding Number: CDC RFA CE19 1905 Agency: Department of Health and Human Services, Centers for Disease Control - NCIPC Category: Health Funding Amount: $462,710 |
| Overdose Data to Action Apply for CDC RFA CE19 1904 Funding Number: CDC RFA CE19 1904 Agency: Department of Health and Human Services, Centers for Disease Control - NCIPC Category: Health Funding Amount: $7,100,000 |
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| Immunization and Vaccines for Children Apply for CDC RFA IP19 1901 Funding Number: CDC RFA IP19 1901 Agency: Department of Health and Human Services, Centers for Disease Control - NCIRD Category: Health Funding Amount: Case Dependent |
| Nurse Anesthetist Traineeship (NAT) Program Apply for HRSA 19 074 Funding Number: HRSA 19 074 Agency: Department of Health and Human Services, Health Resources and Services Administration Category: Health Funding Amount: Case Dependent |
| One Health Workforce - Next Generation (OHW-NG) Apply for 7200AA19RFA00006 Funding Number: 7200AA19RFA00006 Agency: Agency for International Development Category: Health Funding Amount: $85,000,000 |
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